Doctors Increasingly Mention Kratom in Patient Notes

By Crystal Lindell

Kratom is a hot topic these days, as states and local governments scramble to enact bans on the sale of kratom or put age limits on who can purchase the controversial herbal supplement.

Kratom is also being talked about more in hospital settings, according to a new study published in JAMA Network Open.

The study looked at how often the word “kratom” was mentioned in clinical notes after an emergency department visit or hospitalization at Mass General Brigham (MGB), a large healthcare system based in Massachusetts. 

Researchers looked at patient records between 2017 and 2024, and found a steady increase in kratom being mentioned, both in the ER and in the hospital – about 15% a year in the case of hospitalizations. 

Mentions of “Kratom” in Patient Notes

JAMA NETWORK OPEN

Researchers did not analyze the context under which kratom was mentioned, only that that word “kratom” was included in the clinical notes. Whether or not kratom caused a health problem for patients was not studied.

But that didn’t stop researchers from sounding the alarm about the growing use of kratom and its potent alkaloid, 7-hydroxymitragynine (7-OH). 

“Clinicians should routinely inquire about kratom use and inform patients of its risks and benefits. While additional research on kratom’s therapeutic potential may be warranted, a focus on the serious adverse effect profile from kratom, 7-hydroxymitragynine, and other kratom alkaloids is urgently needed,” wrote lead author Anika Kopczynski, a clinical researcher at Brigham and Women’s Hospital..

Researchers found that doctors who mentioned kratom in their patient notes were mostly treating white males between the ages of 20 and 49. 

Kratom has been used for centuries in Southeast Asia as a natural stimulant and pain reliever, but its use in the United States is relatively new. Estimates on the number of Americans who have used kratom vary widely, from 1.7 million to as many as 20 million.

“The significant increase of encounters with kratom mentioned in our health care system indicates a need for greater clinical awareness,”  said Kopczynski.

Kratom has not been approved by the FDA for any medical condition, and health officials say it has opioid-like effects that can lead to addiction and overdoses. The evidence supporting those claims is thin however, as most of the overdoses involve other substances. 

While “greater clinical awareness” of kratom and 7-OH is probably a good idea, it’s unclear what advice healthcare providers should give to patients about kratom’s “risks and benefits.”  

Should they tell them kratom is “gas station heroin” – as it is often depicted in the media? 

Or should they say it is “safe and well tolerated” with “no evidence of meaningful abuse potential,” as a recent study found?  

The gap between those two conclusions is likely to confuse both patients and doctors, and lead to less discussion, not more.

Unfortunately, opioid-phobia has turned many patient-doctor appointments into something closer to a visit with a probation officer. And the last thing you want to tell your probation officer about is additional substance use. 

Pain sufferers are rightly worried that anything they say will be used against them, and cited as a reason to reduce or even eliminate opioid prescriptions. Even non-opioid patients have a right to be worried about discussing kratom, because they won’t know how that information will be perceived or used. 

So it’s a little short-sighted to advise clinicians to ask patients about their kratom use, without also noting how uncomfortable patients may be with that line of questioning. 

While I have long called for more research into kratom, the predictable focus on its “serious adverse effect profile” is frustrating. I would argue that research into kratom’s potential benefits is needed just as urgently.

Clearly there’s a need for more education about kratom for medical professionals, but my hope is that some of that education is based on research into actual patient experiences.   

U.S. Overdose Deaths Down Significantly

By Pat Anson

The number of fatal drug overdoses fell sharply in the U.S. in 2024, led by a significant decline in deaths involving illicit fentanyl, according to a new analysis.

Over 79,000 Americans lost their lives to a drug overdose in 2024, compared to 105,000 in 2023, a 24.5% decline in one year. Over 54,000 of the deaths in 2024 involved an opioid of some kind. 

The analysis by KFF further demonstrates the declining role of prescription opioids in the nation’s drug crisis. Prescribed opioids are now involved in about one in seven (13.6%) drug overdoses. 

In 2024, 10,851 Americans died from an overdose involving a natural or semi-synthethic prescription opioid, compared to 47,735 deaths involving synthetic opioids, mostly illicit fentanyl. 

Deaths from prescription opioids peaked at 17,029 in 2017 and have steadily declined.

U.S. Opioid Overdose Deaths 2004-2024

SOURCE: KFF

“Since the opioid epidemic was declared a public health emergency in 2017, it has claimed more than half a million lives. While the epidemic was initially driven by prescription opioids and heroin, it has evolved in recent years, to be dominated by illicit synthetic fentanyl — a substance significantly more potent than morphine,” KFF said. “Provisional CDC data suggest opioid deaths have continued to decline through 2025.”

The KFF analysis also looked at deaths involving alcohol, suicide and firearms.

In 2024, 48,824 American lives were lost to suicide, down slightly from the previous year. Firearms accounted for 57% of those deaths. There were 46,714 “alcohol-induced” deaths in 2024 caused by health conditions attributed to excessive alcohol use, about the same number of fentanyl overdoses.

Those deaths greatly outnumber fatal overdoses involving prescription opioids.

U.S. Deaths in 2024

Source: KFF

As PNN has reported, a recent study ranked alcohol as the 5th most harmful drug In the United States, behind illicit fentanyl, methamphetamine, crack and heroin. Prescription opioids ranked as the 7th most harmful drug in the U.S.

The analysis not only looked at the direct harm to drug users, but the indirect harm to families, communities and society at large caused by excessive drug use.

A panel of experts said the analysis shows how misdirected U.S. drug policy is, which is focused on crime and punitive measures to stop drug use, rather than public health measures to address substance use disorders. Criminalizing drug use may also be making the drug crisis worse, by taking legal drugs away from people who benefit from them.   

“All drugs have benefits to people who use them at least initially, and some may have ongoing benefits. For legal drugs, there may be social benefits like employment in related industries and taxation to fund public services,” wrote lead author Michael Broman, PhD, an Assistant Professor at The Ohio State University College of Social Work.

“Redirecting resources towards harm reduction may reduce social harms by reducing the economic cost of policing and surveilling people who use drugs. Concurrently, PWUD (people who use drugs) could remain contributing members of their families and communities.”

Reflecting on 13 Years of Chronic Pain

By Crystal Lindell

I first developed chronic pain in February 2013. I remember the month because it was Super Bowl weekend and I went to a party to watch the game.

That was the year they had a long blackout delay, so the game ended up running super late. I stayed until the end.

I woke up the next morning with some soreness in my right ribs, and I assumed that I must have just lifted something wrong at some point. It got so bad I went to the ER.

While I had no idea at the time, my life was changed forever that weekend.

I was 29.

Within six months I was celebrating my 30th birthday at my new place: my mom’s house.

I had moved back home, an hour and a half away from my old apartment. I quit my second job, and shifted my full-time job to mostly work-from-home.

I spent the next few years desperately seeking answers, while trying to figure out a medication regimen that actually worked for me.

I also got extremely depressed.

I watched the entire TV series House, hoping to find an episode about a patient with the same symptoms as mine. I never did.

I mostly lingered without a diagnosis.

Eventually, the doctors decided to call it “intercostal neuralgia.” But that basically just meant “rib pain.” And how it had happened or why, they had no clue. They also had no idea how to treat it beyond managing the pain.

My long-term boyfriend – the one I had been with long before I got sick -- cheated on me. We broke up.

I cried a lot. I cried because my heart was broken, but also because my body was broken. I cried because of the physical pain, and I cried because of the emotional pain.

Then, finally, on March 15, 2018, I was diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS). I remember the date because it was the Ides of March. And the day felt just as ominous to me as I imagine it was for Julius Caesar.

A moment I had long hoped for, one where I finally got some answers, instead turned to extreme grief.  

But that night, I went to a local political event in town and ran into this guy I knew named Chris. A week later we went on a date to see the movie Black Panther, and we have been together ever since.

In fact, we are celebrating our eight-year anniversary this Sunday.

At the time of my hEDS diagnosis, I was so worried that I would never find a man who could love my broken body. But within just a few hours, I was proven wrong.

Lessons Learned

Over the last 13 years of life with chronic pain, I have learned that I was wrong about a lot of things. As it turns out, pain is an extremely strict, rigid teacher. 

I used to believe the government messaging that “all opioids are always bad for you.” But these days I now advocate for patient access to opioid pain medication.

I used to think that if you told a doctor your exact symptoms, that they would be able to find out what was wrong with you and be able to fix it. 

Now I know that if you want to get treated, you have to be your own biggest advocate.

I also honestly believed that I had good health insurance. I truly did think it would cover most of my medical expenses if I ever got sick. 

But after drowning in medical bills for more than a decade, I have come to realize that the only people who like their health insurance are the ones who never need to use it.

I also thought my ex-boyfriend and I could get through anything together. Clearly, that was not the case.

I assumed that my friends would be sympathetic with what I was going through. But in the end, chronic pain left me with a much smaller circle of loved ones. 

I also like to think that chronic pain has made me a more empathetic person. When I meet other people in pain, I do my best to show them empathy and to give them realistic advice that could actually help them.

Today, over a decade since I first woke up with chronic pain, it’s difficult to envision what my life would have been like if I had never gotten sick. 

So many of my life choices have revolved around my pain – from who I live with, to who I love, and to what I do for work.

To be completely honest, I like my life right now. Yes, I wish that I didn’t have to arrange my entire day around my physical pain. But I love what I do, I love the people I spend my days with, and I am content.  

I think that, in a lot of ways, chronic pain forced a contented life onto me. It forced me to evaluate everything I did, to see if it was actually necessary and if it was actually worthy of my time and energy. What was left was only the best parts. 

It is noteworthy that my pain is pretty well managed these days, at least compared to how bad it was in 2013. I still have bad flares, but for the most part, my medications help me get through the day. 

Looking back, there are so many dark nights in my past where I felt like the best choice was to just give up. So many painful hours in bed where I genuinely considered killing myself. 

But now, after 13 years of this life with chronic pain, I am so relieved that I decided to keep living it.

Low Vitamin D Levels Linked to Chronic Low Back Pain

By Pat Anson

Low levels of Vitamin D are a leading cause of disability worldwide and have been associated with fibromyalgia, rheumatoid arthritis, migraines, and musculoskeletal problems. 

A new study in India suggests the “sunshine vitamin” may also play a role in the development of chronic low back pain.

Researchers at a teaching hospital in eastern India took blood samples from 75 adult patients with chronic low back pain and found a remarkably high rate of low vitamin D serum levels – a condition known as hypovitaminosis D.

Over two-thirds of the patients (69.3%) had “deficient” levels of Vitamin D, while the remaining ones had serum levels that were below normal and considered “insufficient.” 

“Notably, none of the participants had sufficient serum vitamin D levels. These findings are in agreement with existing literature reporting a high prevalence of hypovitaminosis D in the Indian population, even in regions with adequate sunlight exposure,” wrote lead author SK Imran Ali, MD, an orthopaedic surgeon at Dr. Bidhan Chandra Roy Hospital in Haldia. 

Ultraviolet rays in sunlight are the principal source of Vitamin D for most people. India usually gets a significant amount of sunshine, especially from October to May, so why would Vitamin D levels be so low?

Vitamin D deficiency rates on the Indian subcontinent range from 50% to as high as 95%, a phenomenon attributed to darker skin pigmentation, poor diets, and increasingly sedentary (indoor) lifestyles with little sun exposure.

While researchers found an association between chronic low back pain and hypovitaminosis D, they did not establish a causal link. Pain severity and disability levels were about equal between the “deficient” and “insufficient” groups, and between men and women.

Researchers did find that patients from lower socioeconomic classes were statistically more likely to have inadequate Vitamin D levels compared to those in the upper class.

“This observation aligns with existing evidence indicating that socioeconomic factors influence nutritional status, sun exposure, dietary quality, and access to healthcare services, all of which may affect vitamin D levels,” researchers found. “Individuals from lower socioeconomic backgrounds may have limited access to vitamin D-rich foods, reduced opportunities for outdoor activity, and decreased healthcare access, thereby increasing the risk of hypovitaminosis D.”  

In addition to sunshine, you can increase your Vitamin D levels by eating oily fish and eggs. Vitamin D has a wide range of positive health effects, such as strengthening bones and teeth, and inhibiting the growth of some cancers. Vitamin D also improves immune function and reduces inflammation.

I Am Being Forced Off Oxycodone in the Name of Opioid Rotation

By Neen Monty

The current myth in opioid science is that buprenorphine is inherently safer than oxycodone.

The truth is far more ordinary: it depends on the individual. Some people do better on buprenorphine. Others do better on oxycodone. There is no universal “safer” opioid for every patient.

I have trialed buprenorphine before. It was profoundly sedating. I could not function on it.

Despite this, I was required to trial it again.

Here’s what happened.

Week One: Hope

The first few days were incredible.

Less pain.

More functional hours.

And I was sleeping until 5am!

I was thrilled to be wrong about buprenorphine. I ignored the severe nausea and the nagging headache because I could go back to the archery range. I started planning a fitness routine. I allowed myself to feel hopeful.

Week Two: Wearing Down

The nausea intensified. Even with ondansetron (Zofran), it was relentless.

The headache persisted. Not dark-room migraine territory, but just constant enough to make thinking difficult.

Panadol. Nurofen. Naproxen. Nothing touched it.

I also realised my mood had shifted. I felt low. Irritable. Short-tempered. Sad. Defeated.

I controlled it. I always do. I don’t take out my moods on others. My children didn’t see it. They saw normal. They did not see the enormous effort it took for me to stay calm and reasonable. 

The crying happened in the one private space I have: the bathroom. The sadness stayed hidden.

Week Three: Something Was Wrong

By week three, I was done.

My pain doctor told me to persevere. I did, as long as I could. At the end of week three, I ripped the buprenorphine patch off and did not apply the next one.

Enough was enough.

Within four days the nausea was gone.

The headache was gone.

I could think again. I could function again.

You never realise how severe something is until it stops.

Why did I tolerate it for so long? Because if I am labelled “non-compliant,” if I am judged not to be trying hard enough, I risk being forcibly tapered off all opioid medication.

And that would be catastrophic for me.

So, I tried.

Positive attitude! Yes, Doctor. I will trial it. With a smile on my face.

But I cannot continue with buprenorphine.

Next: Palexia

Now the rotation moves to another opioid: Palexia (tapentadol).

Doctors have been convinced that these newer opioids are “safer” than oxycodone. There is no high-quality evidence showing they are safer for stable, long-term chronic pain patients. But the safety narrative has been repeated so often, it is treated as fact.

Palexia is now the most commonly prescribed opioid in Australia. It has overtaken oxycodone. This did not happen because Palexia offers improved pain control. Or because it has fewer side effects. Or because it’s safer.

It happened because doctors were encouraged — in some cases pressured — to rotate patients off their “old school” opioids, to “atypical opioids” like Palexia, buprenorphine, and even tramadol.

A patient’s preference is no longer central. Being stable on a dose is no longer enough.

Opioid rotation is being enforced on me for two reasons.

First, because policies and guidelines position buprenorphine and tapentadol as the “safest” opioids. This is not evidence based; it is opinion.

Second, because I am not getting enough pain relief from my current regimen. My 20mg of oxycodone stops working after 6-8 hours, when it should last 12 hours.

The obvious solution is to prescribe it every 8 hours, instead of every 12 hours. That’s what happened in the past and was the standard of care. Because it is well recognised that the 12-hour formula rarely lasts 12 hours. 

But that would put me over the arbitrary daily dose ceiling of 100 MME. Which is also not evidence based. 

What is evidence based is that I was happier, healthier, fitter and more functional on 120 MME, rather than 100 MME.

But my well-being, pain control and function are not the important issues here.

Instead of the simple and obvious solution, the only solution is opioid rotation. The theory being that I have built up tolerance to oxycodone, but I have not built up tolerance to buprenorphine or tapentadol. So those medications will supposedly work better for me.

Except that’s not how it works in the real world.

Pain relief is not the goal here. It’s just not that important. It’s a money-making policy masquerading as “safety.”

Follow the money if you want to understand rapid prescribing shifts. Pharmaceutical policy rarely moves without financial incentive.

But here is the uncomfortable truth: My GP is not corrupt. She is not malicious. She is a very good GP. She is following guidelines.

She does not have time to audit every citation behind every recommendation on every guideline for every condition she treats. She has to trust her medical college, her training, and the documents placed in front of her.

That trust is not deserved. At least when it comes to treating chronic pain.

The current Australian guidelines are built on expert opinion, not randomised controlled trials. Opinion, layered over selective and cherry-picked evidence. Shaped heavily by academic pharmacology and population-level policy concerns. Not patient outcomes, preference, function or stability.

And patients like me pay the price.

A Four-Week Pause

I told my GP I cannot continue buprenorphine.

She immediately began discussing Palexia.

I asked for four weeks. Just four weeks to stabilise. I am only just beginning to feel like myself again. I am only just becoming functional again. I just lost four weeks of my life to the last rotation attempt. I don’t feel ready to tackle the next medication yet.

I need to take a breath. I need to get back to “normal.” Albeit my normal.

This rotation destabilised me. Made me far worse, not better. 

Also, it would make medical sense to start the next medication from a steady baseline, not during biochemical and emotional turbulence.

She agreed. Very readily. I didn’t have to argue my case. I very much appreciate that. She prescribed my usual regimen of oxycodone extended release and immediate release.

So, for four weeks, I remain on oxycodone. For four weeks, I will stabilise. And feel like myself again.

After that, the forced rotation begins again. I have trialed Palexia before, a few years ago. It did not go well. But still, I am being forced to trial it again.

Round and round.

None of this is my choice.

None of this is evidence based.

None of this is for my benefit.

The Systemic Problem

This is not just about me.

Patient choice has been steadily displaced by policy-driven prescribing. Stability is no longer considered sufficient. Long-term patients who are functioning are being told their medication is “unsafe.” Not because of their individual outcomes, but because of population-level risk narratives built on low-quality evidence and relative risk framing.

Meanwhile, newer opioids are positioned as “safer” without robust comparative long-term data in stable chronic pain populations. 

When prescribing patterns shift this dramatically and this quickly, it is reasonable to ask whether evidence alone is driving the change.

Medicine should be individualised. Instead, it is being standardised around risk optics, regulatory anxiety, and market forces.

And patients bear the instability.

Yes, some patients can safely be rotated, with no adverse events. But not all patients.

A large percentage are objectively and substantially worse off. But this does not matter. Patient satisfaction, patient function, pain relief are all secondary concerns. Often not considered at all. Or, if acknowledged, are dismissed as the patient being difficult or non-compliant.

Patients no longer have any agency, any choice, any control, or even a voice.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. For more information on chronic pain, the science, the politics and the lived experience, got to Pain Patient Advocacy Australia. You can also subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

More Kids Are Going to ERs for Dental Pain

By Farrell Brenner and Angela Y. Zhang, KFF Health News

Eight-year-old Jonah woke up one May morning with a swollen face and a toothache. He refused the pain medication that his mom, Geneva Reynolds, tried to give him. He didn’t sleep or eat and cried constantly.

Within a few days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, dumping pain medication down his throat as he screamed in pain.

“It broke our hearts,” said Reynolds, who lived in Georgetown, Kentucky, at the time. “And I remember just thinking that it shouldn’t have to come to that.”

JONAH REYNOLDS

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety.

Over the course of five days, Reynolds took Jonah twice to a nearby emergency room as he struggled with persistent pain and a fever due to a likely infected tooth with an exposed nerve.

The ER had no dentists; both times, the family was sent home with only pain medication and an ice pack.

Across the nation, more children are entering ERs for preventable tooth problems. Dentists, hygienists, and researchers attributed that trend to a shortage of pediatric dental care professionals in rural areas and worsening oral hygiene since the covid-19 pandemic. 

Tens of thousands of kids end up in the hospital for dental emergencies each year, according to Melissa Burroughs, senior director of policy and advocacy at the national health nonprofit CareQuest Institute for Oral Health.

ER visits for tooth problems unrelated to physical injuries rose almost 60% nationally for children under 15 years old from 2019 to 2022, according to a report released late last year by CareQuest. 

And local data reflects that national trend: At Children’s Hospital Colorado in the Denver area, nontraumatic dental cases, such as cavities or gum infections, in its ER increased 175% from 2010 to 2025, according to hospital spokesperson Sarah Bonar. In Kentucky, where Jonah lives, children’s visits to the ER for dental problems rose 72% from 2020 to 2024, according to the state.

Policy changes under the Trump administration are poised to worsen the trend. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, called for billions in cuts from Medicaid, which may force states to limit or drop dental coverage from the public insurance program for those with low incomes or disabilities. 

New eligibility requirements for Medicaid in some states could affect kids’ access to dental care, even though children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even kids with coverage are more likely to have untreated cavities and less likely to go to a dentist.

The Trump administration has also promoted skepticism about fluoride. Decades of research show that fluoride in drinking water and topical fluoride treatments dramatically reduce tooth decay and prevent cavities. 

In recent months, the Food and Drug Administration warned health professionals against the use of fluoride supplements and the Environmental Protection Agency released an assessment of “potential health risks of fluoride in drinking water.” 

Health and Human Services Secretary Robert F. Kennedy Jr. has called fluoride a “neurotoxin” and “industrial waste.” A 2025 study in JAMA Pediatrics linked high levels of fluoride with lower IQ in children — but only at concentrations far exceeding the recommended level in public drinking water.

Donald Chi, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode trust in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills prohibiting or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to enact fluoride bans.

“Will that have an effect on cavity rates?” Chi asked. “Absolutely.”

Severe Dental Cases Rise

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases have become more common, too. Puranik said he used to typically see patients with only one cavity, but now his patients are often coming in with tooth decay throughout their mouth.

During the pandemic, many dental offices closed temporarily, and studies show children also increased their sugar intake, a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect children’s developing jaws, sometimes causing long-term problems with talking or sleeping.

Millions of people live in dental care shortage areas in the U.S., with scant dentists within driving distance. On top of that, only 1 in 3 dentists treat Medicaid patients, due to low reimbursement rates, which are on average less than 40% of their typical dental charges, according to the American Dental Association.

Children with intellectual or developmental disabilities may especially struggle to access quality dental care. Few general dentists have sufficient pediatric training to care for kids with disabilities such as Jonah, who are easily overwhelmed or need to be sedated for an exam, according to KFF, a health information nonprofit that includes KFF Health News. 

Over 26% of children have special health care needs, and those children are twice as likely to have unmet dental needs. Their parents are also more likely to report challenges finding a dentist.

When he was younger, Jonah would not let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the ER, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist did not know how to examine Jonah in a way he could tolerate and wasn’t prepared to provide sedation. Jonah left without treatment and was soon back in the ER when his fever returned.

ERs Rarely Provide Solutions

Bradley Weitz, a pediatrician in Washington County, Maine, said he is fielding “the most horrifying cavities” at Down East Community Hospital.

ERs are often ill-equipped to treat dental concerns, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on staff. Weitz often finds himself prescribing antibiotics as a temporary measure.

“But a month later, they’re back again because it’s flaring up again,” Weitz said.

As a potential solution, states such as Maine and Alaska are proposing to use money from the $50 billion Rural Health Transformation Program to develop the oral health workforce or to create specialized dental care centers, which can better serve children with special health care needs on short notice. 

But those initiatives won’t address the loss of coverage anticipated from Medicaid cuts. California last year awarded $47 million in state grants to develop or expand over 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work from her job as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket costs.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went poorly, she said. When Jonah became upset over a needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis of what caused Jonah’s pain. 

The procedure did resolve his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to the families. Four years later, forcing Jonah to take his pain meds still lives fresh in her memory.

KFF Health News is a national newsroom that produces in-depth journalism about health issues.

Why I Recommend Living with Family if You Have Chronic Pain

By Crystal Lindell

Last summer my fiancé and I moved in with my mom, my grandma, and my brother. Essentially, I was moving back home – and truth be told, I felt like a failure.

I hadn’t been able to find full-time work after being laid off in 2022, and the bills were just getting to be too much. Actually, let me be more accurate. It’s not that I couldn’t find full-time work, it’s more that I hadn’t been able to bring myself to go back to a corporate job while dealing with burnout and chronic pain.

And so, we made the hard choice to move in with my family in hopes of saving some money and getting our bearings.

Almost every day, we all disagree. There are debates over who needs to do the dishes; discussions about how often the bathroom needs to be cleaned; and lots of arguments about someone in the house being too loud when someone else in the house wants quiet.

Yet, even with all that, my only regret is that we didn’t move in here sooner.

In the United States, it’s still often culturally frowned upon to move back home. It’s often framed as a failure to be an adult living with your parents, regardless of the circumstances. But for most of human history, living with family wasn’t just accepted practice, it was the norm. 

And if you have chronic pain, living with family could be exactly what you need, if that’s an option for you. Especially if stigma is the only thing holding you back.

There are so many practical reasons that it just makes sense to live with family if you have a chronic illness.

First and foremost, chronic pain is expensive in so many ways. There are medical bills, reduced ability to work, and all the convenience fees you have to pay for services because you can’t just go out and do it yourself. Living with family almost always makes life cheaper.

But chronic pain is also draining. And living with family helps fend off the depression that creeps in on bad pain days. Even more so during bad pain months.

It’s hard to wallow in my room all day when someone in the house is always checking on me, keeping me in conversation, and wanting to hang out.

Yes, it can be frustrating to have arguments about who is responsible for vacuuming the hallway, and whether or not we can put the couch on the left side of the living room. But that frustration is more than countered by the benefits of living with family.

If you are at a place where dealing with chronic pain is just draining all the life out of you, then I would highly recommend moving in with relatives, if you can. 

And if you love someone with chronic pain, an invitation to live with you could be the thing that saves their life. 

Every Chronic Pain Patient Should Have Their Hormone Levels Tested

By Dr. Forest Tennant

Periodic hormone panel testing should be a standard procedure in chronic pain care. Why? Some specific hormones are essential for pain control and others for healing and restoration of damaged tissues. 

Unfortunately, both chronic pain and opioid medications can suppress hormones, which the body needs for pain control and tissue healing. Nerve receptors in the brain that control pain, such as the opioid/endorphin, dopamine, GABA, and serotonin receptors, use hormones as energizers – the same way gas is needed to fuel your car. 

One of the first signs that your hormone levels are deficient — and that you’re running out of gas —- is when your pain relief medication seems to be losing its effectiveness. If that is the case, hormone panel testing should be performed and hormone replacement may be necessary. 

Six hormones that you should test for:

• Pregnenolone

• Progesterone

• Dehydroepiandrosterone (DHEA)

• Estradiol

• Testosterone

• Cortisol

Opioids can suppress all of these hormones. Long-acting opioids like oxycodone, morphine, methadone, fentanyl patches, and intrathecal opioids are the worst.

Short-acting opioids like hydrocodone and hydromorphone are less disruptive, because they do not constantly remain in the blood, so they give the pituitary and other hormone-producing glands time to recover. 

Long-acting opioids constantly suppress the pituitary and other glands. Consequently, any person who takes a long-acting opioid needs hormone panel testing at least every 6 months. All deficiencies must be replenished.

Hormone Therapies

Given the importance of hormone testing and hormone replacement therapy, I recently published a new book, “Hormone Therapies in Chronic Pain Care.”

I wrote the book because I strongly believe it is time to incorporate hormonal therapies into the care of essentially every chronic pain patient.  

Despite an imperfect pain care system that admittedly has some supply, regulation, and financial issues, modern pain management has achieved great success.  

Recently developed medications, physical therapies, and surgical procedures have brought pain relief and recovery to millions around the world.  Hormones can and will build on this foundation. 

The book is designed to help both medical practitioners and patients identify hormone therapies that can improve their current treatment. You can’t control pain or acquire healing and restoration with deficient hormone levels.

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to its research bulletins here.   

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section. 

Today’s Wounded Troops Are Tomorrow’s Chronic Pain Patients

By Crystal Lindell

This week Reuters reported that as many as 150 U.S.troops have been wounded so far in the War on Iran. Of those, eight were seriously injured.

That’s in addition to the 7 U.S. service members who have been killed in the conflict, which started less than two weeks ago.

Those numbers will continue to rise the longer the war drags on.

It can feel tempting to dismiss wounded soldiers as no big deal, and that’s how the Pentagon is framing it, saying the vast majority of injuries are minor and that 108 of the wounded had already returned to duty.

But many of those who get wounded in conflict zones will experience life-long symptoms, including chronic pain, post-traumatic stress disorder (PTSD) and traumatic brain ​injuries, which are common after exposure to blasts.

According to the National Institutes of Health, about two-thirds of U.S. veterans (65.6%) have  chronic pain, and one in ten (9.1%) live with severe chronic pain. 

Of course, it’s not just U.S. troops who are casualties in the war. Estimates vary, but about 1,200 Iranians have died, 28 Israelis and nearly 600 in Lebanon. The number of injured is well into the thousands.

Even if the war ends tomorrow, its effects will likely linger for generations. Living with chronic pain can impact your life until you die — and enduring it can impact everyone around you, including your children.

It can make you more short-tempered, less productive, and more depressed. It can make you harder to live with emotionally, and harder to live with logistically because you need extra care.

I doubt most of the wounded understand the ramifications. I don’t blame them. It’s almost impossible to understand chronic pain until you suffer through it yourself.

But as a chronic pain patient, I know what their future holds.

It’s years, even decades, of dealing with dismissive doctors; fighting for pain medication; and spending your days and nights in bed because it hurts too much to move.

I think, if they truly understood, many members of the military would tell you it’s not worth it.  

A recent report from the Department of Veterans Affairs found that 6,398 U.S. veterans died by suicide in 2023. While that’s down slightly from 2022, the veteran suicide rate actually increased to 35.2 deaths per 100,000 veterans. That’s about twice the suicide rate of civilians.

It averages out to over 17 suicides by veterans each day. Most of them probably suffered from chronic pain.

It’s easy to skim past headlines about the number of people wounded in the War on Iran. But for the people who are enduring it, and those who love them, nothing about their future will likely be easy.

PEA: A Supplement That Helps Reduce Pain and Inflammation

By Julie Titone

It is a question I’ve long had but never bothered to look up: How do drugs get their names? Then I heard about palmitoylethanolamide and, given it has the longest name of anything I ever considered consuming, I had a solid reason to pursue the question.

PEA, as the tongue-twister is unsurprisingly known, isn’t a prescription drug. It’s a fatty acid found naturally in our bodies and in some foods. PEA can also be manufactured and is sold in over-the-counter supplements. It binds to cells in the body and reduces inflammation and pain.

When a fellow arachnoiditis sufferer called it to my attention, I read up on it.

PEA was first identified in the 1950s, after doctors observed that children who ate eggs were less likely to get rheumatic fever. Early studies found PEA not only in the fatty solids of egg yolks, but also in components of peanuts and soybean lecithin.

Researchers found that the compound had anti-inflammatory effects in animal models, and noticed it could also reduce allergic reactions. That lead to early clinical trials for conditions like influenza and the common cold.

Interest in PEA then dropped off for two decades. It was revived again thanks in large part to Nobel Prize-winning neurobiologist Rita Levi-Montalcini. Her work in the 1990s and 2000s helped establish PEA's role in modulating mast cells, which are key players in inflammation and allergic responses. She was a huge fan of PEA, reportedly taking it herself. She lived to be 103.

Interest in PEA is strong and getting stronger. For two recent reports, researchers analyzed scores of studies, tabulated the results of the rigorous ones, and reached upbeat conclusions.

The 2023 meta-analysis in the Swiss journal Nutrients looked at PEA’s effect on chronic pain, and found “PEA was associated with improved functional status and quality of life in many studies, while reported side effects were essentially negligible.”

A 2025 meta-analysis published by the journal Nutrition Reviews confirmed that “PEA effectively reduces pain and enhances quality of life, with significant benefits observed within 4-6 weeks of treatment. Palmitoylethanolamide is a promising alternative to chronic opioid analgesics, potentially reducing the risk of opioid abuse and dependency.”

That last point — that PEA could provide a safe alternative to opioids — is a big driver of interest in the nine-syllable compound. Researchers are also looking at its promise in treating long Covid, glaucoma, Alzheimer’s, Parkinson’s, ALS and more. So far, it’s shown to be most effective in the treatment of neuropathic pain.

To make PEA more effective, researchers have figured out how to make it more available in the body. Thus “micronized,” PEA is now available in some countries as a prescription drug. Why didn’t that happen earlier? For one thing, drug manufacturers apparently didn’t see great promise or profit in it.

Chemists also discovered PEA before the United States and WHO came up with national and international naming councils, which give drugs generic names such as ibuprofen.

Manufacturing marketing teams are the ones who come up with brand names. Though I find it hard to picture a room full of those folks looking at PowerPoint slides, rubbing their chins thoughtfully until someone exclaims “Yes! Let’s call it Advil! That certainly says ‘Be gone, demon headache’ to me!”

Am I taking PEA? Yes, dear reader, I am. For the past three weeks. Because the research says it takes four to six weeks to see results, I have nothing to report. Perhaps PEA won’t show definitive improvement, but works in the background to keep my inflammatory spinal disease from getting worse.

I would certainly take that outcome from a supplement that is readily available, doesn’t break the bank, and has no side effects.

Following a career in journalism and academic communications, Julie Titone writes about health, environment and other issues at julietitone.substack.com.

Weight Loss Drugs May Help Fight Addiction

By Dr. Ziyad Al-Aly 

A patient of mine, a veteran who had tried to quit smoking for over a decade, told me that after he started a GLP-1 drug for his diabetes, he lost interest in cigarettes. He didn’t use a patch. He didn’t set a quit date. He simply lost interest. It happened without effort.

Another patient on one of these drugs for weight loss told me that alcohol had lost its pull – after years of failed attempts to quit.

People struggling with many addictions, ranging from opioids to gambling, are reporting similar experiences in clinics, on social media and around dinner tables. None of them started these drugs to quit. This pattern of people losing their cravings across a broad range of addictive substances has no precedent in medicine.

But my patients were giving me an important clue. People taking GLP-1 drugs often talk about “food noise” vanishing: the constant mental chatter about food that dominated their days simply goes quiet. But my patients were reporting that it wasn’t just food: They were noticing that the preoccupation with smoking, drinking and using drugs that drives people back despite their best intentions to stop was going quiet too.

As a physician whose patients are often on GLP-1 drugs, and as a scientist who works on answering pressing public health questions – from long COVID to medication safety – I saw a problem hiding in plain sight: Many addictions have no approved treatment.

The few medications that exist are massively underutilized, and none works across all substances. The idea that a drug already taken by millions might do what no addiction treatment has done before was too important to ignore.

My team and I set out to test whether GLP-1 drugs – medications like semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound), originally developed for diabetes and then approved for obesity – could do what no existing addiction treatment does: curb craving itself.

Our evidence strongly suggests they can.

Reduced Cravings

The hormone that these drugs mimic – GLP-1 – is not only produced in the gut. It is also active in the brain, where the receptors it binds to cluster in regions governing reward, motivation and stress – the same circuitry that gets hijacked by addiction. 

At therapeutic doses, GLP-1 drugs cross the blood-brain barrier and dampen dopamine signaling in the brain’s core reward center, making addictive substances less rewarding.

GLP-1 drugs seem to inhibit cravings for several different substances in multiple animal models. For instance, rodents given GLP-1 drugs drink less alcohol, self-administer less cocaine and show less interest in nicotine. 

When researchers gave semaglutide to green vervet monkeys – primates that voluntarily drink alcohol much like humans do – the animals drank less without showing signs of nausea or changes in water intake. This suggests the drug lowered the reward value of alcohol rather than making the animals feel sick.

Fewer Overdoses

To find out whether these drugs have a similar effect on people, we turned to the electronic health records of more than 600,000 patients with Type 2 diabetes at the U.S. Department of Veterans Affairs – one of the largest health care databases in the world.

We designed a study that applied the rigor of randomized controlled trials – the gold standard in medicine – to real-world data. We compared people who started GLP-1 drugs to people who did not, adjusting for differences in health history, demographics and other factors, and followed both groups for three years.

My team and I asked two questions: For people already struggling with addiction, did the drugs reduce overdoses, drug-related hospitalizations and deaths? And for people with no prior substance use disorder, did GLP-1 drugs reduce their risk of developing one across all major addictive substances: alcohol, opioids, cocaine, cannabis and nicotine?

What we found was striking. In the group already struggling with addiction, there were 50% fewer deaths due to substance use among those taking GLP-1 drugs compared with those who were not. We also found 39% fewer overdoses, 26% fewer drug-related hospitalizations and 25% fewer suicide attempts. Over three years, this translated to roughly 12 fewer serious events in total per 1,000 people using GLP-1 drugs – including two fewer deaths.

Reductions of this magnitude are rare in addiction medicine – and what’s remarkable is that the finding came from drugs initially designed for diabetes, later repurposed for obesity and never intended to treat addiction.

The drugs also appeared to prevent addiction from developing in the first place. Among people with no prior substance use disorder, those taking GLP-1 drugs had an 18% lower risk of developing alcohol use disorder, a 25% lower risk of opioid use disorder and an approximately 20% lower risk of cocaine and nicotine dependence. Over three years, this translated to roughly six to seven fewer new diagnoses per 1,000 GLP-1 users.

With tens of millions of people already using GLP-1 drugs, the reductions in deaths, overdoses, hospitalizations and new diagnoses could translate into thousands of prevented serious events each year.

Our findings align with a growing body of evidence.

A Swedish nationwide study of 227,000 people with alcohol use disorder found that those taking GLP-1 drugs had 36% lower risk of alcohol-related hospitalizations. This is more than double the 14% reduction that the same study found with naltrexone, which was the best-performing medication approved for treatment of alcohol use disorder in that analysis.

Other observational studies have linked GLP-1 drugs to lower rates of new and recurring alcohol use disorder, reduced diagnoses and relapse in cannabis use disorder, fewer health care visits for nicotine dependence and lower risk of opioid overdose.

Meanwhile, randomized controlled trials that directly test whether these drugs help people with addiction also show promise. In one trial, semaglutide reduced both craving and alcohol consumption in people with alcohol use disorder. In another, dulaglutide reduced drinking. More than a dozen additional trials are already underway or actively enrolling, and several more are planned.

The Future of Addiction Treatment?

GLP-1 drugs are the first type of medication to show potential benefit across multiple substance types simultaneously. And unlike existing addiction medications, which are prescribed by specialists and remain vastly underused, GLP-1 drugs are already prescribed at enormous scale by primary care doctors. The delivery system to reach millions of patients already exists.

The consistency of GLP-1 effectiveness across alcohol, opioids, cocaine, nicotine and cannabis suggests these drugs may act on a shared vulnerability underlying addiction – not on any single substance pathway. If confirmed, that would represent a fundamental shift in how society understands addiction and how doctors treat it.

Some unanswered questions remain, though, about how these drugs would affect addiction. Many people who take GLP-1 drugs to treat obesity or diabetes discontinue them; afterward, their appetite typically returns and they regain the weight they lost.

Whether the same rebound would occur with addiction, and what it would mean for someone in recovery to face the roar of craving again, is unknown. Nor is it clear whether the benefits persist over years of continuous use, or whether the brain adapts in ways that dampen those effects.

Also, because GLP-1 drugs engage the brain’s reward circuitry – the same system that governs not just craving but everyday motivation – prolonged use could, in theory, dampen motivational drive in some people. Whether that might affect real-world outcomes, such as initiative, competitive drive or performance at work, remains an open question.

GLP-1 drugs have not been approved for addiction, and there is not yet enough evidence to prescribe them solely for that purpose. But for millions of people already weighing whether to start a GLP-1 drug for diabetes, obesity or another approved indication, it is one more factor worth considering.

A patient living with diabetes who is also trying to quit smoking might reasonably choose a GLP-1 drug over another glucose-lowering medication, not because it is approved for smoking cessation, but because it may help them quit, a benefit that other diabetes drugs do not offer. Similarly, for people living with obesity who also struggle with alcohol, the potential for benefit beyond weight loss could be one more reason to consider a GLP-1 drug.

If additional trials confirm that they effectively curb cravings across addictive substances, these drugs could begin to close one of the most consequential treatment gaps in medicine. And the most promising lead in addiction in decades will have come not from a deliberate search but from patients reporting a benefit no one anticipated. Like my patient who quit smoking after a lifetime of trying, it happened without effort.

Ziyad Al-Aly, MD, is a Clinical Epidemiologist at Washington University in St. Louis. He also directs the Clinical Epidemiology Center, and serves as the Chief of Research and Development Service at the VA Saint Louis Health Care System. 

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

Bill Expands Pain Care Options and Lowers Cost for Medicare Patients

By Dr. Lynn Webster

Everyone who reads this publication understands chronic pain is often treated as a symptom. However, for tens of millions of Americans, it is a disease state. It reshapes the nervous system, erodes function, and can narrow life experiences to what hurts least.

It’s also becoming more common. Federal survey data show that roughly a quarter of U.S. adults report chronic pain, and a substantial subset report “high-impact” chronic pain severe enough to limit work or daily activities.

The public conversation about pain has been dominated for a decade by opioids, and for good reason. Opioids carry real risks, especially with long-term use, and the nation has paid dearly for indiscriminate prescribing and poor safeguards. But focusing only on opioids can obscure a quieter policy failure. Many patients who are trying to avoid opioids can’t reliably access effective non-opioid options, particularly in Medicare Part D.

That gap is structural, as well as clinical. Medicare Part D plans commonly use utilization management tools, prior authorization and step therapy among them, that can delay or block access to certain medications. For older adults living with neuropathic pain, fibromyalgia, or other chronic pain conditions, delays can mean months of impaired function while paperwork circulates, appeals are filed, and “fail-first” sequences play out.

In practice, these barriers can shape prescribing in ways that have little to do with what a clinician believes is best. When a newer non-opioid medication is placed on a high cost-sharing tier, requiring multiple authorizations, or is only covered after a patient “fails” other therapies, the path of least resistance too often becomes the therapy that is easiest to access — not necessarily the therapy that best matches the patient’s needs.

A bipartisan bill now before Congress is designed to address a narrow but consequential piece of that problem for Medicare beneficiaries: the Relief of Chronic Pain Act of 2025 (S. 3064). Its basic logic is simple: If policymakers want less reliance on opioids, coverage rules should not systematically disadvantage non-opioid alternatives.

The bill would do three things for qualifying non-opioid chronic pain management drugs in Part D plans, beginning in 2026. It would waive the deductible, require plans to place the drug on the lowest cost-sharing tier, and prohibit prior authorization and step therapy, which forces patients to try an opioid first.

Importantly, S. 3064 is not written as an open-ended mandate for all pain treatments. It defines qualifying drugs as FDA-approved non-opioid products for chronic pain conditions that do not act on opioid receptors and, in general, are not simply interchangeable with an existing therapeutically equivalent product.

It also defines “chronic pain condition” with specific examples, including diabetic peripheral neuropathic pain, endometriosis, fibromyalgia, musculoskeletal pain, neuropathic pain, post-herpetic neuralgia, and trigeminal neuralgia.

Why does a target change like this matter? Because pain is not just discomfort; it is an economic and social force. Chronic pain drives health care use, disability claims, and lost productivity on a massive scale, with major national cost estimates in the hundreds of billions of dollars annually.

When coverage delays effective treatment, the downstream costs do not disappear. They shift to more Medicare patients falling, more deconditioning, more depression and isolation, more emergency visits, and -- in some cases -- greater exposure to higher-risk medications.

Coverage policy won’t solve chronic pain by itself. The best care is multimodal: movement, behavioral strategies, physical and occupational therapy, interventional options when appropriate, and medications when they add meaningful benefit. Opioids will remain appropriate for a subset of people with chronic pain. But insurance design can either support alternative therapies or quietly undermine them.

S. 3064 asks Congress to make one pragmatic adjustment: Stop treating certain non-opioid options as luxuries for Medicare beneficiaries and start treating timely access as a basic component of safer pain care.

Unfortunately, since its introduction in Congress last October by Sen. Steve Daines (R-MT) and Sen. Maria Cantwell (D-WA), the bill has languished in the Senate Finance Committee. No hearings on S. 3064 are currently scheduled.

Readers who want to follow the proposal can review the bill text and legislative updates here. A public petition supporting the measure is also circulating for those who wish to add their names. If you want more options that are accessible and affordable, you should consider signing the petition and spreading the word. 

Lynn R. Webster, MD, is a pain and addiction medicine specialist. He writes and lectures on pain policy, patient safety and evidence-based treatment. Webster is currently a Senior Fellow for The Center for U.S. Policy. He is the author of the forthcoming book, “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis.”

Sounds Are More Intense When You Have Chronic Pain

By Crystal Lindell

Throughout the day, whenever I hear something particularly high-pitched or loud, I will often turn to my fiancé and say, “Turn it down. That sound is literally causing me pain.”

He always obliges, but I know he’s skeptical. And I understand that my complaint doesn’t really make sense. 

However, new research seems to support my experience.

A study at the University of Colorado Anschutz School of Medicine, published in the Annals of Neurology, found that people with chronic pain are significantly more sensitive to sound.

For the study, researchers recruited 142 adults with chronic back pain and 51 healthy people who were pain free. While receiving MRI brain imaging, both groups had mechanical pressure put on their bodies to stimulate pain, while being subjected to annoying sounds. Participants were then asked to rate how unpleasant the experience was.

The differences in responses between chronic pain patients and healthy controls was significant. On average, back pain sufferers reacted more strongly than 84% of people without pain.

The researchers also looked at brain activity during the experiments. The MRI scans showed stronger responses in brain regions that process sound (the auditory cortex) and emotional sensations (the insula). There was lower activity in regions that normally help calm or regulate emotions, like the medial prefrontal cortex.

Interestingly, the results overlap with other studies showing how patients with fibromyalgia react to painful stimuli.

"Our findings validate what many patients have been saying for years, that everyday sounds genuinely feel harsher and more intense. Their brains are responding differently, in regions that process both the loudness of sound and its emotional impact,” said senior author Yoni Ashar, PhD, Co-Director of the Pain Science Program at the Anschutz School of Medicine. 

“This tells us chronic back pain isn't just about the back. There's a broader sensory amplification happening in the brain, and that opens the door for treatments that can help turn that volume down." 

The researchers wanted to see which treatments could help reduce the brain’s response to noise. The pain patients were broken up into three groups that received either Pain Reprocessing Therapy (PRT), a placebo saline injection, or the usual care they were already getting for back pain. 

PRT is a type of mindfulness therapy, in which patients are encouraged to think differently about their pain in order to minimize it.

Out of all the treatments, PRT was the most effective. It reduced the heightened brain response to sound and increased activity in brain regions involved in regulating unpleasant experiences. But the effect was only minimal.

"These findings add to growing evidence that chronic back pain is not just a problem in the back. The brain plays a central role in driving chronic pain, by amplifying a range of sensations – such as sensory signals from the back, sounds and likely other sensations as well," said Ashar.

Overall, it’s great to see research like this validating what I know is a common experience for chronic pain patients.  

However, I do think there may be some “chicken and the egg” issues with this study. Which comes first: sensitivity to sound or back pain?

Maybe people who are more sensitive to sound are more likely to develop chronic pain. In other words, does the pain cause sound hypersensitivity, or does hypersensitivity cause the pain? 

Ashar and his research team plan further studies of senses other than hearing — such as light, smell or taste — to see if chronic pain causes sensitivity to those stimuli and how brain regions respond to them.

California Expands Crackdown on Kratom and 7-OH

By Pat Anson

California is expanding a statewide crackdown on kratom and 7-OH products, with Gov. Gavin Newsom boasting of a “95% compliance rate” in removing the products from store shelves.

“California will not stand by while dangerous, illegal products are sold in our communities. We’ve shown with illegal hemp products that when the state sets clear expectations and partners with businesses, compliance follows. This effort builds on that model — education first, enforcement where necessary — to protect Californians,” Newsom said in a statement.

California’s crackdown began last October, when state health officials issued a consumer warning claiming that kratom and 7-OH are dangerous and illegal to sell. State agents also began visiting over 4,500 licensed retailers, urging them to voluntarily remove the products from their shelves.

Enforcement actions stepped up in January, with most retailers complying. To date, 61 violations have been reported, with over $5 million worth of kratom and 7-OH products seized.  The state has warned non-compliant vendors that they could lose their licenses to operate.

To be clear, the enforcement action is uneven. It’s still relatively easy to order kratom or 7-OH products from out-of-state and have them shipped to California, where I live.  

I visited a retail outlet in the San Gabriel Valley this morning that was still selling kratom, but not 7-OH. A clerk at the store told me they knew 7-OH “would be a problem” due to its potency and, as a result, had never sold 7-OH products. 

7-OH (7-hydroxymitragynine) is an alkaloid that occurs naturally in kratom in trace amounts. When concentrated, it has opioid-like effects that can relieve pain and boost energy levels. Natural leaf kratom has similar, but milder effects, and has been used for centuries in Southeast Asia as a natural pain reliever and stimulant.

While hundreds of fatal overdoses in the U.S. have been blamed on kratom, the evidence supporting that claim is thin. Other drugs and substances are usually involved, making it difficult to attribute the deaths to a specific cause.

Federal Efforts Foiled

In recent years, several states and dozens of local municipalities have banned kratom and/or 7-OH sales, but federal efforts have been stymied by lack of evidence they are harmful. 

In 2016, the DEA and FDA tried unsuccessfully to classify 7-OH and the kratom alkaloid mitragynine as illegal Schedule One controlled substances, only to drop those efforts after a public outcry. A top federal health official later said the FDA withdrew its scheduling request because of “embarrassingly poor evidence & data.” 

Last summer, the FDA said it would ask the DEA once again to schedule 7-OH as a controlled substance, but the DEA has yet to act on that request.

Even when the FDA has acted on its own, it has run into difficulty. In 2023, the agency seized nearly 250,000 bottles of “Feel Free,” an herbal drink containing kratom, from Oklahoma-based Botanic Gardens. The FDA alleged the drink was an adulterated substance and there was inadequate information that it was safe to consume.

Over a year later, the FDA quietly dropped the case. Botanic Gardens has continued to manufacture and sell Feel Free, because the FDA never obtained a permanent injunction telling them to stop. 

Some of the agency’s own research, recently published in the journal Therapeutic Drug Monitoring, supports the safety of kratom.  

When natural leaf kratom was given to 116 healthy volunteers for 47 days in a placebo-controlled clinical trial, including some at very high doses, researchers reported kratom was “well tolerated,” with no serious adverse events and “no evidence of meaningful abuse potential or withdrawal.”

The FDA now says it “not focused on natural kratom leaf products” and only wants concentrated 7-OH extracts banned.

Critics say ham-handed efforts by federal, state and local governments to ban either kratom or 7-OH could backfire by fueling demand for a new illicit drug. 

“Moving 7-OH into Schedule I would not eliminate demand; it would displace it, shifting sales from regulated retail settings into illicit markets where potency is unverified, adulteration is common, and risks are far greater,” Jeffrey Singer, MD, a senior fellow at the Cato Institute, wrote in an op/ed in the Washington Examiner.

“Such a step could also provide transnational criminal organizations with yet another product to layer onto a portfolio already dominated by fentanyl and its analogues. In striving to prevent harm, lawmakers risk repeating a familiar policy pattern — one that inadvertently amplifies danger while removing a lower-risk alternative from the legal marketplace.”

Why Is There Always Money for War, But Never Healthcare?

By Crystal Lindell

When Sen. Bernie Sanders was running for president in 2020, he campaigned for universal healthcare, also known as “Medicare for All.”

As someone with a chronic illness that started to impact my life at just 29 years old, it’s a program I supported. I was too young for traditional Medicare, and was quickly getting too sick for traditional work. So, I was desperate for a realistic alternative.

But any time Bernie’s Medicare for All proposal was mentioned, people always responded in the same robotic way: “How are we going to pay for it?”

They were not calling for the federal budget to suddenly be balanced. The question was solely intended to make advocacy for Medicare for All sound childish. And unaffordable.

Nobody ever asks that about war though.

As the United States showered multi-million-dollar bombs and missiles on Iran this week, the war was framed as such a national security imperative that the cost was barely worth addressing.

Questions about how we’ll pay for the war were dismissed as absurd by the political class and by many Americans.

But no mistake, there is a price tag — and it’s a large one.

Kent Smetters, director of the Penn Wharton Budget Model and one of the nation’s foremost fiscal analysts, told Fortune that the total economic cost of “Operation Epic Fury” could reach $210 billion.

It’s tempting to think of these things as separate problems. War in one bucket, healthcare in another.

But the thing about my federal taxes is that I don’t pay them in separate buckets. I pay my taxes and let someone else decide how to spend it.

That means, when they take my tax money and give it to weapons manufacturers, that’s money not spent on funding things that would actually improve my life as a citizen, like universal healthcare.

It’s a lose-lose option.  

I was laid off from my full-time job in 2022 — and that was the last time that I had health insurance. In the years since, I have navigated life with a mix of freelancing, DoorDashing, and cash payments for medical care that I couldn’t avoid.

In fact, I have a prescription to pick up this afternoon, and my main concern is a familiar one: “How am I going to pay for it?”

When our government abandons us, our problems don’t go away. Rather, they just turn into personal struggles that we are expected to figure out on our own.

So, if it’s childish to not want my taxes used to kill people in Iran, and childish to prefer that money be use for universal healthcare – then call me a little kid, because that’s not the type of adulthood I want to be a part of.