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A fourth concern, which is related to the long-term use of medications, is the potential toxicity that may be associated with chronic use, even though the toxicity is lower than that of tobacco products

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But in the last few years, a synthetic form of kratom refined for its psychoactive compound, 7-hydroxymitragynine or 7-OH, has entered the market that is highly concentrated and not clearly labeled, leading to confusion and problems for consumers

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