Kratom and 7 Hydroxymitragynine (7 OH): Common Provider Questions

As kratom containing products have become widely available, clinicians are increasingly encountering patients with kratom use disorder. Kratom, derived from Mitragyna speciosa, contains the alkaloid mitragynine, which is the primary compound targeted in available presumptive (immunoassay) laboratory testing.

Questions have emerged regarding newer products marketed as “high potency” or “pure” 7 hydroxymitragynine (7 OH) and whether existing testing approaches remain appropriate, as the immunoassay does not detect 7-OH directly. Outlined below are responses to common provider questions related to kratom and 7 hydroxymitragynine testing.

Q: Are we seeing 7‑OH positives isolated from mitragynine?

A: At this time, we are not commonly seeing 7‑OH detected in isolation without mitragynine in clinical testing.

Q: Are we missing 7‑OH positives on kratom immunoassay screening?

A: Although the immunoassay is not designed to detect 7‑hydroxymitragynine (7‑OH) directly, our internal evaluation of commercially available 7‑OH products and published reports show that these products commonly contain mitragynine. As a result, the presence of mitragynine is typically sufficient to produce a positive screen in most cases.¹

Q: Have we seen an increase in positivity, particularly related to 7‑OH? 

A: While interest in higher‑potency products has grown, current laboratory data does not suggest a widespread increase in 7‑OH‑only positivity distinct from kratom/mitragynine exposure.

Q: What methodology is recommended for kratom testing? 

A: Presumptive testing via immunoassay remains appropriate first line testing for identifying kratom or 7-OH product exposure in most clinical settings. As there are some situations where false positives can occur with the immunoassay, definitive testing by mass spectrometry is also available when appropriate.