Opinion | We need to address kratom, 7-OH in Michigan but there’s more to the story

Michigan lawmakers are currently debating a ban on kratom products.

As a family and addiction medicine doctor, I applaud them for acting on the disturbing stories they have heard, especially recently as lab-made forms of highly potent 7-OH have burst onto the market. This chemical, which acts on the same brain receptors as opioids like heroin or fentanyl, is easily confused with natural leaf kratom, a safer product that contains small amounts of 7-OH.

Dr. Eliza Hutchinson is an assistant professor of family medicine at the University of Michigan, medical director of addiction services at Packard Health and physician director of the OPEN Warmline. (Courtesy photo)

The stories that have moved lawmakers include those of young children poisoned by 7-OH products sold in candy-like packaging, Michiganders who have been successful in their recovery from opioid use disorder before finding themselves lured by 7-OH products at their local gas station and adolescents dying of a seizure after picking up 7-OH on the way home from school.

Without a doubt, swift action is needed.

I am one of the physicians who has urged lawmakers and health agencies to address this new wave of the opioid crisis. In my community health center, I have seen a rapidly growing wave of patients seeking care to manage 7-OH dependence and withdrawal.

Fortunately, I can help by prescribing the same life-saving medication — buprenorphine — that I use to treat addiction to other opioids, like prescription pills and fentanyl.

I treated a father who battled back from prescription opioid addiction, raised a family and engaged in meaningful work in our community. He tried 7-OH when a vape shop advertised that it could give him energy to parent and work.

Weeks later, he died of an overdose, leaving behind three children and a grieving community.

I treated a single mom working two jobs to raise two children and volunteering at her church to serve free meals. She found 7-OH after a friend suggested it would boost her mood. Soon she was spending $150 per day on it to avoid withdrawal symptoms and continue working and parenting. Thankfully, with buprenorphine treatment, she was able to stop 7-OH and focus on her children again. But she carefully maps out gas stations and convenience stores that do not sell 7-OH, terrified she will be tempted to try it again.

I treat patients who not only ask for freedom from addiction but also urge me to speak out about the damage these products – specifically 7-OH – have caused in their lives. Most began using them without knowing that they pose life-altering and life-threatening risks.

As a physician, my top priorities are the health of my community and ensuring that every individual can make informed decisions about their health. As such, I am deeply concerned about the wide availability, and lack of regulation and labeling, of these products.

But there are other stories to tell. Ones that remind us that the picture is more complex than can be solved with a ban on one product.

For example, my patient who, lacking insurance to cover non-opioid pain management like physical therapy, uses natural leaf kratom to manage her pain. Another who, struggling with opioid addiction since taking prescription opioid medication as a teen, uses natural leaf kratom as a safer alternative to the street supply of life-threatening fentanyl.

And another who successfully stopped using 7-OH after starting on buprenorphine — only to return to use and overdose after his Medicaid plan declined to cover the dose he needed.

Or another who started using opioids to manage severe anxiety related to childhood trauma, who drives two hours to see me because he is unable to find a buprenorphine provider in his county.

So yes, without a doubt, swift action is needed. But not just on kratom, 7-OH, or the substance of the moment. The problem is much larger.

The economics of supply and demand dictate that as long as there is untreated pain, mental health conditions, and trauma from childhood or homelessness, the market will respond with another substance. New products will appear in convenience stores, on street corners, across the internet. While kratom and 7-OH must be addressed, let us not allow the current focus on these products to distract us from the underlying threats that fuel our substance use epidemic.

Michigan must strengthen its efforts to prevent and treat substance use disorders broadly. We need support for families with young children to prevent childhood trauma that often leads to substance use. We need affordable and high-quality care for physical and mental health conditions so that people aren’t forced to turn to products like 7-OH or fentanyl to manage their symptoms. We need rapidly accessible, evidence-based addiction treatment like buprenorphine.

If a ban on kratom and 7-OH becomes law in Michigan, as it has in other states, the need for treatment will be particularly urgent.