HERSHEY, Pa. — Michael Krause was picking up vape supplies when a shop employee offered him a free sample of a pill he said would boost his energy and help him lose weight.

“I'm over 50,” said the West Hanover Township resident, “so I thought, a magic pill? All right, wow.” He'd just taken his first dose of 7-hydroxymitragynine, or 7-OH for short.

“I took the recommended dose,” he said, “and I knew right then and there that I was screwed.”

He knew because he'd been there before. In 2008, after a kidney removal, Krause said, he was prescribed OxyContin and became addicted. He got clean in 2010 and stayed opiate-free for well over a decade.

That free sample undid all his hard work in one dose, he said. “I felt a high that was the exact same thing as an 80-milligram oxycodone,” he said.

That was in January 2025. By March, Krause said, “I knew there was no turning back.” He'd gone from a free sample to a $100-a-day habit in just three months, he said. By August, he was back in medical treatment for addiction.

7-OH, or 7-OH-mitragynine, is a compound found naturally in trace amounts in the kratom plant, an evergreen tree native to Southeast Asia. But the 7-OH products sold in vape shops, convenience stores and gas stations today are much more powerful than traditional kratom.

“It’s the primary psychoactive compound found naturally in kratom, but it’s been synthetically isolated and manufactured,” explained Sarah Kawasaki, director of the Advancement in Recovery Program at Penn State Health Psychiatry and Behavioral Health.

People take kratom for its stimulant effects, or, at higher doses, for pain relief and sedation. Concentrated 7-OH is different, Kawaski said. It acts like a powerful opioid because it is one. Clinically, it behaves similarly to morphine or heroin, which lines up with what Krause felt after taking that single free sample.

7-OH products show up as gummies, tablets, drink mixes and small liquid shots, often packaged with bright, energy-drink-style branding right at the counter. Krause remembers a liquid version called "Feel Free" sitting in plain view next to the register at his local gas station.

Because 7-OH acts on the same brain-stem receptors that control breathing, an overdose looks identical to a prescription opioid overdose: slowed or stopped breathing, sedation, even potential death.

Physical dependence can set in within two to three weeks of regular use, Kawasaki said. Strong cravings can start sooner, sometimes within days. Kratom withdrawal — and withdrawal from concentrated 7-OH especially — is severe.

"It’s the flu times a thousand," Krause said.

Right now, 7-OH is largely unregulated in Pennsylvania. That's starting to change.

In Harrisburg, lawmakers have introduced two bills that would update Pennsylvania's kratom sales law to classify synthetic 7-OH as a Schedule I substance and ban sales of both 7-OH and kratom products to minors. Schedule I substances, which include heroin, are defined as having a high potential for abuse and no currently accepted medical use. The bills are still moving through the legislature. Pennsylvania's Department of Health has already flagged a sharp rise in poison-control calls tied to kratom and 7-OH.

At the federal level, the U.S. Drug Enforcement Administration announced on July 1 that it’s moving to temporarily classify concentrated, synthetic 7-OH — and several related compounds — as Schedule I. That order is expected to take effect in August.

Some manufacturers have already reportedly begun swapping in other compounds in an effort to sidestep the new rules. Regulation is racing to catch up with the market.

The good news, Kawasaki said, is that 7-OH and kratom use disorder responds well to the same medications used for other opioid use disorders, particularly buprenorphine. "It works like a charm and completely extinguishes their physical cravings," she said. Unlike fentanyl, which can complicate buprenorphine treatment, 7-OH allows for a more straightforward transition to treatment. "It’s an eminently treatable problem," she added.

Krause is proof. Nearly a year into treatment, he said, he's regained much of the weight he lost during his struggle with 7-OH and has his family's full support.

His advice to anyone already trapped in a 7-OH addiction, thinking they can taper off on their own: "You need professional medical help. Trying to do it alone is the literal definition of insanity."

And to anyone who thinks a free sample is harmless, Krause has this warning: "I took one free sample, and it dragged me straight to rock bottom."

The Medical Minute is a health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.