The Deadliest ‘Legal’ Drug You’ve Never Heard Of

Lawmakers and health officials warn that this over-the-counter opioid could be the next fentanyl-level crisis.

7-OH sold in a local gas station with colorful packaging and designs. Nicknames like “Perks” allude to the street nickname for Percocet (Percs)

As an addiction psychiatrist, I’ve seen so many misconceptions about substances perceived as “natural” or harmless. The emergence of 7-hydroxymitragynine (7-OH)—a potent, concentrated derivative of kratom— is the latest player on the block posing a serious and growing threat, especially to teenagers and young adults who mistakenly view it as safe.

What Is 7-OH, and Why Is It So Dangerous?

7-OH is a semi-synthetic alkaloid derived from mitragynine, the main active compound in kratom. While natural kratom leaves contain only trace amounts of 7-OH—typically less than 2% of its alkaloid content—manufacturers and cartels have found ways to isolate or even fully synthesize concentrated versions of 7-OH, resulting in products with up to 98% purity.

Pharmacologically, 7-OH has significantly higher potency than both mitragynine and morphine:

• Studies show over 10 times greater potency than morphine, and 13–46 times greater potency in certain animal models. Whoa!

• It binds strongly to mu-opioid receptors and acts as a full agonist, eliciting classic opioid effects—euphoria, respiratory depression, dependence, and withdrawal.

These are not mild effects—they mirror those of traditional opioids like morphine and fentanyl. To the “opioid naïve” individual, they can pose a serious and real risk of fatal overdose.

Why Teens and Young Adults Are at Greater Risk

7-OH products are commonly sold over the counter. They are found in smoke shops, gas stations, convenience stores, or online. To appear harmless, they are often disguised in candy-like forms, including gummies, tablets, shots, or even flavored packets. This misleading packaging and over the counter availability creates a dangerously false perception of safety and harmlessness.

Teens and young adults may see 7-OH marketed as “natural,” “legal,” or energy-boosting supplements, leading to assumptions that they’re benign—far from it. In reality, these compounds are structurally and functionally closer to Schedule I opioids in their abuse potential.

Recent Clinical and Regulatory Developments

• The FDA has just recently released an assessment urging immediate regulation of concentrated 7-OH products due to their high abuse liability and rising exposure in humans.

• On August 13^th, Florida Attorney General James Uthmeier moved swiftly to categorize 7-OH as a Schedule I controlled substance under state law.

• At the federal level, health agencies—including the FDA and HHS—are pushing to list 7-OH under the Controlled Substances Act. They warn that its effects resemble those of heroin or LSD and highlight its growing availability in consumer products.

Why Awareness Is Critical

• Perceived Safety ≠ Actual Safety: Over-the-counter status does not equate to safety. The potency and opioid-like central nervous system depressant effects of 7-OH make it inherently dangerous.

• Addiction Can Start Quickly: With high receptor binding and potency, even occasional use can ignite physical dependence, and withdrawal potential can escalate rapidly.

• Overdose Risk Is High: In the absence of controlled dosing and medical oversight, the risk of respiratory depression—and potentially fatal overdose—is significantly elevated. We are seeing 7-OH overdoses in the ERs.

• Youth Are Especially Vulnerable: Similar to the previous decade when e-cigarettes came in fruity flavors and bright colors (prior to regulation), 7-OH’s bright packaging, novelty of product formats, and social trends are luring underage users into experimentation—without realizing the peril.

Because of similar targeted marketing to teens ten years ago, we now have a generation of millennials who are addicted to e-cigarettes. We’ve seen this play out before. Now, 7-OH manufacturers are hoping to use the same flashy marketing and packaging to addict another generation before regulators catch on. So far, it seems to be working.

We can’t depend on the regulators to act quick enough. If I’ve learned anything living in Washington DC for the past ten years, it’s that malicious innovation always outpaces regulation when there is profit involved. Knowledge is prevention. Teens and their guardians must be equipped to recognize that just because a product is sold over the counter in bright packaging at their local Sunoco does not make it harmless. Educators, parents, and communities must prioritize conversations that:

1. Explain that 7-OH is a powerful synthetic opioid, not a benign herb.

2. Clarify that even “natural” labels can mask potent drugs.

3. Encourage youth to question the marketed safety of supplements found at smoke shops or convenience stores.

4. Advocate for quicker policymaking and enforcement that restricts easy access to these highly deadly compounds.

As an addiction psychiatrist, my priority is safeguarding young lives through education and prevention. Let’s make sure that the rise of 7-OH does not become another silent chapter, or “fifth wave” in the opioid crisis. If you know or love someone under the age of 25, please send this article to them. It takes 90 seconds to read. And it just might make a life-or death difference.

-Lauren Grawert

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