New Kratom Variants: What You Need to Know
What is Kratom?1
Kratom is a psychoactive botanical derived from the leaves of the mitragyna speciosa tree, which is indigenous to Southeast Asia. “Kratom” is often used to refer to the primary alkaloid in the leaf, mitragynine. The presence and use of mitragynine within the United States has escalated over the last two decades for recreational purposes due to its euphoric effects, mood elevation, and relaxation.
What are 7-hydroxymitragynine and Mitragynine Pseudoindoxyl?2
7-hydroxymitragynine, commonly abbreviated as 7-OH, and mitragynine pseudoindoxyl are both known urinary metabolites that are eliminated in urine after use of kratom. Additionally, these compounds exist naturally in small quantities in kratom plants. Both 7-hydroxymitragynine and mitragynine pseudoindoxyl have demonstrated significantly greater potency at opioid receptors compared to kratom. These federally unregulated substances are being isolated, synthesized, and formulated into products that are readily available over the counter.
Why It Matters
A Changing Landscape
The growing types of semi-synthetic kratom-related products are found in diverse forms, including chewable/sublingual tablets or strips, gummies, drink mixes, shots, syrups, vape pens, capsules, food products, or powders. These products may be inaccurately labeled and are marketed to appeal to young people for “general wellbeing,” “pain relief,” or “stress/anxiety reduction.”
Unpredictable Potency5
7-hydroxymitragynine and mitragynine pseudoindoxyl may be 13x more potent than morphine, acting as a strong mu-opioid receptor agonist.
Risk to Consumer
Kratom is associated with respiratory depression, dependency, and overdose, especially if combined with opioids or sedatives.
Easy Accessibility
Many of these products are available online, in vape shops, or in local gas stations. While the DEA has labeled kratom as a “drug of concern,” it is not federally scheduled. Some states have banned its sale or moved to schedule it locally. Consult your state legislation for local restrictions.
Since the addition of 7-hydroxymitragyinine and mitragynine pseudoindoxyl (MP) to the kratom testing method in urine, Aegis has observed*:
2.6%
Overall positivity rate for kratom alkaloids in samples where testing is requested
62.5%
Increase in kratom alkaloid detection since implementation of expanded testing
22%
of urine samples that were positive for only 7-OH and/or MP – if only testing for parent mitragynine, kratom alkaloid use would have not been detected in these samples
Laboratories must continue to evolve test offerings to match the changing trends in substance use. Higher detection rates provide a clearer picture of real-world substance use among patients in healthcare settings.
*In samples received on or after 10/13/25 and reported as of 12/1/25
Testing for Kratom Alkaloids Can Help Clinicians:
Understand Unexpected Clinical Presentation
Individuals may present with a range of adverse effects such as agitation, central nervous system depression, rapid or slowed heart rate, confusion, vomiting, high blood pressure, kidney/liver toxicity, seizures, or withdrawal-like symptoms.6
Identify High-Risk Co-Exposures
Kratom is often taken with other substances such as Opioids, Benzodiazepines, Stimulants, Alcohol, and/or designer/synthetic drugs.6
These combinations can increase overdose risk, complicate withdrawal, and change treatment decisions.
Improve Care Planning
Clinicians can make safer, more informed treatment decisions around medication management and other clinical evaluations.
Uncover Patient Self-Medication Trends
Individuals are increasingly using kratom for self-treatment of chronic pain, anxiety, or opioid withdrawal. Detecting kratom alkaloids offers critical insight into patient behaviors and informs conversations about safer alternatives.
Clinical Impact
Early detection of 7-hydroxymitragynine enables providers to identify high-risk opioid-like exposure, tailor treatment plans as needed, and ultimately prevent adverse outcomes.
AEGIS SCIENCES CORPORATION KRATOM TESTING VIA TANDEM LC-MS/MS TECHNOLOGY | ||
Test Code/Specimen Type | 04466 - Urine | 04467 - Oral Fluid |
Includes | Mitragynine 7-hydroxymitragynine Mitragynine Pseudoindoxyl | Mitragynine 7-hydroxymitragynine |
