Addiction treatment centers across the United States are reporting a growing volume of patients seeking care for dependence on kratom and concentrated derivatives, particularly 7‑hydroxymitragynine (7‑OH). Telehealth provider Boulder Care documented an increase in new patients who reported kratom use from 3% in September 2025 to 8% by July 2026 and 14% in August 2026. Clinicians at multiple inpatient facilities likewise describe an abrupt jump from isolated weekly cases to treating dozens of patients per week for kratom or 7‑OH dependence or for polysubstance presentations that include these products.
Traditional kratom products are derived from the dried leaf native to Southeast Asia and historically sold as powders, pills, or teas. Most leaf products contain trace amounts of 7‑OH, while the more dominant kratom alkaloid does not act as directly on opioid receptors. Newer commercial formulations, however, are highly concentrated in 7‑OH. Because 7‑OH acts directly on the brain’s opioid receptors, it can produce stronger, more opioid‑like effects such as sedation and euphoria, and appear to carry a higher risk of rapid tolerance and physical dependence compared with lower‑potency leaf products.
Federal agencies have taken note: the Food and Drug Administration has flagged 7‑OH products as an emerging opioid threat, and the Drug Enforcement Administration proposed an effective ban on 7‑OH above a certain threshold, a rule that has not been finalized. Several states have already enacted restrictions. Clinicians at treatment centers have speculated that removal of legal access to certain products may be contributing to increased presentation for withdrawal and treatment as people lose access and seek medical assistance.
Clinicians report two broad groups presenting for care: people who are new to drug use and treatment, and people with prior substance‑use histories who may have been in treatment before. Motivations for use include boosting energy, easing anxiety, and self‑managing chronic pain. Some individuals have used kratom or 7‑OH products to self‑treat withdrawal from opioids or alcohol, either intentionally escalating to stronger 7‑OH formulations or encountering them incidentally.
Kratom and 7‑OH products now appear in multiple formats beyond traditional powders and teas, including gummies and liquid shots. Investigations have found some commercial products contaminated with unlisted compounds or mixed with additives such as caffeine, kava, or CBD. Additionally, 7‑OH is often marketed misleadingly as kratom, which can obscure potency and opioid activity for consumers.
Clinicians report that dependence can build quickly with high‑potency products. Symptoms described during discontinuation resemble opioid withdrawal and include agitation, sweating, anxiety, diarrhea, insomnia, and reduced appetite. While prior research often characterized kratom withdrawal as generally mild, frontline providers describe presentations ranging up to severe opioid‑like withdrawal, and some centers now treat kratom or 7‑OH withdrawal similarly to fentanyl, oxycodone, or heroin withdrawal.
Treatment centers are using opioid‑use disorder tools to manage kratom and 7‑OH dependence. Early case reports and clinical experience indicate that medications for opioid use disorder, including buprenorphine alone or combined with naloxone, may help manage kratom‑related withdrawal, and methadone has also shown potential. At Boulder Care, nearly a third of newly started buprenorphine patients recently reported current kratom or 7‑OH use. Clinics are providing standard supportive measures for withdrawal and, in many cases, treating these patients within existing addiction medicine frameworks.
Available evidence is limited. Clinicians emphasize that their observations reflect patients who present for care and therefore may overrepresent more severe cases. Epidemiologists caution that people successfully discontinuing kratom or 7‑OH without medical assistance would not appear in treatment‑based reports, creating sampling bias. National surveillance data do indicate broader increases in exposure: lifetime kratom use rose from about 4 million to 5 million people from 2019 to 2023, and poison center reports increased from 258 to 3,434 over the last decade with a sharp rise in 2025, but these figures do not directly quantify dependence or need for treatment.
Alongside clinical presentations, online forums document many personal accounts of kratom and 7‑OH use and attempts to quit. Reddit channels dedicated to quitting kratom and quitting 7‑OH contain posts describing self‑directed tapering, relapse, and, in some cases, transitions to formal treatment and inpatient care. These communities illustrate the range of user experiences but are anecdotal and not representative of population‑level outcomes.