San Francisco Reports First Fatal Overdose Tied to MGM-15

San Francisco health officials issued a health alert on Wednesday, Oct. 21, 2026, after the city recorded its first known fatal overdose involving MGM-15, a semi-synthetic opioid derived from kratom that federal regulators have now placed in Schedule 1.

The San Francisco Department of Public Health said an adult died in late September. The medical examiner found MGM-15 in the person who died and in the packaging of the product the person consumed. That product carried the brand name Script Botanicals x Maui Labs. It held four tablets of 100 milligrams each and sold for about $20. The packaging made no reference to kratom and no reference to 7-OH, the kratom compound at the root of the drug.

What MGM-15 is

MGM-15 is short for dihydro-7-hydroxymitragynine. Chemists build it from compounds found in kratom, a plant sold in the United States as powders, capsules and shots. The drug is not approved for any medical use. The Drug Enforcement Administration recently designated it Schedule 1, the federal category for drugs with no accepted medical use, and it is illegal for sale.

One report estimates MGM-15 may be up to 50 times stronger than morphine. Treat that figure as an estimate, not a settled measurement. What health officials state plainly is the risk. Too much of the drug can slow or stop a person's breathing, a failure called respiratory depression, and that is what kills in an overdose.

Where it has turned up

San Francisco is not the first place to meet this drug. MGM-15 was identified earlier in overdoses in Utah and in Washington. It has also been found in products marketed as uncaria tomentosa, sold under the common name cat's claw, in smoke shops and gas stations. A buyer who picks up a packet labeled as a plant extract has no way to see the lab made opioid inside it. The San Francisco case shows the same gap from the other side. The dead person's tablets came in packaging that named a brand and nothing about what the tablets held.

Enforcement in San Francisco

Police have already moved on the shops that sell this shelf of products. Officers seized more than 400 kratom products and other items from two smoke shops in searches carried out in September and October. In a Sept. 10 search on the 1400 block of Haight Street, officers took suspected psilocybin, kratom and 7-OH items, flavored vapes, nitrous oxide and glass pipes. The seizures show the products sit in ordinary retail stores, on shelves next to legal goods, and that officers were pulling them before the health alert went out.

A second unfamiliar drug death this year

The MGM-15 death is the second time in 2026 that San Francisco officials have had to name a drug most residents have never heard of. In April 2026, a San Francisco teenager died after taking a counterfeit pill that contained cychlorphine, another synthetic opioid. Health officials said no further cychlorphine deaths have been detected since that case. The pattern across both deaths is the same. The product looks familiar, a pill or a branded packet, and the drug inside it is neither familiar nor labeled.

What happens next

The health alert puts smoke shops, gas stations and their customers on notice at the same time. Products sold as cat's claw or under boutique brand names can contain MGM-15 without saying so anywhere on the packet. Anyone who bought tablets like the Script Botanicals x Maui Labs pack should treat them as an illegal Schedule 1 opioid, not a plant supplement. For the city, the next facts to watch are whether the medical examiner finds MGM-15 in more cases and whether the shop seizures grow into charges. A first death is a warning. Officials issued this one so it does not become a count.