From the Los Angeles County Department of Public Health

LAC DPH Health Alert:

Fatal Overdoses Associated with 7-Hydroxymitragynine (7-OH) in Los Angeles County

September 12, 2025

This message is intended for emergency, urgent care, primary care, and behavioral health providers in Los Angeles County.

Please distribute as appropriate.

Fatal overdoses linked to 7-hydroxymitragynine (7-OH), a synthetically concentrated metabolite of the kratom plant (Mitragyna speciosa), have been identified in Los Angeles County.
High doses of 7-OH, or co-use with alcohol or other sedatives, can cause severe respiratory depression and death.
Naloxone can reverse 7-OH toxicity, though repeated doses may be required.
Concentrated 7-OH products, often marketed as dietary supplements (e.g., labeled “plant alkaloids” or “alkaloid”), are available and sold in gas stations, smoke shops, and other retail and online venues. These unregulated products may contain unknown concentrations of 7-OH, increasing the risk of unintentional overdose.

The County of Los Angeles Medical Examiner recently identified three fatal 7-OH overdoses in Los Angeles County in residents between the ages of 18 to 40 years old. Alcohol was present in all cases. The decedents were otherwise healthy, with no other substances identified as substantively contributing to their deaths.

7-OH is available for sale in LA County and is derived from the kratom plant. Because these products are commercially available 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, LA County residents may not be aware of the risks associated with their use. Products are often labeled with terms such as “plant alkaloids” or “alkaloid.”

In July 2025, the Food and Drug Administration (FDA) issued warning letters to firms for illegal marketing of concentrated 7-OH products and posted product images. The FDA indicated that “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.”

Medical and behavioral health providers should be aware that their patients’ health may be impacted by 7-OH use, provide anticipatory guidance, dispense overdose reversal medications (such as naloxone), and treat or refer patients who have substance use disorders, including those related to 7-OH.

7-OH is a psychoactive compound derived from the kratom plant and typically comprises less than two percent of the alkaloids in natural kratom leaves. However, 7-OH being sold is often concentrated in the form of tablets, gummies, drink mixes, and concentrated (“enhanced” or “super”) liquid extracts or shots for drinking, significantly increasing the risk of adverse and potentially life-threatening effects. At low doses, 7-OH can have stimulant-like effects and at higher doses it has opioid-like effects via the mu-opioid receptor.

Concentrated 7-OH-only products have become more available and are linked to addiction, tolerance, withdrawal, respiratory depression, seizures, overdose, and death.

Actions Requested of Providers

Administer naloxone to patients with symptoms of 7-OH (or other opioid-like) overdose who have stopped breathing. Naloxone can reverse the opioid-like effects and restore breathing, though repeated dosing may be necessary due to its pharmacokinetics.
Report suspected or confirmed 7-OH overdoses to Poison Control: 1-800-222-1222.
Offer naloxone to patients at risk for overdose:
- Emphasize that naloxone should be given for any suspected drug overdose, even if the substance is unknown.
- Explain that the goal is to restore breathing and save life.
- Note that naloxone can be given intranasally or intramuscularly; both methods are equally effective.
- Provide education on how to use naloxone: Recover LA Naloxone Guide
Identify patients at risk for overdose and provide anticipatory risk reduction guidance:
- Screen all patients, including adolescents, for recreational drug use.
- Advise patients of the risks of 7-OH, described above.
- Educate patients who use drugs to:
  - Never use alone
  - Use small “tester” doses
  - Stagger drug use with others
  - Avoid mixing drugs
  - Carry naloxone
- Inform patients that medications and other forms of treatment for substance use are available through treatment programs, primary care services, and other health providers.

Additional Resources

Los Angeles County Department of Public Health Overdose Prevention Webpage This Substance Abuse Prevention and Control (SAPC) website features information sheets and toolkits for the community relevant to overdose prevention. publichealth.lacounty.gov/sapc/public/overdose-prevention.htm
Poison Control 1-800-222-1222
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 (SBAT), in the resource section of www.RecoverLA.org, or by calling the Substance Abuse Service Helpline (SASH). 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 (SASH): 800-854-7771

This communication was sent by Gary Tsai, MD Director, Substance Abuse Prevention and Control, Los Angeles County Department of Public Health.

To view this LAHAN in PDF format, view past communications, or sign-up to receive LAHANs, please visit ph.lacounty.gov/lahan.

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