DEA’s Misguided Crusade Against 7-OH Will Cost Lives

This post originally was published in Ross Marchand’s Policy Jab Substack.

The opioid epidemic has torn through countless American households, destroying lives and robbing families of their loved ones. According to the National Center for Drug Abuse Statistics, 80,000 Americans die each year from opioid overdoses. A harm reduction product called 7-hydroxymitragynine (7-OH)—a naturally occurring organic compound found within the leaves of the kratom plant (Mitragyna speciosa)—has been a critical tool for millions of Americans suffering from opioid use disorder and is a pivotal part of any effort to fight addiction.

Unfortunately, the Drug Enforcement Administration (DEA) is choosing to ignore the evidence and punish 7-OH users. The agency recently posted a notice of intent to temporarily schedule 7-OH, limiting 7-OH to 1 mg per package or 0.05 percent of a product by weight or volume. This emergency scheduling, which bypasses the public comment process and rigorous scientific review, will make it more difficult for Americans to get the help they need and transition away from deadly products. The DEA should embrace harm reduction and end its misguided war against 7-OH.

The evidence shows that 7-OH is a vital pathway for individuals attempting to overcome severe opioid abuse. A 2018 analysis by University of Rochester and University of British Columbia researchers published in the journal Drug and Alcohol Dependence notes, “kratom’s potential as a harm reduction tool, most notably as a substitute for opioids among people who are addicted. Kratom also enhances mood and relieves anxiety among many users. For many, kratom’s negative mental health effects – primarily withdrawal symptoms – appear to be mild relative to those of opioids.”

Publishing in The American Journal of Drug and Alcohol Abuse, another research team reviewing the current state of the scientific literature found studies “support [kratom] alkaloids’ action on opioid receptors, translating in their ability to mitigate opioid withdrawal. Some studies found mitragynine (MG) to have less reinforcing properties than morphine, and possessing tolerance-sparing properties when coadministered with morphine. Two studies that assessed 7-hydroxymitragynine (7OHMG) found it to substitute for morphine.” The National Institutes of Health (NIH) notes, “Interest in kratom … as a treatment for opioid use disorder has increased in recent years, with many reportedly using it for opioid withdrawal, pain, and other conditions as well … research indicates that its potential therapeutic effects are likely driven by the slow conversion of mitragynine in the body.”

While any substance can be harmful if used in excess, there is little evidence that these harm reduction products pose a systemic danger to users. According to the NIH, “Preclinical studies led by scientists at the University of Florida and NIH’s National Center for Advancing Translational Sciences (NCATS) and NIDA have demonstrated that mitragynine administration, across several doses, did not raise significant safety concerns in animal models.” Due to its pharmacological profile as a partial agonist, 7-OH exhibits a distinct “ceiling effect” regarding respiratory depression, drastically lowering its fatal overdose risk compared to full opioid agonists such as morphine, heroin, or fentanyl. This crucial safety differentiator is further underscored by real-world toxicology data. The vast majority of fatalities involving kratom or 7-OH feature multi-substance contamination, most frequently driven by illicit fentanyl.

The key danger is not 7-OH, but prohibition—which fuels criminal activities and product contamination. The U.S. learned the prohibition lesson the hard way in the early 20th century with alcohol. Ratified in 1919, the 18th Amendment to the Constitution banned the manufacture, sale, transportation, importation and exportation of “intoxicating liquors.” As historian and author of “Dry Manhattan: Prohibition in New York City” Michael Lerner noted: “As the trade in illegal alcohol became more lucrative, the quality of alcohol on the black market declined. On average, 1,000 Americans died every year during the Prohibition [era] from the effects of drinking tainted liquor.” The U.S. has repeated this failed experiment through the War on Drugs and heavy-handed restrictions on tobacco harm reduction products, and the result is the same each time: less choice, more suffering, and rampant criminal activity.

Bureaucrats at the DEA and other government agencies should reject the failed approach of prohibition and embrace harm reduction with commonsense safety guardrails such as labeling standards and health surveillance. It’s time to break with the past and help Americans overcome the devastation of addiction.