Chemicals of concern: Kratom and 7-hydroxymitragynine (7-OH)

What happens when a drug people can buy in everyday stores behaves like an opioid—yet regulators still treat it as a “gray zone”?

In The Lancet Pulse episode, host Matthew Gilbert and co-host Niall Boyce are joined by Dr. Liza Hutchison, Assistant Professor of Family Medicine at the University of Michigan, an addiction medicine physician overseeing services at a federally qualified health center in Washtenaw County, Michigan, and supervising a statewide telehealth on-demand buprenorphine service. Dr. Hutchison explains how natural leaf kratom contains multiple alkaloids (serotonergic, noradrenergic, and opioid-acting), with only about 1% opioid-active component, while concentrated 7-hydroxymitragynine (7-OH) products are reported to be 15–20 times more potent and can drive rapid tolerance, opioid-like withdrawal, and overdose risk.

They also discuss the clinical use of buprenorphine/Suboxone (reducing overdose death risk by 50%+ in traditional opioid use disorder), policy proposals in Michigan (including a prohibition bill), and why naloxone reverses the opioid-like breathing suppression but not other causes like seizure or liver injury.

The Lancet Pulse is part of the Lancet Group podcast offering. 

Editorial team: Chloe Wilson, Ben Abbott, Matthew Gilbert, and Jonathan Pimm

Podcast editing and production: Matteo Simonetti

Visit https://www.thelancet.com/multimedia to learn more about our multimedia offering. 

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