Three U.S. Senators Call for FDA Regulation of Leaf Kratom

By Pat Anson

Three U.S. Senators are calling on the FDA and DEA to regulate the “entire kratom plant” under the Controlled Substances Act, a step that far exceeds current plans by the DEA to classify concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) as illegal Schedule One controlled substances.

Sen. Chuck Grassley (R-Iowa), chair of the powerful Senate Judiciary Committee, initially said in a post last week on Twitter/X  that “All Kratom is deadly” and that it “is killing our kids BEWARE of special interest snake oil.”

The 93-year old Grassley was joined this week by two other U.S. senators, Sen. Mike Lee (R-Utah) and Sen. Susan Collins (R-Maine) in a joint letter to the DEA administrator and acting FDA commissioner calling for the immediate scheduling of 7-OH and to “consider scheduling the entire kratom plant.”

“We urge the Food and Drug Administration to conduct the necessary scientific and medical evaluations of these substances and provide a permanent scheduling recommendation to the Drug Enforcement Administration for the full kratom plant, its derivatives, and all levels of the semi-synthetic analogues like mitragynine pseudoindoxyl, MGM-15, and MGM-16 that are being marketed as natural products.”

The DEA, in fact, has already scheduled mitragynine pseudoindoxyl, MGM-15 and MGM-16 – synthetic forms of kratom alkaloids – as Schedule One controlled substances. 

The agency announced plans to schedule 7-OH in July, but has delayed implementing the order at the request of the Department of Health and Human Services (HHS), to allow more time for public comment on the appropriate threshold level of 7-OH that would still be legally allowed. 

Nearly 36,000 public comments were made in the Federal Register, most of them opposed to the DEA’s plan to set a limit of 1 mg per 7-OH tablet, gummy or shot, saying there is no evidence to support it.   

Confusion Over Letter

“I think there is a tremendous amount of confusion about the letter,” said Mac Haddow, a spokesman and lobbyist for the American Kratom Association (AKA), an advocacy group for leaf kratom vendors. “I know for a fact that Senator Lee does not agree with the request that all natural kratom be scheduled.”

In talking with Judiciary Committee staff about the letter, Haddow said there were “misunderstandings” about the differences between 7-OH and leaf kratom, and confusion about how the substances might be regulated under the Controlled Substances Act (CSA). 

Kratom comes from the leaves of a tree that grows in Southeast Asia, where it has been used for centuries as a stimulant and pain reliever. 7-OH occurs naturally in kratom in trace amounts, but manufacturers have recently found ways to concentrate the alkaloid in 7-OH products, turning a mild pain reliever into a more potent one that has opioid-like effects.  

The AKA maintains that 7-OH and other concentrated alkaloids are synthetic opioids created in a lab that have no relation to leaf kratom. The AKA supports the scheduling of 7-OH, but wants leaf kratom left alone.  

“I know where Mike Lee is on this, and my understanding is he didn't agree with the premise of that letter at all, and maybe because he's out of town, didn't read it carefully,” Haddow told PNN. “But that’s neither here nor there, the letter's written. I hope they rescind it and they give a more detailed analysis of what they really want.” 

Haddow said the Judiciary Committee staff, which likely wrote the letter, thinks leaf kratom should be classified under the CSA as a Schedule Two or Three substance that could be used for medical purposes. But that requires the approval of the FDA, which has long maintained that kratom is not approved for any medical condition.

“You can schedule FDA-approved drugs in any of those schedules,” explained Haddow. “But you can't take one that doesn't have a drug approval and schedule it anywhere but Schedule One. And they didn't even know that, so that was surprising to me. You'd think the Judiciary staff would understand the Controlled Substance Act better than that, but maybe I misunderstood them. But I don't think I did.”

If what Haddow says is accurate, it’s a surprising level of ignorance, as the Senate Judiciary Committee oversees the U.S. Justice Department, DEA, FBI and Department of Homeland Security. The DEA is the primary agency responsible for enforcing the CSA.   

It’s not the first time Haddow has encountered confusion at the federal level about kratom and its derivatives. In August, he told PNN there was “enormous confusion among some members of Congress and even staff at the DEA” about the differences between leaf kratom, 7-OH, and other kratom alkaloids. 

He fears that confusion could lead to all kratom related products being scheduled or banned – including leaf kratom –  which is exactly what the Grassley, Lee and Collins letter is proposing.  

The American Medical Association (AMA) also supports the regulation of leaf kratom and kratom derivatives.  In June, the AMA’s House of Delegates passed a resolution calling for a complete ban on 7-OH and recommended that kratom be scheduled under the CSA after the FDA evaluates its safety and efficacy through clinical trials — a process that could take several years. 

Until that happens, the AMA says kratom should not be “marketed or prescribed as treatment for any condition.”

Fear and Worry Living in 7-OH Limbo

By Crystal Lindell

Ever since the Trump Administration announced on July 1 that it planned to make the kratom alkaloid 7-OH a Schedule One controlled drug, people like me who use it have been living life in a horrible anxious limbo. 

I’ve had a deep feeling of dread in my stomach that a text or alert could bear the news I most fear: “7-OH is now illegal nationwide.” 

The original 30-day public comment period offered by HHS was set to end on July 31. We all expected the official ban to come shortly after that, sometime in early August. But then we got a respite when the comment period was extended through September 10.

Another month has come and gone, and the comment period ended weeks ago. But an official federal ban by the DEA still has not been announced. So 7-OH users like me are still unsure of what's happening.

Don't get me wrong. I would much rather live in this dark unknown limbo than have the ban be imposed.

But it's all very stressful.

While I have tapered down on my dose, I do still use 7-OH. It’s too much of a life-changing drug for me to stop when it is still legal where I live.

But that means if the DEA does make it Schedule One, in the same category as heroin and LSD, I’ll be stuck either going into instant physical withdrawal or becoming a felon.

I have had chronic pain from intercostal neuralgia since 2013. When concentrated 7-OH products became available a couple years ago, they seemed like an answer to a prayer I was reciting for over a decade. 

7-OH instantly treats my pain anytime I take it, and helps fight the fatigue I developed from living with chronic pain for so many years.

As such, it has allowed me to have so much of my pre-chronic pain life back. I can wake up early. I can shower in the morning. I can pretty much show up to any and all plans that get made. So many little things that healthy people take for granted.

But it’s also the big things. 7-OH has allowed me to work full-time for the first time in four years. It has allowed me to show up as the happy, bubbly person I used to be before pain destroyed my spirit. It has saved me.

I don’t know what my life will look like if and when the federal ban goes through. I don’t know if I’ll be able to continue working full time. I don’t know how bad the full withdrawal down to zero will be. I don’t know how quickly I’ll be forced back to my pre-7-OH life.

It’s not just me I’m worried about. I have multiple loved ones who also use 7-OH for their chronic pain, and I’m very worried about them as well. I’m worried how they will treat their pain once 7-OH is illegal, and I’m worried about how they will handle the withdrawal once they aren’t able to buy any more of it.

Sometimes, when I’m alone with my thoughts at night, I let myself believe that maybe there’s a chance the DEA and HHS will reverse course. It’s not a completely crazy thought, either. There’s precedent. In 2016, when the Obama administration announced plans to make kratom leaf a Schedule One drug, it dropped them a few months later after a public outcry.

My deepest, most sincere hope is that the same thing will happen with 7-OH now too. But I know I can’t count on that.

Truth be told, I’ve been scared to even write this column for fear that it will somehow jinx things. 

But this is my life right now with chronic pain. I’m in 7-OH limbo. I could either lose the most effective treatment I’ve ever found for my chronic pain, or I can risk being arrested for felony drug possession. 

For now, all I can do is anxiously wait.

Should AI Be Used to Prompt People in Pain to Exercise?

By Crystal Lindell

We all know that being too sedentary contributes to poor health. It might even make your pain worse. But many of us still spend way too much time sitting in one place watching TV, scrolling on our phones, or working at a computer.   

“Individuals with certain chronic pain disorders face a paradox: they are at increased risk for sedentary behavior due to pain-related interference, even though significant gains in symptom relief and health benefits from increasing their PA (physical activity) for symptom management have been demonstrated,” says Ipek Ensari, PhD, who studies artificial intelligence (AI) and human health. 

Ensari and her colleagues at the Icahn School of Medicine at Mount Sinai wondered if wearable devices could be used to help women with chronic pelvic pain stand up and move around more. 

Their study, recently published in the journal Women’s Health, wanted to see if AI could predict when patients would have prolonged periods of inactivity. 

They recruited 134 women with chronic pelvic pain, primarily from endometriosis, along with 61 healthy women for a control group. Participants wore Fitbit devices for up to 90 days, generating minute-by-minute information about their physical activity, heart rate, steps, and sleep patterns.

"Our goal was to determine whether everyday wearable devices could serve as an early-warning system for prolonged sitting in women living with chronic pelvic pain," Ensari explained in a news release. 

"Rather than offering generic advice after the fact, we wanted to determine whether we could anticipate these moments and support people with simple, well-timed prompts that fit naturally into their daily lives."

The research team gathered data from each participant and developed personalized forecasting models to predict their activity levels one hour ahead of time. The goal was to identify 15-minute periods when a participant could stand up and move around, which the researchers called an “exercise snack.” 

Those short activity breaks may be more realistic and achievable than longer exercise periods, especially for people with chronic pain. The work also challenged the assumption that AI focused on health needs to be complex. Relatively simple AI models forecast prolonged periods of sitting just as well as complex ones.   

"We were surprised by how well the simplest models performed," said lead author Jannes Jegminat, PhD, a former postdoctoral research fellow at the Icahn School of Medicine. "More complex AI is not always better. Lightweight, interpretable models can accurately forecast sedentary behavior while being practical enough to run directly on a person's own device, which also helps protect privacy." 

Unfortunately, the research did not include any further investigation into whether or not participants would actually get up for a walk when prompted. And there seems to have been no consultation with pain patients on whether this technology is something they’d want and use.

The researchers admit that further study is needed to see if the AI prompts could actually help patients.

"This study suggests that predicting prolonged sitting is feasible, even if the individual has chronic conditions that might impact their daily routine," said Ensari. "The next step is determining whether delivering personalized movement prompts based on those predictions actually helps reduce sedentary time, improves symptoms, and enhances quality of life. Those questions will require prospective clinical trials."

It’s unclear how the technology would be applied to periods when someone needs to be sedentary, such as when they are working, eating, watching a favorite show, or in too much pain to move. 

The last thing I want to see on my AI watch as I’m driving late to work is a notification telling me to go for a walk instead.  

It’s becoming clear that anything and everything related to artificial intelligence is the new trendy topic for research, and it’s likely the topic is now also yielding better funding opportunities. But as researchers continue to study the ways AI can help us medically, they would do well to remember to ask patients for their input as well.

The work was funded in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development and by the Clinical and Translational Science Awards at the National Center for Advancing Translational Sciences. 

Ketamine Infusions Effective in Reducing Fibromyalgia Pain

By Pat Anson

Ketamine infusions provided “substantial and sustained” relief for women suffering from severe symptoms of fibromyalgia, according to a small new study. But the results were uneven, with some patients reporting over 50% pain relief, while others had minimal or no benefit despite multiple treatments. 

Fibromyalgia is a poorly understood disorder characterized by widespread body pain, fatigue, headaches, brain fog and insomnia. About 3% of the world’s population has fibromyalgia, most of them women. 

For the study, researchers at the Carolinas Pain Institute enrolled 92 women suffering from chronic fibromyalgia, ranging from 24 to 78 years of age. Their median pain score at the start of the study was 8 on the zero to ten pain scale. About a third of them were on opioid pain medication.

Ketamine is an anesthetic drug that is only FDA-approved for depression and anesthesia, but is increasingly used off-label for chronic pain conditions such as Complex Regional Pain Syndrome. 

Participants received 1.5 mg/kg per hour of ketamine during 3-hour infusion sessions, which were repeated as needed every 3 to 10 months. Some patients needed only one infusion, while others needed as many as 32 infusions.

The study findings, reported recently in the Journal of Pain Research, show the median pain score for the women fell from 8 to 5 after three months. About a third reported more than 50% pain relief – improvements that were sustained for 24 months. 

“Although the duration of pain relief varied between patients, it was generally consistent for each individual patient and averaged approximately 6 months, which was considered highly satisfactory by most patients undergoing repeated infusions,” wrote lead author Leonardo Kapural, MD, an anesthesiologist at the Carolinas Pain Institute in North Carolina. 

“Clinically meaningful improvement, defined as at least a two-point reduction on the pain scale, was achieved in 75% of patients through 24 months, suggesting that the majority of patients with severe fibromyalgia benefited from this therapy.”

But 19 patients – about 20% of the participants – reported minimal or no benefit from treatment. Nineteen patients also experienced side effects, such as nausea, vomiting, hallucinations, confusion, and nightmares. 

It is common for patients to experience dissociation and “out of body” sensations during ketamine infusions. They appear to be awake, but are often unable to respond or react to sensory input.

Researchers say there were numerous changes in medication for the 92 participants during treatment. The number of patients taking opioids fell from 33 to 27. Others continued taking  antidepressants, muscle relaxants, and anti-inflammatory medications. Because of that, it is difficult to say if ketamine is best used alone or as an adjunct therapy used in combination with medication.

Despite those limitations, researchers say their findings of substantial pain relief from chronic fibromyalgia justifies a larger clinical trial with ketamine infusions. Previous small studies of ketamine as a treatment for fibromyalgia also suggest that infusions could be beneficial.  

Until recently, there were only three FDA-approved drugs for fibromyalgia: duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella). Many patients consider the drugs ineffective or have too many side effects.

Last year, the FDA approved Tonmya, a fourth drug for the treatment of fibromyalgia in adults. Tonmya is a new formulation of a muscle relaxer (Flexeril), which was originally developed as an antidepressant. 

‘Peak Pain’ Happens at a Younger Age Than Many of Us Think

By Pat Anson

We often think of pain as a symptom of old age. Aching muscles and sore joints don’t heal as quickly as we grow older, and chronic painful conditions like arthritis, neuropathy and spinal degeneration become more common as we age.

A large new international study published in Nature Medicine debunks that common belief, finding that many types of pain begin earlier and reach their peak before the age of 55.

Led by researchers at McGill University in Montreal, the study looked at self-reported pain data collected between 1990 and 2025 from over 6 million people in 118 countries and territories.

Of the 11 body areas studied, pain prevalence varied considerably depending on location, age and sex. Women reported pain in nearly every location more often than men. The one exception was chest pain, which occurs slightly more often in middle-aged men.

Headaches often peaked for both men and women in their 30’s, while stomach pain peaks for women at the age of 23 and males at age 5. Pain in those locations tends to decline as people grow older. 

The universal curse of back pain often begins for men and women in their 20’s, and tends to keep growing worse as we grow older. Knee pain and hip pain follow a similar upward trajectory.

Lifespan Pain Projections for 11 Body Areas

NATURE MEDICINE

“The global lifespan trajectories show that pain is not a single epidemiological phenomenon but, rather, a set of distinct nonlinear patterns that differ in their timing and anatomical distribution,” wrote lead author Matt Fillingim, PhD, a data scientist and researcher at McGill University who now works for Johnson & Johnson.

“Across most phenotypes, pain did not increase monotonically with age; instead, the steepest rises occurred before age 55 years, indicating that a substantial share of lifetime pain burden develops during working-age adulthood.”  

There is a fair amount of regional variability in pain prevalence. Headaches were most likely to peak in North America and Western Europe in early adulthood, while headaches in East and Southeast Asia were less common and have a flatter trajectory over time.  

Eastern Europe and Sub-Saharan Africa had some of the highest rates of back, joint and overall body pain. If you live in those regions, pain prevalence really is associated with age and just keeps growing worse the older you get.

Not surprisingly, smoking, obesity and coming from a low-income household are also contributing factors that significantly raise the risk of pain.

By age 80, overall pain prevalence is about 31% higher in less developed countries and low back pain was nearly twice as common  

Interestingly, the risk of having facial pain is significantly higher for female smokers, while pain in the foot, ankle, knee and hip — weight-bearing joints — is often linked with obesity.

What all this data tells us is that life-style changes, pain prevention and pain management need to start at an early age. And pain is a universal experience that knows no borders.

Exploring the Connection Between Chronic Pain and Dementia

By Cynthia Toussaint

Difficulty in finding words – also known as “brain fog” -- started for me 30 years ago after I began taking the medication gabapentin for Complex Regional Pain Syndrome. While it initially proved to be effective for me, pulling me out of a ten-year bout of bedridden hell, brain fog was an embarrassing side effect, as I was speaking publicly for HMO reform.

As a spokesperson, having the right word at the right time can make all the difference in “selling” something I’m passionate about. I prayed this troubling symptom would pass as my brain acclimated to gabapentin. It did not.

With time, not only did my brain fog worsen, I started losing thoughts and ideas mid-sentence. Though I could attribute the word loss symptom to gabapentin, my new challenge was something more, something scarier.

Research taught me that long-term persistent pain leads to neural overload and atrophy, literally shrinking parts of the brain responsible for language and memory. Concurrently, I learned that both gabapentin and the clonazepam that I’d been taking for pain and dissociation for four decades worsen dementia symptoms. That was shocking. 

Then in 2014, my mother, a woman grounded in pure love and goodness, but who’d not been herself for a decade, was finally diagnosed with Alzheimer’s disease.

Though Mom wasn’t on any pain meds, she’d suffered since her mid-20s with throbbing varicose veins made worse by failed surgeries.

She also struggled for most of her life with significant low back pain, often eschewing beds for the hard floor. Later, Mom had hip pain severe enough to provoke screams throughout the day. 

I believe my mother’s chronic pain very likely contributed to her dementia development. She’d been dealt a number of other cards that certainly aided the deterioration of her brain.

By the mid-2010s, there were multiple studies linking trauma to dementia. My mom suffered a tsunami of that from her family of origin, her husband, and some of her own children.

lEONA AND CYNTHIA

That trauma produced high levels of toxic stress that led to elevated inflammation, two factors now recognized as drivers of dementia. And she was a woman at an advanced age. Indeed, Mom was a poster child for dementia.

I fear that I may be, too. 

Though for me developing dementia often feels inevitable, being at high risk is not a fait accompli. Regardless of my future’s uncertainty, this I know: I’m not going to just wait for the lights to dim. And I’ll be damned if I suffer the way my beautiful mom did.

For Pain Awareness Month in September, For Grace launched its most personal project in our nearly 25-year history. Named for my beloved mom, “Leona’s Legacy” is a safe, online nurturing space where one can learn about the connection between chronic pain and dementia and how to avoid or, at least, slow down the onset of the disease.

For me, cognitive wellness comes in the form of a plant-based diet, abundant exercise, sleep hygiene, daily meditation, meaningful work, ample reading, and creative therapies like piano, singing and writing.   

But it’s the last pillar of this project that is most meaningful to me, and the closest to my heart. We at For Grace are working on state legislation that, if signed into law, will mitigate financial elder abuse in California.

You see, it wasn’t watching Mom waste away from this wretched disease that was the worst for me. It was what I witnessed during her last ten years, when she lost her capacity for decision-making and was utterly vulnerable to bad players. That’s when she was abused in every way possible by those she loved and thought she could trust.

I know my family’s horror show is far from unique. Elder abuse, in all its forms, is going to become a bigger problem as Boomers age.

Putting a face to the issue, Leona’s Legacy includes touching personal stories from people with pain who have heartbreaking, powerful connections to dementia. Taking a cue from their truth-telling, you’ll also learn about my forthcoming memoir, where I lay bare my family’s multi-generational dysfunction and how I finally broke the trauma cycle for my own survival.

While motivated in part by harm and hurt, the core engine of Leona’s Legacy is the epic love Mom and I shared, unflinching and unbreakable.

I can’t go back and change the abuse she endured, abuse that extended to me, as the family scapegoat, and hastened her death.

But I can still help others in her name.

It is Mom’s enduring love that continues to push me forward, love that will never be forgotten.

Cynthia Toussaint is the founder and spokesperson at For Grace, a non-profit dedicated to bettering the lives of women in pain.

She has lived with Complex Regional Pain Syndrome (CRPS) and 19 co-morbidities for 45 years, and is also a cancer survivor. Cynthia is the author of “Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.”

Most Cancer Survivors Have High-Impact Chronic Pain

By Crystal Lindell

Just because someone beats cancer, that doesn’t mean the related physical pain is gone. In fact, new research suggests that a majority of cancer survivors endure high-impact chronic pain that significantly limits their life and work activities.

That’s according to a new study recently published in the journal Supportive Care in Cancer.

Danish researchers studied the different levels of pain, disability, psychological distress, and self-rated health of 270 cancer survivors classified as having high-impact chronic pain. Nearly two-thirds (61%) had high-impact pain, with the rest have mild or “bothersome” chronic pain. 

Compared with the mild and bothersome groups, the high-impact pain group reported significantly higher pain intensity and disability; higher depression scores; more widespread pain; and lower self-rated health and quality of life.

Researchers say medical professionals should be aware that many cancer survivors likely have high-impact chronic pain – and as such they may need more intense treatment options.

“The findings underline the need for systematic assessment of pain impact, not just its presence, in cancer rehabilitation,” the authors wrote. 

When high-impact chronic pain goes unrecognized in cancer patients, it has real consequences. 

Earlier this year, PNN reported how common it is for women to suffer from chronic pain after mastectomies, a lifesaving surgery that removes a patient’s breasts to treat or prevent breast cancer. After surgery, many women have post-mastectomy pain syndrome, which can last for years.

“I’ve known women who’ve had chronic pain — itching, burning, stabbing pain — for years after mastectomies,” said Kathy Steligo, an author of multiple books on breast cancer. “Of all the problems, that is probably the one least talked about by surgeons.”

It’s not just an issue isolated to patients in remission or recovering from surgery and chemotherapy. Even patients with active cancer can have a hard time getting medical teams to take their pain seriously. 

In 2023, we reported on a study that found the number of cancer patients seeking treatment for pain in U.S. emergency departments had doubled from 2012 to 2019.

Of the 35 million visits made to an emergency department by those patients, over half were deemed preventable – meaning the visits could have been avoided if the patient had received proper care earlier. 

One explanation for the lack of treatment was the widespread reduction in opioid prescribing after the 2016 CDC opioid guideline. The guideline was only intended for non-cancer primary care patients, but was quickly adopted by doctors treating all types of pain, including cancer. 

According to a small 2021 study in the journal Cancer, some cancer patients were so aware of the stigma surrounding opioids they were reluctant to take opioid medication to relieve pain – even though the risk of opioid addiction and overdose is low for cancer patients.

Are More Seniors Addicted to Cannabis?

By Pat Anson

Older Americans increasingly identify as cannabis consumers, with nearly 9% of adults over age 65 having used cannabis in the last 12 months.  Most use cannabis therapeutically to treat pain, insomnia, depression and other conditions associated with old age. A recent study even suggested that cannabis may improve cognitive function. 

But there’s a major drawback to the growing use of cannabis by seniors, according to a new study that found about one in nine (11.4%) meet the criteria for cannabis use disorder (CUD). 

While most cases of CUD were considered mild (76%), those that are moderate (20%) or severe (4%) need treatment, according to researchers.

“Given the rapid changes in cannabis use among older adults, it is imperative to understand who may be at risk for developing CUD when weighing the risks and benefits of its use,” wrote lead author Benjamin Han, MD, a geriatrician, addiction medicine physician, and researcher in the Department of Medicine at UC San Diego.  

“While the majority of CUD cases are mild and could benefit from early intervention, nearly a quarter of cases are moderate or severe and likely require additional intervention to prevent worsening severity and co-occurring problems.”

Han and his colleagues analyzed data from the National Survey on Drug Use and Health to assess how often older adults used cannabis, the modes of use (smoking, vaping or eating), and whether medical cannabis was recommended by a doctor. People who used hemp or CBD were not included in the analysis.

The study findings, published in the journal Addiction, show that over two-thirds (67.4%) of the older adults who used cannabis did so in the past 30 days, suggesting their use was fairly frequent. 

Men (10.9%) were more likely to use cannabis than females (7.2%), with smoking the most common form of use (65.8%). Only 20% said their doctors recommended they use medical cannabis.

Identifying who has cannabis use disorder is a less precise metric, since it depends on whether they have two or more of the 11 behaviors that qualify under the Diagnostic and Statistical Manual of Mental Disorders criteria.     

The 11 Cannabis Use Disorder Criteria

1. Taking cannabis in larger amounts or over a longer period

2. Wanting to cut down or stop using cannabis, but failing to do so

3. Spending a great deal of time obtaining, using, or recovering from cannabis

4. Experiencing intense urges, desires, or cravings

5. Failing to meet work, school, or home responsibilities because of use.

6. Continuing use despite recurring social or relationship problems

7. Giving up or reducing social, occupational, or recreational activities

8. Repeatedly using cannabis in situations that are physically dangerous.

9. Continuing to use despite knowing it causes physical or psychological problems

10. Needing larger amounts to get the same effect (tolerance)

11. Experiencing withdrawal symptoms

Among the older adults with CUD, researchers say the three most common criteria were cravings, tolerance, and spending more time obtaining and using cannabis. 

‘Our Definition of CUD Is Broken’

But critics say the CUD criteria are vague and fail to take into account how many seniors are using cannabis to relieve pain or to help them sleep. 

“People are defined as suffering from CUD if they meet two out of 11 possible criteria. Notably, these criteria make no accommodation for those who use cannabis medically,” says Paul Armentano, Deputy Director of NORML, which advocates for marijuana legalization.

“More importantly, the real-world relevance of CUD is undercut by the federal government’s own substance abuse treatment data. According to a 2026 report published by the US Department of Health, the percentage of Americans seeking drug treatment for cannabis has declined steadily for the last half-decade. By contrast, more than four times as many people are admitted to treatment annually for alcohol use disorder.”

Dr. Peter Grinspoon says the number of people estimated to have CUD is exaggerated, in part because tolerance and withdrawal are normal reactions for anyone taking a drug for medical reasons. But that makes them dependent, not “addicted” to a drug.    

“Our definition of ‘cannabis use disorder’ is broken and inadvertently ropes in many medical marijuana patients that couldn’t possibly qualify as being addicted. In my clinic, I have had patients who are thriving on medical cannabis, for insomnia or chronic pain, only to see the diagnosis ‘cannabis use disorder’ added to their medical record after they visit with another doctor,” Grinspoon wrote in a recent Substack column.

“As such, we are saddling people with a diagnosis of marijuana addiction just for having tolerance and withdrawal (which are physiological effects of the medicine). This harmful double standard exists because some of the old guard addiction psychiatrists don’t view cannabis as a medicine.”

Grinspoon says patients who are falsely labelled as addicted – whether to cannabis, opioids or other substances – are often abandoned or neglected by doctors. The label could also interfere with their employment, have legal consequences, and contribute to stigma and feelings of low self worth.

Instead of labeling patients with a diagnosis, a little empathy may be in order. 

“We can’t continue to unjustly label patients as addicted to cannabis when they are using it medically, without problems,” said Grinspoon.

My Cats Help Me Cope with Chronic Pain

By Crystal Lindell

It is ironic that I was initially opposed to getting a cat because I have chronic pain.

I hate getting up early. I hate having to do anything right when I wake up. And I have no money.  

Cats wake you up at 5 am, expect to be fed immediately, and keeping them alive is expensive.

But when the mother of my fiancé Chris moved into senior housing, she was only allowed to take one of her two cats with her.

Thus, her long-haired tortoiseshell cat – affectionately named Princess Diana – had nowhere to go but to our house.

Although I was initially reluctant, Princess D quickly won me over when, on her first visit, she ran over to me while I was sitting in a rocking chair. She stared up at me with the eyes of a cat looking for love, and jumped up into my lap.  

I was hooked.

We became a one cat household.

Eventually, Princess D’s former sister Basil was also looking for a home, after Chris’ mom was no longer able to care for her either.

CRYSTAL WITH PRINCESS DIANA

Basil, a beautiful long-haired black cat, came with a pre-written warning for the vet, and lots of war stories. She was a scratcher. And a biter. If we hadn’t taken her, they were going to put her down.

Over the years, in the comfort and predictability of our home, Basil has softened. But just last week, she bit my arm because she got confused in the middle of the night.

We love her regardless.

After Basil came to live with us, we found our orange boy Goose and our brown tabby Goldie Hawn, outside. 

And when we moved in with my relatives, two gray-haired cats, Gracie and Cinnamon, joined our crew.

Yes, that brings the total to six cats. Yes, I know that puts me into crazy cat lady territory. But the thing about being a crazy cat lady is that I love them all too much to care what you think.

Just as I feared, they do all wake us up at 5 am, asking for food. And it does indeed feel like I’m pulling myself out of cement to get out of bed, just so that I can open a can of Friskies for them at dawn.

Truth be told though, having a reason – actually six reasons – to get out of bed every morning goes a long way when you’re dealing with pain that never ends. They give me purpose, and in return, I give them treats.

Having six cats also means that at least one of them is always willing to nap with me whenever I’m having a bad pain day. And naps covered in cats are healing. 

I confess, we do spend a lot of our money on our cats, especially after Princess Diana developed diabetes and almost died. We buy $140 vials of insulin every other month to keep her alive.

But she keeps me alive by giving me a reason to live, so really it all evens out.

In the end, our six cats give my life meaning, relieve stress, take my mind off my pain, and fill our home with love. All of those things go a very long way toward helping me cope with chronic pain.

In fact, there’s even data to back this up.  

In 2019, a National Poll on Healthy Aging conducted by AARP and the University of Michigan found that pets can offer their owners a wide range of health benefits.

The people surveyed said their pets helped them enjoy life (88%), made them feel loved (86%), helped reduce stress (79%), kept them physically active (64%) and helped them cope with physical and emotional symptoms (60%), such as taking their mind off pain (34%).

For those who said their health was fair or poor, pet ownership offers the most benefits. More than 70% of older adults said their pet helps them cope with life’s challenges, and nearly half (46%) said their pets help distract them from pain.

I used to think that having chronic pain was why I could never care for a pet. But I’ve come to understand that caring for a pet is one of those things that gives more than it takes. It’s because of my chronic pain, that having a pet – or six of them – is so vital to my well-being.

Kratom Leaf Falsely Linked to Ole Miss Deaths

By Pat Anson

The suspected overdose deaths of two college students in Mississippi has renewed fears and misinformation about kratom and its alkaloids.   

Ole Miss students Aidan Hamilton, 18, and Robert Strang, 20, were found dead on Sept. 21 in separate locations.

The Lafayette County Sheriff’s Office said investigators found “packaged kratom” in both locations and released a statement saying, "Out of an abundance of caution, we encourage everyone to avoid kratom and any other medication or substance that was not prescribed to you.” 

That is what led led to numerous reports that the two deaths were “suspected kratom overdoses.”  

It turns out the “packaged kratom” was not natural leaf kratom but Smax Pseudo-DHM tablets. An affidavit lists the tablet ingredients as mitragynine pseudoindoxyl, MGM-15 and 7-hydroxymitragine (7-OH), which are concentrated or synthetic kratom alkaloids.

Mitragynine pseudoindoxyl and MGM-15 were recently classified as Schedule One illegal substances by the DEA. 

A Mississippi state law in 2025 restricts kratom sales to consumers 21 years of age and older, and bans all synthetic forms of kratom.

Deputies arrested two employees at a smoke shop near the Ole Miss campus, where one of the students apparently bought the tablets. A worker allegedly told an informant to “be quiet” about the pills because “people were dying from them.”

It’s not yet clear if the Smax Pseudo-DHM or other drugs played a role in the students’ deaths, because their autopsies are incomplete.

"If law enforcement knew the specific product involved, Ole Miss students should have been warned what product they needed to be concerned about," said Mac Haddow, a spokesman and lobbyist for the American Kratom Association (AKA). "Instead, the public was broadly warned about 'kratom' when the product was not kratom at all.

“When the Sheriff's Office characterized these products as kratom without identifying what they actually were, reporters understandably repeated that description. We now know the information available to investigators was substantially more specific. The public should have received that information."       

Confusing natural leaf kratom with 7-OH is something that even kratom advocates argue about. The AKA has long maintained that 7-OH and other concentrated alkaloids are synthetic opioids created in a lab that have no relation to leaf kratom. 

The Trump Administration agrees and may soon classify concentrated 7-OH as a Schedule One illegal drug, the same category as LSD and heroin.

Whack-a-Mole Alkaloids

At least 54 different alkaloids have been identified in kratom, which comes from the leaves of a tropical tree in Southeast Asia that has been used for centuries as a natural stimulant and pain reliever. 

Banning each individual alkaloid has turned into a game of whack-a-mole, with drug manufacturers developing new exotic formulations of kratom alkaloids faster than the DEA can classify them as illegal drugs.

The latest example is speciociliatine, an “overlooked” kratom alkaloid and partial opioid agonist that metabolizes slowly in humans, which makes it more potent and potentially dangerous. Speciociliatine has not been scheduled by the DEA, although it could fall under state laws that broadly ban “total kratom alkaloids.” 

Because it is still legal at the federal level, at least two kratom vendors are now selling speciociliatine tablets.

American Shaman, which developed the first 7-OH products, is marketing lemon-flavored tablets containing 30mg of speciociliatine to foster “mental clarity” and “an uplifted mood throughout the day.” Consumers are cautioned to only use the tablets occasionally, “rather than as a daily habit.” 

Burman’s Health Shop is selling 200mg speciociliatine tablets, advising consumers to cut the tablets down into 50mg doses. The company is careful not to make any health claims, saying it is “unable to provide guidance on recreational effects, medical concerns, addiction, or controlled-substance comparisons.”

“Speciociliatine is a real problem. No doubt about it,” Haddow told PNN. “I think that that's manipulating the alkaloids to create a novel product for which there's not any evidence of safety.”

AMERICAN SHAMAN

Haddow says vendors selling speciociliatine and other novel kratom alkaloids are trying to stay a step ahead of DEA scheduling efforts, which is one reason the AKA recently threw its support behind the “End Gas Station Heroin Act,” a bill sponsored by Sen. Bernie Moreno (R-Ohio) and Rep. Lance Gooden (R-Texas).

In a recent statement, Gooden said the deaths of the two college students in Mississippi point to a need for legislation that would close loopholes allowing vendors to sell new more potent formulations of kratom alkaloids.

“Dangerous synthetic opioids powerful enough to fuel addiction and destroy lives should not be sitting on convenience store shelves next to snacks and energy drinks,” said Gooden. “My bill permanently schedules these drugs, closes loopholes, and targets the entities putting them into our communities.”      

The bill would essentially do the same thing the DEA is planning to do with 7-OH, but expands its enforcement powers to allow the agency to target manufacturers and distributors who introduce novel synthetic alkaloids before they are scheduled by the DEA. Consumers who purchase or use those products would be exempt from prosecution. Natural leaf kratom would also not be affected by the legislation.

Less Is More: It Doesn’t Take Much Exercise to Reduce Pain

By Pat Anson

It won’t cure you or make your pain go away, but moderate levels of exercise could give you some relief from acute and chronic pain, according to a new study by Australian researchers.

In a systematic review of 157 clinical trials, a research team at Adelaide University found that less than two hours of exercise a week could reduce pain by about 1.1 points on the zero-to-ten pain scale. In fact, exercise of low intensity and short duration appears to be more beneficial than longer, intense workouts.

“Our study found that exercise was associated with substantial reductions in acute and chronic pain across all forms of exercise – whether that be via aerobic or resistance exercise, or through gentler movement such as yoga, Pilates or tai chi,” lead author Ben Singh, PhD, a Research Fellow at Adelaide’s School of Allied Health and Human Performance, said in a press release.

“Importantly, we found that more exercise wasn’t necessarily better. In fact, shorter-duration and lower-intensity programs showed greater reductions in pain, suggesting people may not need to exercise harder or for longer to experience meaningful benefits.”

The study findings, published in the journal PAIN Reports, show the most significant reductions were for pain caused by these conditions:

• Axial spondylarthritis

• Cancer

• Musculoskeletal conditions

• Fibromyalgia

• Hip replacement

• Low back pain

• Migraine and headache

• Neck pain 

• Osteoarthritis

• Idiopathic pain in older adults

• Osteoporosis

• Menopause

• Pregnancy-related pain

• Primary dysmenorrhea

• Rheumatoid arthritis 

Low intensity workouts from tai chi, yoga and Pilates were beneficial, but the form of exercise that produced the largest reduction in pain was a bit of a surprise: Dancing.

That finding, however, is based on a single study of dancing by fibromyalgia patients and should be taken with caution. “Although dance-based interventions may offer promise for this population,” researchers say further studies are needed to prove the effect.

There are four key reasons why exercise has an analgesic effect.

First, exercise stimulates the release of endogenous hormones (endorphins), which act as natural painkillers and increase pain tolerance.

Second, exercise enhances the production of neurotransmitters such as serotonin and norepinephrine, which play crucial roles in mood and pain modulation.

Third, exercise reduces systemic inflammation, a common driver of chronic pain, by modulating immune system function.

Finally, exercise activates the body’s endocannabinoid system, which helps to modulate pain perception, mood, and inflammation.

“When we exercise, our body releases chemicals including endorphins and serotonin that can help reduce how strongly we feel pain and increase our pain tolerance,” Singh explained. “Additionally, it helps calm inflammation and change the way our brain responds to pain, while also improving mood.

“These effects help explain why exercise can be such a powerful tool for pain management. Yet despite the evidence, it isn’t used as routinely as it could be and is rarely prescribed with the same precision as medication.”

The idea that exercising less than 2 hours a week is more effective runs counter to many current exercise guidelines, which recommend 150 minutes or more per week. That amount can feel unattainable for many people with chronic pain. Shorter, less intense physical activity is more realistic and may help people overcome their resistance to exercise. 

“These findings support starting with manageable, lower-dose (exercise) programs to build confidence, promote adherence, and reduce fear of symptom flare-ups, key barriers for people with chronic pain,” researchers concluded. 

“Exercise should not be considered a universal solution or expected to eliminate pain entirely. Its efficacy will depend on individual factors such as the underlying pain condition, level of physical function, and adherence.” 

Why Peripheral Artery Disease Needs More Attention

By Matthew Ades, Anthony Sandre and Sonia Anand

Pain in your legs when you walk may seem like a normal part of getting older. But it can be a warning sign that the arteries carrying blood to your legs are becoming blocked: a condition called peripheral artery disease (PAD). 

If these blockages become severe, blood flow to the leg can suddenly be cut off, causing what is sometimes described as a “heart attack of the leg.”

The PAD burden is also not shared equally. People who smoke and have diabetes have the greatest risk of PAD, and it disproportionately affects those living on lower incomes, those in rural and remote communities, Indigenous Peoples and other under-served populations. 

That’s because these groups often face greater barriers to preventive care, diagnosis and vascular specialists, which — because of delayed care — results in worse outcomes, like amputation.

As physicians working in vascular medicine, we regularly care for people with PAD and see the consequences when the disease is recognized too late. Together with colleagues affiliated with the Canadian Society of Vascular Medicine and Prevention, we developed the Canadian National Action Plan for Peripheral Artery Disease, a road map for improving how we recognize, diagnose and treat this overlooked disease. 

The plan focuses on six areas: awareness, earlier diagnosis, better treatment and care pathways, Indigenous-led care, research and advocacy.

More Than Just Leg Pain 

PAD occurs when plaque builds up inside arteries and restricts blood flow, most commonly to the legs. It is part of the same disease process that causes heart attacks and many strokes.

One of its most common symptoms is discomfort, aching, cramping or fatigue in the leg muscles that occurs during walking and improves with rest. This is called claudication. But symptoms are not always typical, and some people have few or no symptoms.

This helps explain why PAD can go unnoticed. People may simply start walking less, avoid stairs and they or their front-line health-care professionals attribute their symptoms to arthritis or aging. The action plan identifies health literacy as an important issue: many patients do not realize PAD is a cardiovascular disease and may interpret their walking difficulties as a normal part of getting older.

That misunderstanding matters because PAD is not simply about leg pain. It is an important warning sign about a person’s overall cardiovascular health.

Why PAD Goes Undiagnosed

The lack of awareness of PAD extends beyond patients.

Despite its prevalence and clinical importance, PAD receives far less attention than heart disease and stroke. The action plan cites an estimate that Canadian medical students may receive only about 15 minutes of PAD-specific education during their training.

Diagnosis can also be challenging to access.

One of the simplest tests for PAD is measuring leg blood pressure using the ankle-brachial index, or ABI. It compares blood pressure measured at the ankle with blood pressure in the arm. A lower pressure in the leg can indicate narrowed arteries.

Yet access to this simple, non-invasive test varies widely across Canada, particularly in primary care. Canadian guidelines recommend ABI testing for appropriate high-risk patients, but its use remains limited.

The result is a disease that can remain undetected until it has progressed. A recent Canadian call to action highlighted that patients may not receive PAD care until late in their disease, when some already have limb-threatening complications.

Unequal Access to Diagnosis

Perhaps most concerning are the striking inequities in who develops PAD and who receives timely care.

Lower-income populations, Indigenous communities and people living in rural areas experience a disproportionate burden of PAD. Poverty, food insecurity, reduced access to preventive care, long distances to specialists and other structural barriers can all contribute.

For Indigenous people, these challenges are compounded by systemic inequities and the effects of colonial health systems. The action plan therefore calls for PAD strategies to be co-developed with Indigenous communities and under Indigenous leadership, including training community-health workers and supporting Indigenous-led mobile clinics that can bring screening and care closer to home.

Where someone lives or how much they earn should not determine whether vascular disease is recognized before they lose their mobility, or their limb.

A Roadmap for Change

The good news is that much of the harm associated with PAD is preventable. Once PAD is recognized, there are effective ways to reduce cardiovascular and limb complications. These include stopping smoking, controlling blood pressure, cholesterol and diabetes, taking appropriate low-cost medications and participating in regular walking exercise. For some people with more advanced disease, procedures to restore blood flow may also be necessary.

The challenge is getting evidence-based care to the people who need it most.

The Canadian National Action Plan for Peripheral Artery Disease proposes practical changes. These include:

• Increasing public and professional awareness

• Expanding access to ankle-pressure testing

• Bringing screening into rural and remote communities

• Using virtual consultations to connect patients with vascular specialists

• Improving access to supervised exercise programs

• Creating co-ordinated PAD care pathways

The plan also calls for multidisciplinary PAD centres that bring together medical treatment, diagnostic testing, vascular procedures and services supporting exercise, smoking cessation, wound care and other needs, rather than forcing patients to navigate a fragmented system. This builds on previous Canadian calls for PAD centres of excellence and team-based vascular care.

The goals are straightforward: Raise awareness, diagnose PAD earlier, prevent avoidable amputations and hospitalizations, preserve mobility and quality of life and make high-quality vascular care more equitable across Canada.

PAD should not be a disease that’s discovered only after someone develops a non-healing wound, loses a limb or suffers a heart attack or stroke.

Leg pain with walking deserves attention. Recognizing PAD earlier provides an opportunity not only to protect a person’s legs and mobility, but also to protect their heart, brain and life.

Matthew Ades, MD, is an Assistant Professor in the Division of General Internal Medicine at McGill University. He also serves as Director of the Cardiovascular Prevention Centre at the Jewish General Hospital.

Anthony Sandre, MD, is an an Assistant Professor in the Division of General Internal Medicine at McMaster University.

Sonia Anand, MD, is Associate Vice-President of Global Health at McMaster University. 

This article originally appeared in The Conversation and is republished with permission. 

Unexplained Chronic Pain Had Me Hoping for Cancer Diagnosis

By Crystal Lindell

Having chronic pain that can’t be diagnosed or explained will take you to some pretty messed up places mentally.

I had my first mammogram this week, and I have to confess something: Part of me was secretly hoping it came back positive for cancer.

It didn’t. I’m fine. Everything was normal.

But the chronic pain I have in my ribs is just a few centimeters under my right breast, so deep down, I was kind of, sort of, hoping that maybe the cause of the pain that’s plagued me for 13 years was actually a slow moving breast cancer the whole time.

I know it doesn’t make a lot of sense. But my pain also doesn’t make a lot of sense.

At least breast cancer would be treatable.

The official medical diagnosis for the pain in my ribs is “intercostal neuralgia,” which is literally just medical jargon that translates to “rib pain.”

Yes, the pain in my ribs is “rib pain.”

There is no cure for intercostal neuralgia. I’ve tried every possible treatment. So now I just manage it with a cocktail of substances ranging from morphine to Advil.

There’s also no official cause, at least not in my case.

The best theory my doctors have come up with is that it’s a delayed reaction to me having my gall bladder taken out in 2008. The only issue there is that I had my gall bladder taken out five years before the pain suddenly started in 2013.

Taking things one step further, the doctors believe I am more susceptible to intercostal neuralgia because I have hypermobile Ehlers-Danlos Syndrome (EDS). I got that diagnosis in 2018. And so far, that’s as close as I’ve come to anything tangible.

Yes, it was nice to finally have something more specific than “rib pain” to point to. At least there was some sort of underlying cause. 

Finally, my chronic, hard-to-manage, some-days-totally-debilitating pain was kind of, a little bit explained. EDS created the perfect environment for nerve damage to appear five years after my gall bladder surgery.

Fine. Yes. It’s probably that. They think.

None of the doctors will ever say that they know it’s that. It’s all just a theory. There’s no scan that shows intercostal neuralgia, no blood work panel. It’s just their best guess.

The thing is, the pain is so specifically located that I can point to exactly where it is. The best way I know to describe it is that it kind of feels like there’s a jagged marble lodged under my right breast. Sometimes, the marble moves around and ejects a knife further into my ribs, which causes the pain to radiate throughout my entire right torso.

It’s the kind of pain that really feels like it should be caused by something specific, something provable. Something that can be fixed, or at least treated. Something like cancer.

I know how messed up it is to hope for cancer. And I know that if I ever actually do get cancer, I will fully regret these thoughts.

To be honest, I thought my days of hoping the cancer test comes back positive were long gone. After I got the EDS diagnosis, I hoped I could finally just accept my chronic pain fate.

But when I opened my mammogram results on MyChart yesterday, a tinge of disappointment washed over me as I saw that everything was “normal.” 

I realized just how much I still longed for a more tangible diagnosis, and how much I still desperately wished my pain came with some sort of cure.

There is one major upside to all this though: At least I don’t have cancer.

Wearable Device Predicts Migraines With Over 90% Accuracy

By Pat Anson

Imagine what it would be like to know – with over 90% accuracy – that you’re going to have a migraine tomorrow.

You’d be able to plan ahead. Change your schedule. Get extra sleep. Stay hydrated. Avoid stress. And make a point of taking that migraine prevention drug that you often forget to take.

You may not be able to prevent tomorrow’s migraine, but you could reduce its severity and the impact it has on your life.

A wearable neuromodulation device called Nerivio makes that advance warning possible, according to a new study published in the journal Neurology. Sponsored by Theranica, the maker of Nerivio, the study is based on an analysis of data from over 53,000 people who used the device for nearly five years. 

Nerivio is worn on the upper arm and controlled by a smartphone app that uses mild electrical pulses during 45-minute treatments to disrupt migraine pain in the brain. The device also collects a lot of data from users, such as the frequency and severity of their migraines, aura and other symptoms, demographic data, and even the weather where they live.

Using machine learning and artificial intelligence, Nerivio’s Your Day Ahead feature uses data from the app to predict the likelihood of a migraine over the next 24 hours with 91.2% accuracy. The app doesn’t diagnose migraine, but it does help patients take control of their lives by enabling them to plan ahead for a migraine attack.

Migraine experts have known for decades that patients have certain tendencies that can signal a migraine may be coming. They might have an aura, mood changes, yawn more frequently, or have muscle stiffness. These are known as “prodromal” symptoms. 

But Theranica researchers found that those early warning signs contribute just 11% of Nerivio’s predictive performance. The stronger signal is the rolling average of a patient's headache severity over the preceding 30 days. It turns out those long-term headache patterns are more of a tell than the prodromal cues.

"What this analysis suggests, in the largest dataset reported to date, is that the strongest predictive signal isn't in that narrow pre-attack window. Instead, a patient's own recorded pattern of headache severity over the preceding month turns out to be the most informative signal in the model," said Chia-Chun Chiang, MD, Associate Professor of Neurology and a Headache Specialist at the Mayo Clinic. 

"That's a meaningful shift in how we think about forecasting migraine risk, and it matters for patients. Consistent, longitudinal patient-reported data isn't just a record of what's happened — it may be a window into what's likely to come next.”

Migraine affects about 39 million people in the United States and 1.1 billion worldwide. In addition to headache pain, migraine can cause nausea, blurriness, and sensitivity to light or sound. Women are three times more likely to suffer from migraines than men.   

The Nerivio device is FDA-approved for acute and/or preventive treatment of migraine in patients 8 years of age or older. Controlled by the user through the app, Nerivio provides relief during attacks and, when used regularly, helps reduce migraine frequency. The Your Day Ahead feature comes with the Nerivio app.

Nerivio is only available by prescription and is covered by many insurers. Commercially insured patients pay about $89 out-of-pocket for their first device and refills. Each device or refill kit provides 18 separate 45-minute treatments.

Without insurance, prices vary considerably, so it pays to shop around. WellRx charges $769 for a device, while UpScript charges $799 and Super.com charges $831.

Kratom and 7-OH Bans Create New Patients for Addiction Treatment

By Pat Anson

With dozens of states, cities and counties banning kratom and concentrated versions of the kratom alkaloid 7-OH, there are growing reports about people who use kratom products going into withdrawal and seeking addiction treatment. 

Those reports are likely to increase when the DEA classifies 7-OH products as illegal Schedule One controlled substances, which would effectively be a nationwide ban.

“Addiction clinics see rising cases of kratom and 7-OH withdrawal” is the headline of a recent STAT article.  

“Gas station kratom, an emerging addiction crisis in Montana,” warns an op/ed in the Independent Record.   

“Tennessee’s kratom ban brings wave of withdrawal patients to treatment centers,” reported NewsChannel5 in Nashville.

"We’re seeing more people seeking treatment from 7-hydroxymitragynine (7-OH) or kratom addiction than we do fentanyl addiction these days," said Dr. Chapman Sledge, who runs an addiction treatment center in Nashville.

But many of these reports about an “addiction crisis” and people needing treatment for kratom and/or 7-OH withdrawal are anecdotal. And there is little evidence that addiction treatment providers are being overwhelmed with new patients.

Millennium Health, a drug testing company that works with addiction treatment centers nationwide, says only 3.9% of its urine drug screens tested positive for kratom alkaloids in June 2026. That’s up marginally from the 3.1% that tested positive in 2025. 

“I don’t know that more clinicians are submitting urine samples with a request for testing for kratom. I don’t know that that’s the case. But you certainly see among those that are tested for kratom higher positivity rates,” says Eric Dawson, PharmD, Vice President of Clinical Affairs at Millennium Health. 

Kratom Alkaloids Detected in Urine Screens

MILLENNIUM HEALTH

By comparison, that 3.9% positivity rate for kratom alkaloids is well below the 13% that tested positive for fentanyl and the 11% positivity rate for stimulants. Only about 2% of urine screens for patients undergoing addiction treatment tested positive for prescription opioids, an all-time low.  

Kratom comes from the leaves of a tree that grows in Southeast Asia, where it has been used for centuries as a stimulant and pain reliever. The 7-OH alkaloid occurs naturally in kratom leaf in trace amounts, but manufacturers have developed ways to concentrate 7-OH in tablets, gummies and shots, making them potent pain relievers.

Estimates vary, but over 5 million Americans have used kratom in their lifetime. There are no reliable estimates for how many have used 7-OH products.

‘Kratom Use Disorder Isn’t a Diagnosis’

Robert Levy, MD, an addiction specialist in Minneapolis and past-president of the Minnesota Society of Addiction Medicine, says kratom use disorder varies depending on what part of the state patients are from.

“I think in the metro area there is some kratom and 7-OH use disorder, but mostly it's still fentanyl. Rurally, you're certainly seeing more of it, and in certain areas of Minnesota that's all that you will see is 7-OH kratom use disorder coming in,” Levy told PNN, adding that other substances are almost always involved when someone seeks treatment.

“Polysubstance use disorder is still the highest intake, so it's mostly stimulants and opioids together, or alcohol and opioids, or alcohol and stimulants. Those are the ones that are still king.”

Levy says many patients who use kratom or 7-OH don’t even bring it up during their initial consultations. They mention other drugs they use, but not kratom because many consider it a natural substance that won’t lead to addiction. 

“They tell me about other substances they use, but often don’t talk about kratom for whatever reason. Either they don’t view it as a problem or it's legal,” he said.

That makes it difficult to determine the true extent of 7-OH or kratom use disorder, terms that Levy is reluctant to use because there is no diagnostic code for them. 

“In medical parlance, that diagnosis doesn’t exist,” says Levy. “I think the people who come in and need treatment, I would call it opioid use disorder, because kratom use disorder isn’t a diagnosis.”

7-OH and mitragynine, the two most active ingredients in kratom, are alkaloids, not opioids. But because they act on opioid receptors in the brain and have opioid-like effects, the medical establishment often calls them opioids.    

That makes it possible to check the “opioid-use disorder” box on diagnostic forms, making a visit from a patient who uses kratom a billable event for insurance purposes. It also makes it easier for a provider to prescribe Suboxone or methadone off-label, medications that are used to treat opioid addiction.    

Many patients going through kratom withdrawal say the symptoms are mild, not unlike someone trying to give up coffee. Others say it’s the worst withdrawal they’ve ever experienced. A lot depends on the amount of kratom or 7-OH that someone has been taking.

Addiction specialists say Suboxone (buprenorphine) should only be prescribed when a kratom user is going through severe withdrawal and needs help. There are no high-quality clinical studies of Suboxone for kratom or 7-OH dependence, only anecdotal reports and case studies. 

For a kratom or 7-OH user with little or no prior history of using opioids, buprenorphine presents a problem of its own. As an opioid itself, buprenorphine can create opioid dependence – in effect exchanging one addiction for another – and resulting in a lifetime of Suboxone use.

Nevertheless, despite the risks and a lack of evidence, prescribing Suboxone has become the de facto treatment for kratom and 7-OH withdrawal. According to STAT, nearly a third of the new patients prescribed Suboxone last month by a telehealth addiction clinic were using kratom or 7-OH.

“That really is quite an explosion,” Ayesha Appa, MD,  Head of Medical Affairs at Boulder Care told STAT. “I think we’re really seeing and feeling what happens when people lose access and need to seek care in unprecedented numbers.”         

“An increasing number of addiction specialists are winding up having to treat patients who've been using kratom with buprenorphine,” said Andrew Kolodny, MD, President of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group. “I've had to prescribe buprenorphine as well for some of these patients.

“Ideally, not everyone who's addicted to kratom is going to need to be treated with buprenorphine, but certainly there appears to be a substantial subset of people addicted to kratom with severe opioid use disorder who are winding up on the same treatment that we use for these other opioids.”

Unintended Consequences

Kolodny recently began practicing addiction medicine again, after taking a hiatus to testify as a paid expert witness in opioid litigation cases. He said during a recent webinar that he sees similarities to the early years of the opioid crisis. 

“We don't have good surveillance data on addiction involving kratom yet, but I believe that as kratom consumption is going up, we're seeing an increase in addiction involving kratom,” Kolodny claimed. 

“This is what happened with the prescription opioid crisis. As prescription opioid consumption exploded because doctors were massively overprescribing, it led to an epidemic of opioid addiction and deaths, and to the opioid crisis. And I believe that what we're looking at here is happening with kratom today.” 

There were many unintended consequences for patients due to the crackdown on opioids, including untreated pain, abrupt tapers, withdrawal, and suicides. Drug cartels also began mass-producing counterfeit oxycodone and other medications laced with fentanyl after access to prescription opioids was reduced.

Those same unintended consequences are reappearing as kratom and 7-OH products become harder to get. 

In Maryland, where 7-OH was banned in July, state health officials say illicit 7-OH products are already appearing on the black market.  

“Typically, when substances are regulated, like the banning of 7-OH sales in Maryland, it causes dysregulation in the unregulated drug market,” they wrote in a quarterly newsletter on Maryland’s illicit drug supply. 

What have they seen so far? Three illicit 7-OH products have been found in Maryland so far this year. One contained only 7-OH. The other two were laced with fentanyl, a veterinary sedative, and methamphetamine.  

Meanwhile, in Connecticut, which banned kratom and 7-OH products in March, two employees of a smoke shop have been arrested for selling cannabis gummies laced with 7-OH and pseudoindoxyl, a potent semi-synthetic kratom alkaloid. At least one customer who consumed the gummy had "a severe adverse reaction," according to police.