In The Lancet Pulse episode, host Matthew Gilbert and co-host Niall Boyce are joined by Dr. Liza Hutchison, Assistant Professor of Family Medicine at the University of Michigan, an addiction medicine physician overseeing services at a federally qualified health center in Washtenaw County, Michigan, and supervising a statewide telehealth on-demand buprenorphine service. Dr. Hutchison explains how natural leaf kratom contains multiple alkaloids (serotonergic, noradrenergic, and opioid-acting), with only about 1% opioid-active component, while concentrated 7-hydroxymitragynine (7-OH) products are reported to be 15–20 times more potent and can drive rapid tolerance, opioid-like withdrawal, and overdose risk.