Kratom and 7-OH After the Massachusetts Ban: Withdrawal, Risks and Getting Help

What changed in Massachusetts on August 28

On August 13, 2026, Governor Maura Healey announced that the Department of Public Health had issued an emergency order placing all forms of kratom in Schedule I under Massachusetts law. After a 14-day notice period, the order took effect on August 28. It can stay in effect for up to one year, and it gives local boards of health new authority to act against stores that keep selling kratom products (mass.gov announcement).

The order reaches the whole range of products that had been sold in smoke shops, convenience stores and gas stations: powders, capsules, tablets, gummies, drink shots and dissolvable strips, whether they contain natural leaf or concentrated 7-OH. The state paired it with a public message about treatment. People dealing with kratom withdrawal or dependence can get medication, counseling and peer support, and the Massachusetts Substance Use Helpline can help find it. Call 800-327-5050 or text HOPE, any time (Massachusetts DPH).

Because the order is temporary, its status can change if the Legislature or a court acts. The state keeps the current details at mass.gov/kratom.

What New Hampshire and federal law say

New Hampshire has not banned kratom. A 2026 bill, SB 557, would have made synthetic and semisynthetic kratom illegal to prepare, sell, possess or advertise. The House and Senate passed different versions, and the bill died when the Senate declined to accept the House's changes (New Hampshire General Court). For people who live near the border, that means kratom and 7-OH products can still be found on some New Hampshire shelves after they disappeared from Massachusetts ones.

Federal rules are moving as well:

• In July 2025, the FDA recommended scheduling concentrated 7-OH products and said its focus was not the natural kratom leaf (FDA).
• On July 1, 2026, the DEA filed its intent to temporarily place 7-OH above a set concentration into Schedule I (DEA). The notice appeared in the Federal Register on July 6. As of late September 2026, that order has not taken effect.
• Three lab-made relatives of 7-OH (mitragynine pseudoindoxyl, MGM-15 and MGM-16) have been in federal Schedule I since August 26, 2026, under a temporary order that runs to August 2028 (Federal Register).

Kratom and 7-OH are different products

Kratom (Mitragyna speciosa) is a tree native to Southeast Asia. Its leaves contain mitragynine and a small amount of 7-hydroxymitragynine, or 7-OH. In smaller amounts kratom acts more like a stimulant. In larger amounts it acts more like an opioid, with pain relief and sedation (NIDA).

7-OH makes up less than 2% of the alkaloids in the natural leaf. According to the FDA, it acts on the brain's mu-opioid receptors with much greater potency than mitragynine, and than morphine (FDA). Newer products concentrate 7-OH or modify it in a lab, and they are often labeled loosely or sold simply as "kratom." Clinicians who treat these patients note that purified 7-OH products can deliver much stronger opioid effects than the leaf and raise the risk of dependence (Fenske and colleagues, 2026). Someone who moved from leaf powder to 7-OH tablets or shots can end up far more dependent than they expected.

Can you become dependent on kratom?

Yes. Taking kratom products often and consistently leads to physical dependence, which means the body reacts when you stop (Massachusetts DPH). In a study of 293 regular users in Malaysia, where the leaf has been used for generations, more than half had developed severe dependence and 45% had moderate dependence (Singh and colleagues, 2014).

Dependence and addiction overlap. Kratom use disorder, the clinical term for addiction, means continuing to crave and use kratom despite harm, such as an overdose, repeated withdrawal, damaged relationships, or trouble keeping up with work, school or family (Massachusetts DPH). Many people start using kratom to manage pain, anxiety, low mood, or cravings for other drugs (NIDA), which is one reason a dependence can build quietly.

What kratom and 7-OH withdrawal feels like

Withdrawal can start when regular or daily use stops, and it resembles opioid withdrawal (Massachusetts DPH). Common symptoms include:

• anxiety, agitation and restlessness
• muscle aches and spasms
• a runny nose and watery eyes
• hot flashes, sweating and fever
• loss of appetite and diarrhea
• trouble sleeping

People also describe tension, irritability, sadness and strong cravings (Singh and colleagues, 2014).

Research on how long kratom withdrawal lasts is limited, and there is no well-established timeline (NIDA). How hard it hits depends on how much you used, how often, and which products. A 2019 systematic review by clinicians at Dartmouth's Geisel School of Medicine and New Hampshire Hospital concluded that kratom withdrawal should be approached the way clinicians approach opioid withdrawal, with longer-term support afterward to prevent relapse (Stanciu and colleagues, 2019).

Concentrated 7-OH products can bring more serious withdrawal. One published case described a man who needed an inpatient, medically managed withdrawal stay after daily 7-OH use, with symptoms in the moderate range of the standard opioid withdrawal scale (Wightman and Hu).

When withdrawal needs medical care first

A clinician can tell you whether to start in outpatient care or in a medically managed withdrawal setting. Medical supervision is more likely to be the right first step if:

• you also drink heavily or take benzodiazepines (such as Xanax, Klonopin, Valium or Ativan), because stopping those suddenly can be medically dangerous
• you also use opioids, or you have been taking high doses of concentrated 7-OH every day
• you are pregnant, or you have a serious heart, liver or seizure condition
• you have had a complicated withdrawal before

Clear Steps Recovery is an outpatient program and does not provide detox on site. When medical withdrawal care needs to come first, admissions arranges it with a licensed partner facility and plans your first day of outpatient care for after discharge. The Massachusetts detox referral page and the detox questions on the New Hampshire program page explain how that works.

Watch for a stronger substitute

When a supply stops suddenly, some people look for something else to ease withdrawal. Pills and powders bought outside a pharmacy can contain fentanyl, and a person whose tolerance has dropped during withdrawal is especially vulnerable. Our New Hampshire and Massachusetts overdose data brief tracks the latest overdose numbers in both states.

Kratom itself can also cause overdose, especially with highly potent products, products mixed with unknown substances, or use alongside opioids, alcohol, benzodiazepines or other sedatives (Massachusetts DPH). If someone has slowed or stopped breathing after using kratom, give naloxone as you would for an opioid overdose and call 911. Naloxone is available without a prescription at pharmacies (mass.gov announcement).

What treatment looks like

No medication is FDA-approved specifically for kratom withdrawal or kratom use disorder, and NIDA notes that larger clinical trials are still needed (NIDA). In practice, clinicians use the tools that work for opioid use disorder.

Medication

The Massachusetts Department of Public Health states that medications used to treat opioid use disorder, like buprenorphine, have been found effective for kratom use disorder and can ease withdrawal (Massachusetts DPH). The published evidence so far comes from case reports and case series:

• A 2018 report described treating kratom withdrawal and addiction with buprenorphine (Khazaeli and colleagues).
• A 2021 review and case series found that the buprenorphine dose people needed tracked closely with how much kratom they had been using, and proposed starting doses on that basis (Weiss and Douglas).
• A 2026 case series of nine people using purified 7-OH found that eight were successfully started and stabilized on buprenorphine, with no precipitated withdrawal (Fenske and colleagues).

Some people stay on buprenorphine for a period of months. Others use it only through withdrawal and then taper off, as in the 7-OH case above. Our guide to what Suboxone is and how it works explains the medication in more detail.

Counseling and support

Medication handles the physical side. Counseling works on what sits underneath it: the pain, anxiety, sleep problems or cravings kratom was covering, and the routines built around buying and using it. Massachusetts DPH lists counseling and mutual support groups as effective parts of kratom treatment (Massachusetts DPH).

Outpatient care you can fit around work

Outpatient treatment lets you keep living at home. At Clear Steps Recovery, the evening programs meet Monday to Thursday from 6 to 9 pm: Evening IOP in Londonderry and Evening Treatment in Needham. The same medical team that prescribes buprenorphine in our medication-assisted treatment programs in New Hampshire and Massachusetts can review your kratom or 7-OH use at an assessment, which is often available the same day you call.

Where to get help in New Hampshire and Massachusetts

• New Hampshire: call 2-1-1 to reach The Doorway, which connects people to screening, treatment including medication, and naloxone.
• Massachusetts: call 800-327-5050 or text HOPE to reach the Massachusetts Substance Use Helpline, open 24 hours a day.
• Anywhere in the U.S.: SAMHSA's National Helpline, 1-800-662-4357, free and confidential.
• Clear Steps Recovery: (603) 769-8981, answered 24/7, for an assessment in Londonderry or Needham.

For more local options, including family groups and naloxone, see our New Hampshire and Massachusetts help pages.

If you are worried about someone else

Kratom products are easy to miss. They look like supplements, energy shots or candy, and they come from ordinary stores. Signs worth noticing include packets, capsules, gummies or shots from smoke shops or gas stations, energy that swings between alert and sedated, constipation, itching or sweating, and restlessness or irritability when the supply runs out (Massachusetts DPH). Since the ban, you may also notice more urgency about getting product, or trips across the state line.

Pick a calm moment, not a withdrawal day, and lead with concern rather than the law. Our guides to family support and intervention help walk through what to say and how to line up a next step before you talk.