Los Angeles County officials are set to pull kratom and its synthetic extract, sometimes called 7-OH, from shelves immediately.

Inspectors will be sent to retailers next week to begin red-tagging illegal products containing the compounds, the L.A. County Department of Public Health said in a news release Friday morning. Shops that don’t comply could be hit with fines or other penalties.

Kratom is an herbal extract from the leaves of Mitragyna speciosa, a tree native to Southeast Asia. It is sold in shops and online in a variety of forms, including powders, pills and liquid extracts. Brands selling kratom often make claims that it can address pain, anxiety and mood disorders.

Matthew Lowe, executive director of the Global Kratom Coalition, said natural kratom has been used in the U.S. for more than 50 years and according to a 2020 Johns Hopkins Survey, people have been using it to alleviate anxiety and treat chronic pain.

In the last few years, a more potent, synthetic version of kratom refined into its psychoactive compound 7-Hydroxymitragynine, or 7-OH, hit shelves across the U.S.

7-OH products are often marketed as “plant alkaloids,” drawing criticism from some, including Lowe, who argue the labeling is misleading, confusing consumers into thinking it’s the same as natural kratom.

When mixed with alcohol, medications or illicit drugs, the county health department warns, 7-OH products can “cause severe respiratory depression and death. Importantly, these products are unregulated and may contain unknown concentrations of 7-OH, increasing the risk of unintentional overdose.”

There have been six reported kratom-related deaths in Los Angeles County in just the past few months.

“Given that this is new and emerging substance, this is also since the medical examiner started tracking 7-OH data,” the Los Angeles County Department of Public Health told The Times via email. Since the county began tracking 7-OH in deaths only in April of this year, it is unclear how many other overdoses could have occurred previously.

After publication of this article, the county medical examiner released the death reports to The Times. Each of the deceased had kratom and 7-OH in their bodies, according to the reports, but it was not immediately clear what role they played in the deaths, as compared with other substances — including alcohol, prescription sedatives and muscle relaxants, and illicit drugs like cocaine — that were also found in the six bodies. The Times first requested the coroner’s report for the kratom-related deaths on Oct. 24.

“Kratom and 7-OH products are sold as natural remedies, but they are illegal and unsafe,” Dr. Muntu Davis, the county health officer said in the release. “They are sold in gas stations, smoke shops, online, and other retailers. People should avoid using these products, and store owners/operators must remove them immediately to prevent harm.”

Right now, consumers have no clarity on kratom, 7-OH or any other metabolites, said Yaël Ossowski, deputy director of Consumer Choice Center, a nonprofit consumer advocacy group.

“At any gas station or smoke shop, there’s the powder, the liquid extracts, and pills all offered at different doses, with different brands,” Ossowski said. “This obviously leads to consumer confusion and uninformed choices, incorrect dosing and likely bad experiences that smart regulation would avoid.”

The kratom and 7-OH market has grown largely because people want targeted pain relief and remedies for their ailments, “but don’t necessarily want to have the full effects of more powerful opioids that have a fuller effect on the body,” he said.

“Kratom has been successfully used for generations in other countries as an opioid alternative,” Ossowski said. But highly concentrated 7-OH products are a different beast altogether.

According to the U.S. Food and Drug Administration, kratom and 7-OH are not lawfully marketed in the U.S. as a drug product, a dietary supplement or an approved food additive.

California adopts federal law concerning food and dietary supplements, the California Department of Public Health told The Times via email.

“Until kratom and its pharmacologically active key ingredients mitragynine and 7-OH are approved for use, they will remain classified as adulterants in drugs, dietary supplements and foods,” a department spokesperson said.

The spokesperson added that the department has been conducting investigative work associated with kratom for the last two years and “continues to take appropriate action to protect the public against adulterated products containing kratom or 7-OH.”

“CDPH embargoes or destroys foods and dietary supplements within the state that are adulterated with kratom or 7-OH once they are identified during investigations; however, we do not comment on the specifics of ongoing investigations,” the spokesperson said.

7-OH producers have publicly defended their products in the face of lawsuits and FDA crackdowns, arguing it is a safer alternative to illicit opioids like fentanyl and has saved lives, not taken them.

Vince Sanders, founder and CEO of CBD American Shaman who helped develop an early 7-OH product, has said the attack on 7-OH is being led by companies selling natural kratom, who have had their market share overtaken by what he says is “a vastly superior product.”

The Kansas City businessman said a ban anywhere in the country would hurt people who have used 7-OH to treat substance abuse disorders or chronic pain and now rely on the product as an alternative to costly prescription medication.

“People that have changed their life using it are extremely concerned,” Sanders said. “They’re scared to death. I mean, there are people that … plan to pull money out of their 401K, or load up their credit cards, or whatever they’ve got to do to buy years and years of supply.”

He acknowledged that both kratom and 7-OH are frequently taken in higher doses than he recommends, but argued manufacturers and retailers should not be held accountable for those decisions. He compared it to alcohol: “You buy a 750-milliliter bottle, and if you go home and drink that entire bottle, and you do that every single night, is that your fault, or is that Jim Beams’ fault?”

Communities across the state have taken it upon themselves to act in the absence of state and federal regulation. Orange County and the cities of Newport Beach, San Diego and Oceanside have all prohibited the sale, distribution or possession of kratom. Riverside County is looking to deter the sale and marketing of kratom and 7-OH products to people under the age of 21.

Los Angeles County does not have its own regulatory ordinance for the products.

“I think that the local action is signaling intent. It’s saying to the state and [federal authorities], you need to do something about this,” Lowe said in regard to synthetic 7-OH.

But outright prohibition bans that include natural kratom could bring another host of issues including whether local enforcement of the ban will even happen, and the possibility that a black market for the products may arise, he said.

“You leave people without any options, so they either find alternative options or they just drive across city lines or county lines and and go get it themselves,” Lowe said. Indeed, kratom and 7-OH are widely available on online marketplaces.