Another epidemic: health officials warn of stronger substance sweeping the drug market

Poison control centers statewide are seeing more people suffer from overdose-like symptoms of popular drug products, and federal health officials are pressing for restrictions on how they are made.

The Pennsylvania Department of Health says poison control centers continue to see a rise in calls involving kratom and its derivative, 7-hydroxymitragynine (7-OH). From 2022 through June, Allegheny County reported the most cases with 18. The department issued a health advisory this month warning that reports of exposure remain elevated; it also issued an advisory in August.

Joshua Shulman, medical director of the Pittsburgh Poison Center, said kratom and 7-OH can mimic the withdrawal effects of opioids

"[Kratom and 7-OH] is kind of a new epidemiologic threat in substance exposure,” he said.

Statewide, the Health Department recorded 38 unintentional and undetermined drug overdose deaths where kratom/7-OH was a contributing factor in Pennsylvania in 2024.

Kratom is an herbal substance from a tree native to Southeast Asia. It contains compounds such as mitragynine and 7-OH, which have stimulant properties and can have sedative effects. It is available in various forms, such as powder, pill, and liquid. Currently, one must be 21 or older to purchase kratom and 7-OH, which is a synthetic form of kratom.

Shulman said the poison center has had several calls about 7-OH since August.  

“7-OH is more potent than products that contain mitragynine in general, so it makes sense as we’re seeing more of these products in the area; we’re getting more calls about it,” Shulman said.

Smoke shop Exotic Puff in downtown Pittsburgh has been selling products containing kratom for over a year.

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“It’s definitely one of our most popular items,” said employee Charlize Kane. “We frequently restock it...[Customers buying kratom] typically have some pain they are trying to treat or need it for energy.”

The products are legal to sell and have no federal drug restrictions on their production. Kane said most customers who buy kratom products are in their 40s and 50s, are regular customers, and have tried other herbal products, like THC.

“Some come in once or twice a week,” Kane said. She also said her young adult customers who purchase kratom typically buy products that contain kava, a plant used to make a psychoactive beverage from its root.

“The majority of our sales are still traditional vapes with nicotine, regardless of age,” Kane said.

Downtown Pittsburgh convenience store Smithfield News started selling powder containing kratom within the past few months.  

“It doesn’t sell that well, but we do get some questions about it,” employee Humzah Malik said.  

Malik also said their customers who purchase kratom tend to be middle-aged and say they use the products for pain. The U.S. Federal and Drug Administration does not recommend using kratom or 7-OH products for pain. See an alert from the FDA and Pennsylvania DOH.  

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The FDA recommended a scheduling action in July to restrict certain 7-OH products, under the Controlled Substances Act, citing new research that found the chemical to activate opioid receptors. The Controlled Substances Act would create a closed system of distribution of 7-OH, increase security for storage of the products and establish penalties for anyone violating the provisions.  

Allegheny Health Network emergency medicine specialist Dr. Vincent Ceretto, who also works in addiction services, said 7-OH is a partial agonist, the active metabolite of mitragynine, and is significantly more potent than morphine.

“It is dangerous, primarily if you use it with other drugs,” Ceretto said. “It does cause sedation, somnolence, heaviness, sleepiness.”

Ceretto said use of kratom and higher 7-OH concentrated products among his patients has significantly increased recently.  

“With higher use becomes higher abuse potential. With higher abuse potential, it does become threatening to tolerance and withdrawing, causing addiction,” Ceretto said.

Ceretto does not recommend using these or any other non-FDA approved product.

“We don't have any indicated use for it, so there's no reason to use it,” Ceretto said.

Fayette County Coroner Bob Baker issued a public service announcement this month about 7-OH being found in area gas stations, vape shops and convenience stores. He said he has seen the chemical in toxicology reports of two recent fatal overdoses.

“They were utilizing other drugs at the time. I don't want to say that it was a contributing factor, but is [7-OH] going to be another opioid epidemic? Are these products going to get stronger?” Baker said. “We need to get ahead of the curve.”

Baker said he is very concerned about young adults and children using kratom and 7-OH.

“It seems like it is being targeted to children with bright and colorful packaging,” Baker said. “There’s two vape shops within walking distance of one of our middle schools. There are no limits on [7-OH] right now.”

POWER is an organization that provides woman-centered addiction treatments. Clinical Director Kara Hall said there are no current drug screenings for kratom and 7-OH.

“We don’t have much information about this substance yet, beyond recent guidance from the county indicating that 7-OH is present in the local illicit drug supply,” Hall said. “When new substances appear in the supply, we reach out to determine if screening options become available.”

The FDA’s Drug Enforcement Administration is reviewing the recommendation to restrict 7-OH products, which would also need a period for public comments before approval. Due to the government shutdown, the DEA was unavailable for comment.

“It’s safer to go look for help rather than trying to self-treat with kratom or 7-OH,” Shulman said.  

Pennsylvania’s Poison Centers are hosted at Children’s Hospital of Philadelphia and the University of Pittsburgh Medical Center. Their teams of nurses, pharmacists and medical toxicologists are available for 24/7 consultation at 1-800-222-1222.  

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Michelangelo Pellis contributed to this report.

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Erin Yudt is a reporter with Pittsburgh Media Partnership Newsroom, part of the Center for Media Innovation at Point Park University. She most recently was a multimedia content producer and digital reporter at WKBN in Youngstown and is a graduate of Point Park University. Reach her at erin.yudt@pointpark.edu.  

Michelangelo Pellis is an intern with the newsroom for the fall semester. He is a fourth-year digital journalism major at Point Park University. He has served as news editor of The Globe, the university’s student-run newspaper, and as editor of the Point Park News Service. He can be reached at mpelli@pointpark.edu.

The PMP Newsroom is a regional news service that focuses on government and enterprise reporting in southwestern Pennsylvania. Find out more information on foundation and corporate funders here.

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Main image: The back wall of Exotic Puff in Downtown Pittsburgh holds products containing kratom. Employees say they have been selling the herbal product for over a year and that it is one of their most popular items. Photo by Erin Yudt.