It Came in a $20 Pack of Berry Punch Tablets. Now Somebody in San Francisco Is Dead.

San Francisco has recorded its first death from MGM-15, a kratom-derived opioid sold in gas stations and smoke shops. The package didn’t say kratom. It didn’t say opioid. Here’s what to look for, and what to do if someone stops breathing.

SAN FRANCISCO — It came in a little foil pack. Four tablets. Berry punch. Twenty dollars, give or take a penny.

Somebody in San Francisco took what was in a pack like that in late September and didn’t wake up.

The San Francisco Department of Public Health announced Wednesday that the death is the city’s first tied to MGM-15, a semi-synthetic opioid made from a compound in the kratom plant. The medical examiner found the drug in the person’s system and in the packaging of the supplement they appear to have taken. The city has not released the person’s name, age or neighborhood.

The product was sold under the name Script Botanicals x Maui Labs, according to published reports. Health officials said nothing on the package mentioned kratom. Nothing mentioned 7-OH, the kratom extract it’s built from. It looked like a supplement. It was sold like a supplement.

It wasn’t one.

What MGM-15 is

Lab tests on animals suggest MGM-15 is somewhere between 15 and 50 times as potent as morphine, according to the Center for Forensic Science Research and Education, a Pennsylvania lab that tracks new drugs. The federal Drug Enforcement Administration made it a Schedule I controlled substance in late August, the same category as heroin.

The lab’s director, Alex Krotulski, told the San Francisco Standard he knows of more than two dozen MGM-15 deaths around the country, including in California, Nevada, Michigan and Florida.

“People have no idea if they’re consuming it or how much of it they’re consuming,” Krotulski said.

That’s the whole problem in one sentence.

Where it’s sold

Not in an alley. On a shelf. Health officials say products containing MGM-15 have turned up in gas stations and smoke shops. California’s Department of Public Health banned kratom and 7-OH products late last year. The products are still widely available in San Francisco and Oakland, according to published reports.

San Francisco police, working with the City Attorney’s Office and the health department, raided two smoke shops in recent weeks. One was on the 1400 block of Haight Street on Sept. 10. The other was on the 4600 block of Geary Boulevard on Oct. 9, where police say they seized more than 400 kratom products. Police have not said whether either shop is connected to the death.

Nobody has said publicly how many stores in San Francisco or Oakland are selling these products, or where.

What to look for

• Anything labeled “cat’s claw” or “uncaria tomentosa.” Health officials say MGM-15 has been sold under those names. Real cat’s claw is a vine used in herbal remedies. These products may not be.
• “Proprietary blend” with no clear ingredients. That vague wording makes the drug hard to spot, even for toxicology labs.
• Kratom, 7-OH or “mitragynine” in any form: tablets, gummies, capsules, powders, shots and drinks. They’re banned in California for a reason.
• The brand tied to the San Francisco death: Script Botanicals x Maui Labs.
• Anything sold as relief, energy or a “feel-good” supplement near the register that you can’t identify. If the label won’t tell you what’s in it, put it back.

If somebody you love takes these for pain, for energy, to get through a shift or to come down off something else, have the conversation now. Kratom can cause dependence and withdrawal. It is not approved for any medical use.

If someone overdoses

• Signs: slow or stopped breathing, blue or gray lips and fingertips, pinpoint pupils, gurgling or snoring sounds, a person you can’t wake.
• Call 911. California’s Good Samaritan law gives some legal protection to people who call for help during an overdose.
• Give naloxone (Narcan) if you have it. It’s sold over the counter at pharmacies, no prescription needed. City health officials say naloxone may not fully wake someone from an overdose like this one, but it is “vital for restoring breathing.” Give it anyway. A second dose may be needed.
• Stay with them. Roll them on their side so they don’t choke. Don’t leave until help arrives.

Keep Narcan in the glove box. Keep it in the kitchen drawer. Keep it next to the Tylenol. It costs less than that foil pack.

The city lost somebody to a $20 supplement. The package didn’t tell the truth. So we will.

Photo: Kratom leaves. MGM-15 is made from a compound found in the plant. Photo by Uomo vitruviano via Wikimedia Commons, CC BY-SA 3.0.