The Los Angeles County Department of Public Health is making residents and health care providers aware of the significant health risks associated with the synthetic kratom compound known as 7-Hydroxymitragynine (7-OH).

The County of Los Angeles Medical Examiner recently identified three additional fatal overdoses associated with 7-OH ingestion in LA County residents between the ages of 18 to 40 years old. Six overdoses are now tied to this synthetic substance.

Alcohol was present with 7-OH in many of the fatal overdose cases, in addition to other medications and, at times, illicit substances. However, the decedents were otherwise generally healthy.

Retailers should immediately stop selling any 7-OH products, as these are not lawfully marketed in the U.S. as a drug product, dietary supplement, or food additive. To report the illegal sale of 7-OH, individuals can call Public Health Environmental Health at (888) 700-9995.

“Kratom and 7-OH products are marketed as natural remedies and sold illegally in gas stations, smoke shops, online, and other retailers. It’s critical that the community understand that these products are dangerous and can result in fatal overdoses,” said Dr. Gary Tsai, Director of the Los Angeles County Department of Public Health’s Substance Abuse Prevention and Control Bureau. “The safest thing to do is avoid using 7-OH and kratom-related products all together. To prevent overdose, never use alone; avoid mixing 7-OH with other drugs and alcohol; carry naloxone to reverse the effects of opioids, including 7-OH; and make sure someone in the group can administer naloxone to save a life, if needed.”

7-OH, the psychoactive component of kratom leaves, is being synthetically concentrated into various products that are sold in gas stations, smoke shops, and other retail and online venues in LA County. At low doses, 7-OH can have stimulant-like effects and at higher doses it has opioid-like effects. They are unregulated and often labeled with terms such as “plant alkaloids” or “alkaloid” and marketed as dietary supplements to address a broad range of issues such as pain, anxiety and mood disorders, opioid withdrawal, or energy/general well-being. These products come in various forms such as tablets, gummies, drink mixes and concentrated (“enhanced” or “super”) liquid extracts or shots for drinking, which significantly increase its adverse and life-threatening effects.

Particularly when used with alcohol, medications, and/or illicit drugs, 7-OH can cause severe respiratory depression and death. Importantly, these products are unregulated and may contain unknown concentrations of 7-OH, increasing the risk of unintentional overdose.

In July 2025, the Federal Drug Administration (FDA) issued warning letters to firms for illegal marketing of concentrated 7-OH products and posted product images, saying, “7-OH is not lawful in dietary supplements and cannot be lawfully added to conventional foods. Additionally, there are no FDA-approved drugs containing 7-OH, and it is illegal to market any drugs containing 7-OH. Consumers who use 7-OH products are exposing themselves to products that have not been proven safe or effective for any use.”

The safest course of action is to avoid using any 7-OH or kratom-related products. To minimize the risk of overdose and overdose-related death for people who are using drugs, Public Health urges residents to:

Never use alone: Using with another person is protective and increases the chances of lifesaving interventions such as the administration of naloxone in instances of an overdose. Naloxone can reverse 7-OH toxicity.
Stagger drug use with others: Making sure at least one person in the group can administer naloxone to reverse an overdose can save a life.
Avoid mixing 7-OH with other drugs: The effects of combining substances may be stronger and more unpredictable than using one drug alone and mixing and using multiple drugs increases the risk of an overdose.
Carry naloxone: Naloxone can reverse an opioid overdose and successfully restore breathing to reverse the effects of opioids, including 7-OH. Naloxone can be administered through the nose or as an intramuscular injection to save their life. Both methods are equally effective.
Additional Resources:

Los Angeles County Department of Public Health Overdose Prevention Webpage. This Substance Abuse Prevention and Control website features information sheets and toolkits for the community relevant to overdose prevention: publichealth.lacounty.gov/sapc/public/overdose-prevention.htm

Poison Control (800) 222-1222

Finding Substance Use Disorder Treatment In Los Angeles County, the general public, health care providers, and patients can find publicly funded substance use treatment services and bed availability using an online, filterable service locator known as the Services and Bed Availability Tool, in the resource section of www.RecoverLA.org, or by calling the Substance Abuse Service Helpline. Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management, and Opioid Treatment Programs.

Service and Bed Availability Tool: SUDHelpLA.org

RecoverLA mobile-friendly platform: RecoverLA.org

Substance Abuse Service Helpline: (800) 854-7771