San Francisco health department reports the city's first fatal MGM-15 overdose, from "cat's claw" tablets labelled Script Botanicals x Maui Labs

San Francisco's Department of Public Health (SFDPH) says it is aware of a fatal overdose in the city involving MGM-15 (dihydro-7-hydroxymitragynine) [1], the first known fatal overdose involving MGM-15 in San Francisco [1]. MGM-15 has recently been identified in overdoses in Utah and Washington, some of them fatal [1].

The San Francisco Office of the Chief Medical Examiner's forensic toxicology testing confirmed MGM-15 both in the decedent and in the product the decedent took [1]. The alert names it: tablets branded "Script botanicals x Maui labs", a different brand from the MGM-15 products identified in Utah and Washington [1]. The packaging makes no reference to kratom or 7-OH [1]. The card in the alert's photos is the Paradise Blend tablet, Berry Punch flavour, 100 mg a tablet and four to a pack, labelled as Uncaria tomentosa (cat's claw) extract. SFDPH says MGM-15 has been found in products marketed as cat's claw and sold in smoke shops and gas stations [1].

What MGM-15 is

SFDPH describes MGM-15 as a full agonist at the mu-opioid receptor, estimated from animal models to be 15 (under the skin) to 50 (by mouth) times stronger than morphine [1]. Too much causes an opioid overdose: sleepiness, pinpoint pupils, slowed or stopped breathing, and death [1]. It is not approved for any medical use in humans [1]. The DEA placed it in Schedule I, with mitragynine pseudoindoxyl and MGM-16, by a temporary order [2] that runs until August 26, 2028 unless it is extended or made permanent [2].

What to do

• Naloxone works, as far as SFDPH knows. It has no reason to believe an MGM-15 overdose cannot be reversed by naloxone given in time [1]. Give it for any suspected overdose, even when you do not know what was taken [1]. It may not fully wake the person, but it is what restores breathing [1]. Call 911.
• In San Francisco, anyone can get naloxone at the Behavioral Health Pharmacy, 1380 Howard Street, weekdays 9am to 6pm, walk-in and without a prescription [1].
• For clinicians, SFDPH asks that you ask patients about over-the-counter supplements, including ones bought in places such as gas stations [1].

A "cat's claw" label, or a card that says nothing about kratom or 7-OH, is not evidence of what is in the tablet.

Also reported: CBS San Francisco, San Francisco reports first fatal overdose from synthetic opioid sold in gas stations, smoke shops.

References

1. Health Alert: Potent New Semi-Synthetic Opioid (MGM-15) Detected in SF Overdose Death — San Francisco Department of Public Health (Behavioral Health), on sf.gov
2. Schedules of Controlled Substances: Temporary Placement of Mitragynine Pseudoindoxyl, MGM-15, and MGM-16 in Schedule I — Federal Register