Fatal Overdose Involving Kratom-derived Opioid

The San Francisco Department of Public Health (SFDPH) on Wednesday, October 21, 2026, issued a health alert to warn health care providers and the public about a kratom-derived opioid that recently caused a fatal overdose in San Francisco.

Dihydro-7-hydroxymirtragynine, also known as MGM-15, is a semi-synthetic kratom-derived opioid that is not approved for any medical use. Ingesting too much MGM-15 can result in a fatal opioid overdose.

In the first-known case in San Francisco, the Office of the Chief Medical Examiner (OCME) detected MGM-15 in an adult overdose decedent who died in late September. MGM-15 has been previously identified in overdoses in the states of Utah and Washington.

Recently designated as a Schedule 1 substance by the Drug Enforcement Agency, MGM-15 is illegal for sale. It has been found in products marketed as “uncaria tomentosa” or “cat’s claw” sold in smoke shops and gas stations. The below photos show the packaging of the product consumed by the San Francisco decedent.

Forensic toxicology testing by the OCME confirmed the presence of MGM-15 in both the decedent and in the packaging of this product. This “Script botanicals x Maui labs” brand is different from the products identified in Utah and Washington containing MGM-15. This packaging makes no reference to kratom or 7-hydroxymitragynine (7-OH), both of which have recently garnered public attention.

Earlier this year, SFDPH issued a health alert to warn the public about a synthetic non-fentanyl opioid called cychlorphine that caused the April 2026 overdose death of a San Francisco teen who ingested the substance in a counterfeit pill. No further deaths involving cychlorphine have been detected. The Office of the Chief Medical Examiner continues to test for novel and emerging substances, including cychlorphine and MGM-15, and shares results with SFDPH to inform public health interventions.

SFDPH recommends administering naloxone to anyone who appears to be overdosing and calling 911. At present, SFDPH has no reason to believe that intoxication with MGM-15, a mu-receptor agonist, cannot be reversed by the timely administration of naloxone.

Free naloxone is available at the SFDPH Behavioral Health Services Pharmacy at 1380 Howard Street, open on weekdays from 9 a.m. to 6 p.m. Naloxone, also known under the brand name Narcan, is also available in most retail pharmacies.

To learn how to use naloxone and more about the medication please visit About Naloxone | SF.gov. Organizations seeking naloxone and group trainings can contact the SFDPH Naloxone Clearinghouse Project at DPH-Naloxone_Clearinghouse@sfdph.org.

SFDPH offers effective treatment for opioid use disorder. To be linked to a treatment program or speak to an addiction specialist call SFDPH at 888-246-3333.

Read the MGM-15 health alert: Health Alert: Potent New Semi-Synthetic Opioid (MGM-15) Detected in SF Overdose Death | SF.gov

Learn more about kratom and 7-hydroxymitragynine (7-OH): https://www.sf.gov/about-kratom-and-7-hydroxymitragynine-7-oh

Learn more about cychlorphine: Fatal Overdose Involving Novel Synthetic Opioids | SF.gov