What Hawaiʻi Should Know About 7-OH: When “Enhanced Kratom” Starts Acting Like an Opioid

A few days ago, I came across a national report about addiction clinics seeing more people seeking help for kratom and 7-OH dependence and withdrawal. My first thought was the same question I ask whenever a health story seems to be growing elsewhere in the continental U.S.: Is this something we need to be talking about in Hawaiʻi, too?

In this case, the answer is yes.

In May 2026, the Hawaiʻi Department of Health specifically warned residents about the growing availability of 7-hydroxymitragynine, or 7-OH, describing it as a potent opioid-like substance increasingly sold in smoke shops, vape stores, convenience stores and online. That makes this much more than an interesting national health headline. It is already a local consumer-health issue.

Kratom and 7-OH Are Related — But They Are Not the Same Thing

This distinction matters.

Kratom comes from Mitragyna speciosa, a tree native to Southeast Asia. Traditional kratom products are generally made from the leaf and contain several naturally occurring alkaloids.

One of those compounds is 7-OH, but it normally occurs only in trace amounts. The newer concern is concentrated or enhanced 7-OH. These products may be sold as tablets, gummies, drink shots, powders or other convenient forms. Some are marketed using terms such as “enhanced kratom,” which can make them sound like simply a stronger version of an herbal product.

That description can hide an important pharmacologic difference: concentrated 7-OH acts on opioid receptors and can produce opioid-like effects, including sedation, respiratory depression, dependence and overdose risk. The FDA specifically distinguishes concentrated or added 7-OH products from ordinary botanical kratom and recommends that consumers avoid them.

The Convenience-Store Problem

There is something psychologically reassuring about being able to buy a product from a regular store.

If something is sitting beside energy drinks, supplements or other everyday products, it is easy to assume somebody has already determined that it is relatively safe. That assumption does not necessarily hold here.

The Hawaiʻi Department of Health notes that 7-OH products may be marketed as gummies, tablets, drink shots and flavored products. Federal regulators have similarly warned about products being sold in gas stations, smoke shops and online. There are currently no FDA-approved medications containing 7-OH.

National poison-center data also show why the issue is getting attention. America’s Poison Centers reported 593 exposures involving 7-OH during all of 2025, compared with 901 during the first six months of 2026. Among 7-OH-only exposures in that 2026 period, 38.8% involved serious health problems, 63.8% were treated at a healthcare facility, and 20.5% were hospitalized.

Dependence May Not Be Obvious Until Someone Tries to Stop

A person does not necessarily start using one of these products intending to become dependent. People may initially reach for kratom-related products for pain, energy, anxiety or even in an attempt to manage withdrawal from another substance.

Tolerance can develop. The amount needed to produce the same effect may increase. Eventually, someone may realize they are no longer taking the product simply because they want its effect—they are taking it because they feel sick without it.

Published case reports of concentrated 7-OH withdrawal describe opioid-like symptoms including nausea, diarrhea, abdominal cramping, restlessness, chills or clamminess, anxiety, insomnia, muscle aches and sweating. The medical literature is still developing, and case reports cannot tell us exactly how every person will respond, but they support the need to take 7-OH dependence and withdrawal seriously.

Why This Matters in Hawaiʻi

We do not yet have good public data telling us exactly how many Hawaiʻi residents are using 7-OH or developing dependence. That uncertainty is important. We should not take national numbers and pretend they are Hawaiʻi numbers.

But we also do not need to wait for a large local case count before paying attention. Hawaiʻi’s own Department of Health has already warned that these products are increasingly available here and specifically asked health care professionals to watch for both overdose symptoms and withdrawal associated with 7-OH.

For parents, there is another reason to recognize the name. Products packaged as flavored gummies, tablets or drink shots may not immediately look like what many families picture when they hear the word “opioid.”

What I Want Hawaiʻi Families to Know

• “Kratom” on the package does not tell you the whole story. Look specifically for terms such as 7-OH, 7-hydroxymitragynine or “enhanced kratom.”

• Daily use, needing increasing amounts, or feeling sick when a dose is missed can be signs of physical dependence. Someone experiencing this should talk openly with a health care professional rather than trying to hide the use out of embarrassment.

• Do not assume a store-bought product is safe to combine with alcohol, sedatives or other drugs. Hawaiʻi DOH specifically warns that these combinations may increase risk.

• Severe sleepiness, loss of consciousness, trouble breathing or seizures require emergency care. Call 911. Hawaiʻi DOH also advises that naloxone can be used when a 7-OH overdose is suspected while emergency help is on the way.

For substance-use treatment and recovery support in Hawaiʻi, Hawaiʻi CARES 988 provides statewide assistance: call or text 988, call (808) 832-3100, or call 1-800-753-6879. Poison Help is available at 1-800-222-1222 for questions about an exposure or reaction.

“Natural” and “Available” Are Not the Same as Low-Risk

I don’t think the takeaway should be that everyone who has ever used kratom has an addiction problem. Kratom leaf and concentrated 7-OH products should not be treated as though they are interchangeable, either.

The lesson is simpler.

The substance-use landscape changes quickly. Sometimes the first warning that a new product has become a problem comes not from the packaging but from emergency departments, poison centers and addiction clinics seeing the people who are struggling to stop using it.

This time, Hawaiʻi has already sounded the warning. And 7-OH is a name worth knowing.

Sources & Further Reading

Hawaiʻi Department of Health: DOH Warns Public About Dangerous Emerging Opioid-Like Product Known as ‘7-OH’ — health.hawaii.gov

U.S. Food and Drug Administration: Products Containing 7-OH Can Cause Serious Harm — fda.gov

America’s Poison Centers: Health Advisory — Serious Illnesses Associated with Kratom and 7-OH Products — poisoncenters.org

PubMed: Management of acute withdrawal from 7-hydroxymitragynine after high-dose chronic use — pubmed.ncbi.nlm.nih.gov

Hawaiʻi CARES 988: Substance Use Treatment and Recovery — hicares.hawaii.gov