What’s the difference between kratom and drugs like 7-OH? Explaining the products found near dead Ole Miss students

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EDITOR’S NOTE: If you or someone you know is struggling with substance abuse, call the US Substance Abuse and Mental Health Services Administration’s National Helpline at 800-662-HELP (4357) and find more resources here .

The drug products found near two University of Mississippi students who died on September 21 contained three kratom-related compounds, according to court documents reviewed by CNN and law enforcement.

The substances aren’t natural kratom — as was suspected due to earlier law enforcement reports — which is an herb from the leaves of the tropical tree Mitragyna speciosa native to Southeast Asia. Having both stimulant and sedative effects, the herb carries a risk for addiction due to how it interacts with the brain, researchers told CNN in a previous story . What’s in the packaged tablets that law enforcement discovered when investigating those deaths are mitragynine pseudoindoxyl, MGM-15 and 7-OH, which are semisynthetic, concentrated and potent derivatives of certain components of kratom.

Two of those substances, MGM-15 and mitragynine pseudoindoxyl, were banned in August by the US Department of Justice, which includes the US Drug Enforcement Administration, as the agencies classified them as Schedule I controlled substances for two years on an emergency basis. That’s the category the government uses for illicit substances with no currently accepted medical use and a high potential for abuse.” The Schedule I list also includes heroin, LSD and cannabis.

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The compounds have not been confirmed to have caused or contributed to the deaths, as the autopsies and toxicology reports have not yet been released. But reports of poisonings , mild to severe addictions, or deaths from kratom or semisynthetic derivatives, have been growing — though data documentation limits mean it’s not always clear how many of those reports are due to natural kratom versus semisynthetic derivatives.

Scientists at the National Institute on Drug Abuse are “very concerned” about how easily accessible certain kratom products are, as well as other substances that also have strong opioid effects, NIDA Director Dr. Nora Volkow said in a Tuesday briefing for journalists.

In states that haven’t banned the substance, it’s sold at gas stations, smoke shops and convenience, grocery and health food stores in various forms, including powders, loose-leaf teas, capsules, tablets and concentrates.

What makes kratom psychoactive are its alkaloids, which naturally occur in many flowering plants, contain nitrogen and have pronounced physiological effects on humans. Mitragynine is one of the most abundant alkaloids in kratom, and when it’s metabolized in the body or dried in the manufacturing process, it turns into 7-hydroxymitragynine, commonly called 7-OH. That resulting compound is typically up to 1% to 2% of the total content of natural leaf kratom products and some kratom extracts. Then 7-OH metabolizes into mitragynine pseudoindoxyl.

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These compounds, especially 7-OH, bind to the brain’s mu opioid receptors , which help regulate pain, breathing, gastrointestinal activity and more. That binding — along with effects similar to opioid drugs such as heroin, oxycodone or fentanyl — makes kratom an opioid-like drug, though its biological effects are weaker than those of typical opioids.

While natural kratom has been used in the United States since 1990 and increasingly over the past decade, the semisynthetic products have been available in the United States consumer market — though not regulated or verified — for about three years, said Dr. Kim Aldy, director of the ToxIC (Toxicology Investigators Consortium) program at the American College of Medical Toxicology. They are more potent since they’re isolated, which can amplify the opioid-like abilities and effects that can lead to dependency and overdose via slowed breathing and stimulant toxicity, Aldy added.

Some patients are experiencing “withdrawal syndromes that are similar to what we see with heroin or fentanyl,” Aldy said.

Semisynthetic 7-OH has not been federally restricted as the government had extended the period for public comment on a proposed threshold for 7-OH scheduling under the Controlled Substances Act through September 10. Some states have already banned or otherwise restricted the compound, including Florida , Ohio , Kentucky and California .

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Kratom isn’t federally regulated and thus isn’t “lawfully marketed in the U.S. as a drug product, a dietary supplement, or a food additive in conventional food,” according to the US Food and Drug Administration . Natural kratom is regulated in some way in at least 30 states and has been banned in nine of those states, including Alabama, Connecticut, Louisiana and Vermont.

Signs of poisoning by kratom or its derivatives can include high blood pressure, vomiting, heart attack, tremors , seizures, delusions, hallucinations, liver damage and an increased heart rate , known as tachycardia. That can cause heart palpitations, dizziness or lightheadedness, shortness of breath, fainting and chest pain.

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编者注：如果您或您认识的人正在与药物滥用作斗争，请拨打美国药物滥用和精神健康服务管理局全国求助热线 800-662-HELP (4357)，并在此处查找更多资源。

据 CNN 和执法部门查阅的法庭文件显示，在 9 月 21 日两名密西西比大学学生死亡地点附近发现的毒品产品含有三种与克拉托姆相关的化合物。

这些物质并非天然克拉托姆——此前执法部门的报告曾怀疑是天然的——克拉托姆是一种原产于东南亚的热带树木Mitragyna speciosa的叶子制成的草药。研究人员此前在接受CNN采访时表示，这种草药兼具兴奋和镇静作用，由于其与大脑的相互作用，存在成瘾风险。执法部门在调查这些死亡事件时发现的包装片剂中含有帽柱木碱伪吲哚、MGM-15和7-OH，这些都是克拉托姆某些成分的半合成、高浓度且强效的衍生物。

MGM-15 和伪吲哚米特拉宁这两种物质于今年8月被美国司法部（包括美国缉毒局）列为一级管制物质，并被紧急列入管制清单，为期两年。一级管制物质是指政府用于指代目前没有公认的医疗用途且极易被滥用的非法物质。一级管制物质清单还包括海洛因、LSD 和大麻。

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由于尸检和毒理学报告尚未公布，因此尚未证实这些化合物是导致或促成死亡的原因。但有关服用卡痛或其半合成衍生物中毒、轻度至重度成瘾或死亡的报告越来越多——尽管数据记录的限制意味着我们并不总是清楚这些报告中有多少是由天然卡痛引起的，又有多少是由半合成衍生物引起的。

美国国家药物滥用研究所所长诺拉·沃尔科夫博士在周二的记者简报会上表示，该研究所的科学家们“非常担心”某些克拉托姆产品以及其他具有强烈阿片类药物作用的物质的易得性。

在尚未禁止该物质的州，加油站、烟草店、便利店、杂货店和保健食品店以各种形式出售该物质，包括粉末、散装茶叶、胶囊、片剂和浓缩物。

克拉托姆之所以具有精神活性，是因为其中含有生物碱。这些生物碱天然存在于许多开花植物中，含氮，并对人体产生显著的生理作用。帽柱木碱是克拉托姆中最丰富的生物碱之一，它在体内代谢或在加工过程中干燥后，会转化为7-羟基帽柱木碱，通常简称为7-OH。这种化合物通常占天然克拉托姆叶产品和某些克拉托姆提取物总含量的1%至2%。之后，7-OH会进一步代谢为帽柱木碱假吲哚。

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“一旦酗酒，终身酗酒”这种说法已经过时了。原因如下。

这些化合物，尤其是7-OH，能与大脑中的μ阿片受体结合，而μ阿片受体有助于调节疼痛、呼吸、胃肠道活动等。这种结合，以及与海洛因、羟考酮或芬太尼等阿片类药物类似的作用，使卡痛成为一种类似阿片类药物的物质，尽管其生物效应弱于典型的阿片类药物。

美国医学毒理学会毒理学研究者联盟（ToxIC）项目主任金·奥尔迪博士表示，虽然天然克拉托姆自1990年以来就在美国使用，并在过去十年中使用量不断增加，但半合成克拉托姆产品已在美国消费市场销售约三年，尽管这些产品未经监管或验证。奥尔迪补充说，由于这些半合成克拉托姆是分离出来的，因此效力更强，这会增强其类似阿片类药物的能力和作用，并通过呼吸减慢和兴奋剂中毒导致依赖性和过量服用。

奥尔迪说，有些患者出现了“类似于海洛因或芬太尼戒断症状的戒断综合征”。

由于政府已将《管制物质法》下 7-OH 管制门槛的公众评议期延长至 9 月 10 日，因此半合成的 7-OH 尚未受到联邦管制。一些州已经禁止或以其他方式限制了该化合物，包括佛罗里达州、俄亥俄州、肯塔基州和加利福尼亚州。

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根据美国食品药品监督管理局（FDA）的说法，克拉托姆不受联邦监管，因此“不能合法地在美国作为药品、膳食补充剂或传统食品添加剂进行销售”。天然克拉托姆在至少30个州受到某种程度的监管，其中9个州已禁止销售，包括阿拉巴马州、康涅狄格州、路易斯安那州和佛蒙特州。

服用卡痛或其衍生物中毒的症状可能包括高血压、呕吐、心脏病发作、震颤、癫痫发作、妄想、幻觉、肝损伤和心率加快（即心动过速）。心动过速会导致心悸、头晕或眩晕、呼吸急促、昏厥和胸痛。

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