From CRPS Patient to Triathlete

By Madora Pennington

“It’s called the ‘suicide disease’ because the pain is so bad people cannot live with it,” Susie Ruvalcaba tells me about Complex Regional Pain Syndrome (CRPS), a severe pain condition she’s had for about eight years.

“It was really bad, but I am much better now,” Ruvalcaba adds. 

Tanned and amazingly fit, she is training for a double triathlon: an ultra-endurance multi-day race that includes a 4.8 mile swim, 224 mile bike ride, and 52.4-mile run.

Her recovery from CRPS is astounding. For many, it is a lifelong disability. 

CRPS usually starts with an injury that triggers — for reasons not well-understood — inflammatory and immune dysfunction, resulting in extreme, difficult-to-treat nerve pain and musculoskeletal problems. About 26 out of 100,000 people get this mysterious condition every year.

For Ruvalcaba, it started with a chiropractic adjustment to her neck. Past chiropractic visits always made her feel relaxed. But this time, things just didn’t feel right. She was in pain immediately. That pain turned into more pain as weeks went by. 

The pain was also weirdly different. It ran down one arm, skipped her torso, then continued down her leg. It was maddening in how it made no sense.

“Did you just stick your hand in hot water?” a doctor asked because one of her hands was sweaty and red, a telltale sign of CRPS. Ruvalcaba was referred to a neurologist.

“I don’t remember how many doctors I saw, but I think they were afraid to tell me this might be CRPS,” she recalls. 

Susie Ruvalcaba

Early intensive treatment for CRPS with physical therapy, pain medication, and modalities such as nerve blocks has a better chance of stopping CRPS and reversing it. But Ruvalcaba was not lucky enough to get diagnosed quickly.

A year and a half later, a doctor finally leveled with her that she had CRPS. He advised her to quit her job and go on disability. Ruvalcaba was horrified. She was young and had kids to raise. She refused his disability paperwork, but eventually lost her job as coping with CRPS interfered with work. 

Ruvalcaba’s “crazy pain that would not stop” would fluctuate but wouldn’t go away. Often, it was triggered by touch. During bad flares, she had to lie in bed unclothed, her body feeling like it was on fire.    

The sensation of clothing made the pain sensations worse. She had to keep her hair tied up and off her neck for the same reason -- the slight touch of her own hair was too much to bear. 

“Doctors gave me pain meds. They didn’t do enough. I became physically dependent on them. Then I had to take them just to prevent withdrawal symptoms,” she says. 

Some CRPS patients are helped by opioids, but for others, opioids can increase pain sensitivity and suppress hormones and the immune system, making CPRS worse.  

‘Doctors Didn’t Believe Me’

 Ruvalcaba kept trying to find better treatment. 

“Some doctors didn’t believe me. I often left appointments in tears. Pharmacists looked at me like I was a drug addict. I didn’t look like someone who was sick,” she recalls. 

A CRPS specialist gave Ruvalcaba high-dose ketamine infusions, which lessened her pain. She also tried a nerve block, which seemed to irritate her nervous system and make her pain worse. She was too afraid to try an implanted stimulator.

Throughout her illness, Ruvalcaba was advised to limit exercise to gentle walking. She was spending most of her days in bed. It was a good day if she could do some chores. 

“It was a dark time. I felt like I was withering away.”

Depressed and hopeless about her circumstances, she got the idea to try the CrossFit gym nearby because she had enjoyed being an athlete as a teenager.

“I loved it. I got to feel alive for one hour per day," she says. "Doctors, friends, and family begged me to stop, telling me I would hurt myself. I didn’t care. I would come home after, take a pain pill and lie down.” 

She kept at it, and her body became stronger and able to tolerate more. 

Ruvalcaba's instinct to exercise was spot on. High intensity exercise can boost immunity, lower stress hormones, reduce inflammation and re-set pain sensitivity.

A recent, large European study showed that intense exercise is more protective from immune-mediated inflammatory diseases than more gentle exercise done with more frequency. 

The isolation of Covid gave Ruvalcaba extra time and space to take care of herself. She switched from opioids to cannabis edibles, which provided better pain relief with fewer side-effects.

The THC in cannabis is known to be more effective than opioids for the nerve pain common to CRPS. In 2025, a survey of CRPS patients using THC found that THC improved pain, sleep quality, and overall health while reducing anxiety. 

"Covid was the perfect storm, but in a good way. I avoided stress and took care of myself like this for eight months. This gave my nervous system a break,” Ruvalcaba says. 

She did CrossFit everyday, meditated, and pursued healthy diets. She also went to psychotherapy. This focused regimen seemed to give her body the opportunity and support to heal. 

"Before I knew it, I was signing up for a triathlon, wondering where all my pain and gone.” 

Ruvalcaba is working on a documentary about her recovery from CRPS called “Double the Distance, Beyond the Pain.” You can follow her journey on Instagram @susythesoulreader 

Methylene Blue: A New Pain Relief Option

By Dr. Forest Tennant

Over the past 1-2 years, the fatty acid palmitoylethanolamide (PEA) was found to reduce pain and inflammation. PEA occurs naturally in our bodies and in some foods, and is sold in over-the-counter supplements.  

PEA has been urgently needed because of the poor accessibility of opioid pain medication. The menu of non-opioid pain relievers is small: ketamine, oxytocin, CBD, marijuana, and kratom.  

I am pleased to add methylene blue (MB) to the list. Every adhesive arachnoiditis (AA) patient needs to try PEA and MB. One can no longer be confident that their doctors and insurance plans will cover opioids. 

Methylene blue is a salt first used in the 1870’s as a textile dye. It was then used medically as an anti-malaria drug and to treat a rare blood disorder called methemoglobinemia. 

MB has also been used off-label for a variety of medical conditions. Its best-known value has been for the treatment of severe pain associated with head and neck cancer.

About a year ago, Arachnoiditis Hope began receiving reports that MB was being used by persons with AA. Some had stopped taking opioids or were no longer able to obtain them.

There are multiple ways to purchase MB online as a supplement. MB is typically sold as a liquid taken orally, or in capsules and gummies. It is inexpensive and the recommended dosage is on the label. 

AA patients can take MB to boost the effect of opioids or PEA. It is important to note that MB is a monoamine oxidase inhibitor, so patients who are taking an anti-depressant should not take it.

The medical world is well aware of the CDC opioid guidelines and the prosecution of physicians who prescribed high dose opioids. For the most part, there was not a governmental assault on the use of short-acting low potency opioids, such as tramadol and codeine. 

I cannot identify a single case in which a physician was disciplined for prescribing a short-acting, low potency opioid to an MRI-documented case of AA.

The movement to force all patients to stop taking potent long-acting opioids doesn’t seem to be calming down. Their goal is to stop patients from taking high dose opioids and to use electric stimulators, intrathecal pumps, or buprenorphine/methadone. 

Every AA patient needs to be aware of PEA and MB as alternatives. 

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. 

How To Tell if Your Dog Is in Pain

By Jacqueline Boyd

If you live with a pet, you might feel like you can almost read each other’s minds.

You might even have experienced your pet responding to your emotional state. Animals seem to have impressive skills at detecting our state of health too.

However, new research suggests that many dog owners are not skilled in recognising pain in their pets as they might like to think. This could have significant consequences for the behaviour, health and welfare of our pets.

As a migraineur, I am amazed at how my dogs cope with me when a migraine hits. They seem to recognise the pain, distress and incapcacity that comes along with a migraine and respond with more gentle interactions than usual. I hope that when the situation is reversed and they are unwell or in pain, that I too can recognise it.

So, how can you recognise if your pet is in pain and what should you do if you think they are?

Signs of Pain

It is easy to assume that an animal in pain will make some noise about it and show obvious physical signs. This might be the case if they are in acute pain as the result of severe injury for example. However, animals often disguise pain as a survival mechanism, and many signs of pain show only as subtle changes in behaviour.

Humans do seem to be able to recognise basic animal emotional states such as anger, fear or joy, through facial and body expressions. But we are less good at linking these cues to more complex emotional states including pain, anxiety and frustration.

The recently published study assessed how good people are at recognising signs of pain in dogs. This was carried out via an online questionnaire completed by 530 dog-owners and 117 non-owners. 

Participants were given a list of 17 types of dog behaviour. They were asked to rank how likely  the behaviour types indicated their dog was in pain, based on their prior knowledge and experience. In reality, all 17 types of behaviour listed suggest a dog is in pain.

The signs of pain provided included obvious behavioural changes such as hesitant paw lifting, reduced play behaviour and changes in personality. Participants were good at recognising these prominent behaviour changes were linked with pain. 

However, they didn’t realise more subtle indicators such as yawning, lip and nose licking and changes in facial expressions including looking away and increased blinking. These are all warnings that a dog may be suffering.

Notably, participants without dogs were actually more likely to recognise that freezing or turning the head or body away are associated with pain than dog owners. This suggests that dog owners may become complacent in their observations of their dog’s behaviour.

The Link Between Pain and Behaviour

The study participants were also asked to assess the potential relevance of pain in three written canine behaviour cases. The participants were not told this, but two were suffering from painful conditions, one outwardly obvious, and one more subtle. The third case was not linked to a painful condition.

Dog owners noted that pain was likely in the case with obvious signs of movement problems – hopping and lifting of legs. This was higher for dog owners than non-owners. In the case where pain signs were more subtle (night restlessness and “shadowing” family members), there was no difference in the ability of dog-owners and non-owners to identify the behaviour as signs of pain.

However, the dog owners with previous experience of pets with a painful condition seemed to be better at recognising signs of suffering. This applied to overt changes in movement as well as body language. This suggests that prior experience can be valuable in developing skills when its comes to pet behaviour.

What is interesting from this study is that there were some discrete differences between dog-owners and non-owners in recognising signs of pain. However, owning a dog was no guarantee that someone would be better able to identify subtle pain indicators.

Previous studies have shown animal species may show pain in different ways. For example rabbits often freeze, which might be considered a fearful response. Facial grimace scales are also increasingly being used to assess pain for a range of species including cats and horses. These assessment tools track minute muscular movements in the face such as tightening eyes.

What To Do If Your Pet Is in Pain

Recognising signs of pain in your pet is critical so you can respond quickly. This may also help reduce the risk of dog bites, which are often linked to the dog struggling with chronic pain.

Pain can lead to increased noise reactivity too, where dogs flinch or bark loudly in response to sudden, unusual or loud noises.

If you suspect your pet might be in pain because of a sudden change in their behaviour or movement, seek veterinary advice. Soreness can manifest outwardly such as lameness, lethargy or a lack of desire to exercise or play, but it can be easy to miss more subtle signs such as altered blinking, momentary pauses or freezing.

Research indicates that dog owners should be alert to altered sleep patterns, restlessness, clinginess and unusual licking or chewing their body. Even changes in a dog’s ear position, coat quality, texture, or how their coat lies on their skin can indicate underlying discomfort. Reluctance to being touched in specific areas of a dog’s body might also be a sign of discomfort that needs veterinary investigation.

So if you think your dog needs training or a session with a behaviourist because of a gradual or sudden alternation in their behaviour, it’s worth ruling out whether your pooch is acting strangely because they’re in pain first.

Jacqueline Boyd, PhD, is a Canine Consultant and Senior Lecturer in Animal Science at Nottingham Trent University.

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

Can AI Outperform Human Doctors?

By Crystal Lindell

It may not be long before a trip to the emergency room means telling your symptoms to an AI robot, potentially before you even talk to a human doctor. 

New research published in Science seems to highlight the potential for artificial intelligence to create such a future in healthcare.

The study -- which was conducted by both Harvard and Stanford researchers – tested OpenAI’s experimental “o1 preview” models against human physicians. OpenAI makes ChatGPT.

They asked the o1 models to do a patient diagnosis and create a diagnostic testing plan, then compared its skill in clinical reasoning to experts and generalist physicians.

They also assessed AI on 76 real-life emergency room patients at a Boston hospital in three stages: the initial triage at first arrival; first contact with a physician; and upon admission to the hospital. 

The results showed that the new AI model outperformed human physicians and showed improvement from earlier generations of AI. 

“Our findings suggest the urgent need for prospective trials to evaluate these technologies in real-world patient care settings and for health care systems to prepare for investments for computing infrastructure and design for clinician-AI interaction that can facilitate the safe integration of AI tools into patient-care workflows,” wrote lead authors Arjun Manrai, PhD, Assistant Professor of Biomedical Informatics at Harvard University and Adam Rodman, MD, Director of AI Programs at Beth Israel Deaconess Medical Center. 

In the emergency department cases, the o1 model was diagnostically correct 67.1% of the time during the initial triage, outperforming two expert attending physicians (55.3% and 50.0%).

Physicians who reviewed the diagnostic results – without knowing if they were made by AI or human doctors – were unable to distinguish between the two. 

“AI models are evolving from static question-and-answer tools into agents that can, for example, analyze patient records, monitor clinical encounters through ambient listening, and interact in real time with predictive models built on patient data," Ashley Hopkins, PhD, and Erik Cornelisse, PhD candidate, at the College of Medicine and Public Health at Flinders University in Australia, wrote in an op/ed on the study.

“This advance sets a new evaluation benchmark — testing AI against physician performance, and ideally alongside physicians, on authentic clinical tasks.”

Interestingly, Hopkins and Cornelisse pushed back on the idea that the ideal method for evaluating patients is physicians collaborating with AI. They think AI may perform better on its own. 

“That collaborative configuration itself must be tested,” they write. “It has been argued that for certain well-defined tasks across health care, AI may operate more effectively independently.”

They also wrote that since many doctors are already using AI in their practices, sometimes without institutional oversight, further studies are urgently needed to determine when AI improves patient care and when it does not.

In an article about the AI study published in Harvard Magazine, Arjun Manrai, the senior co-author of the study, said the results do not show that “AI replaces doctors, despite what some (AI) companies are likely to say.”

“I think it does mean that we’re witnessing a really profound change in technology that will reshape medicine,” Manrai said. “We need to evaluate this technology now and rigorously conduct prospective clinical trials.”

Manrai also makes an important point. The AI study was based entirely on text-based inputs, while practicing physicians evaluate many other forms of information and communication, such as listening to a patient, observing how a patient behaves, examining images and x-rays, and evaluating other test results. 

AI can’t do all those things – at least not yet.

Manrai’s co-author, Adam Rodman, also thinks it’s premature for AI to replace doctors in clinical settings. AI might prove useful in providing second opinions and finding diagnostic mistakes, but Rodman doesn’t want to see “AI doctor companies” replacing human physicians.

“I do not think that these results support that,” Rodman said. “What these results support is a robust and ambitious research agenda to try to figure out how we can use these technologies to make patients’ lives better.”

How Emotional Distress Makes Chronic Pain Worse

By Pat Anson

Many chronic pain sufferers bristle at the notion that pain is “all in their head” or that it has psychological origins.

They’re not going to like some recent headlines in the news:

“Chronic pain is not just in your head, but it is in your brain”

“Mental defeat can worsen chronic pain, researchers say”

“This Common Mental Disorder Has a Strange Link to Severe Chronic Pain”

“New Study Finds Link Between Difficulty Identifying Emotions and High Chronic Pain Levels”

Yikes. It’s almost like the headline writers wanted to insult pain patients, as much as they want to inform them.

I found the last headline intriguing though, if only because it introduced me to a new word: alexithymia.

Alexithymia is a personality trait characterized by difficulty in identifying or describing emotions. If someone is always “at a loss for words” and can’t express their feelings to others, it could mean they have alexithymia. 

About 10% of the population has alexithymia, which is more common in men (no surprise there), and people who have autism, post-traumatic stress, or depression.

Researchers at Johns Hopkins Medicine wondered if there was a connection between alexithymia and chronic pain. They enrolled over 1,450 people with various chronic pain conditions in a two-year study to answer a chicken-and-egg question: Does chronic pain cause alexithymia or does alexithymia make chronic pain worse? 

“Prior studies have shown that alexithymia tends to be higher in people who have chronic pain. However, we did not know whether alexithymia leads to worse pain, or whether worse pain leads to alexithymia. We also have not had a good understanding of why these two distinct processes were related,” said senior author Rachel Aaron, PhD, Associate Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine.

Aaron and her colleagues had patients fill out questionnaires to see how well they identified their feelings and described their emotions. They also asked participants about their pain, anxiety and depression levels.

The research team then used statistical modeling methods to see if emotional difficulties could predict pain outcomes.

The study’s findings, recently published in the journal American Psychological Association, show that patients with higher levels of alexithymia at the start of the study developed greater psychological distress one year later. That emotional stress had a profound impact. After two years, those same patients had greater pain interference – meaning their daily functioning and quality of life were worse. 

Alternatively, researchers found that chronic pain did not predict or cause alexithymia. That supports evidence that emotional processing difficulties are a risk factor, but not a consequence of chronic pain.

“Greater difficulties identifying one’s own feelings can lead to greater symptoms of psychological distress, including symptoms of depression and anxiety,” says Aaron. “This in turn can lead to greater difficulties managing chronic pain. These findings highlight the role of considering alexithymia in psychological treatment for chronic pain, and how it might lead to psychological distress.”

Aaron led a previous study, which found that 40% of adults with chronic pain have clinical symptoms of depression or anxiety.

How do you treat alexithymia? Various types of psychotherapy can be used, such as Cognitive Behavioral Therapy (CBT) or Emotion-Focused Therapy (EFT), to help patients recognize and express their emotions in healthier ways. Creative therapies can also be used to help people express their feelings through journaling, art, music and dancing. 

There are no drugs that specifically treat alexithymia, although antidepressants and anti-anxiety medications can treat co-occurring conditions like depression or PTSD, which may help improve emotional processing. 

How to Dress When You Go to the Doctor

By Crystal Lindell

I always wear mascara when I go to the doctor. 

In fact, every time I have a doctor’s appointment, I leave myself plenty of time beforehand to shower, curl my hair, put on a nice outfit, and do my makeup.

It may sound unrelated to medical care, but it’s worth it.

You see, there’s actually a dress code for doctor’s appointments that nobody at their office ever tells you about. Rather, you just have to figure it out on your own.  

The common misconception is that you should look as sick as possible when you show up for a visit. A lot of patients assume that looking disheveled while wearing pajamas is the best way to convey just how crappy you feel. Not to mention the fact that being sick means you probably have less energy to dress nicely anyway.  

But doctors are just as ableist as the rest of society, and the truth is they don’t actually like people who look too sick. In my experience, doctors will actually treat you better if you get a little bit dressed up.

Not too dressed up, obviously. You don’t want to show up in a suit and tie, or a dress. But you do want to look at least as nice as you’d look for a casual date. Showered, business casual clothes, and light makeup if you present as female.

Dressing nice conveys that you are trying to take care of yourself, and doctors like that. In essence, they want to invest their time and energy into patients who are also invested, which dressing nicely conveys.  

In 2010, Consumer Reports surveyed 660 primary care physicians and found that being “respectful and courteous” was the second most important thing doctors said patients could do to get better care. 61 percent of physicians said it would help very much.

Note the word "respectful." And how doctors admitted that showing them respect leads to better care. Make no mistake, doctors very much see how you present yourself in appointments as a sign of how much you respect them. 

It all makes sense, when you consider how many doctors love their own dress codes, e.g. their famous white coats, which they use to convey authority.

I know it is tempting to show up to appointments in the comfiest clothes available. I also know that it’s not always ideal to use precious time and energy to shower and pull yourself together. But it’s one of the few ways you can control how good your medical care is. 

So it really is worth it to grab a nice shirt and a little mascara before you head to the doctor’s office.

Bitter Rivals: Kratom’s Three-Ring Circus

By Pat Anson

In recent years, you’ve probably come across stories about kratom, an herbal supplement used by millions of Americans for pain relief and to help manage conditions such as anxiety and depression. 

While the vast majority of consumers use kratom safely, there is growing concern about outlier cases where kratom is abused or has even been associated with overdoses. 

That has led to several states and dozens of cities and counties banning natural leaf kratom or a potent, concentrated kratom alkaloid called 7-hydroxymitragynine (7-OH). In some cases, they’re banning both.

Less well known is that the growing controversy over kratom is being fueled, in part, by an ongoing turf war between three rival industry-funded advocacy groups. Or, to use another cliche, a three-ring circus.

In one ring is the American Kratom Association (AKA), an organization of kratom manufacturers and vendors that sell natural leaf kratom products. 

In another ring is the Holistic Alternative Recovery Trust (HART), which represents 7-OH manufacturers like American Shaman. 

In the third ring is the Global Kratom Coalition (GKC), which was founded by JW Ross, who made a fortune selling a popular kratom-kava shot called “Feel Free.” 

Like the AKA, the GKC favors natural leaf kratom, and takes a pugnacious approach to critics and competitors. The GKC likens rival 7-OH products to “powerful prescription opioids” that should be banned or heavily regulated. 

You would think the AKA and GKC would be on the same team, since they both want to keep natural leaf kratom legal and accessible. But they are bitter rivals.

In an open letter, AKA chairman Matt Salmon claimed that GKC founder Ross is actually Jerry Cash, a convicted embezzler, who is trying to “make the AKA look bad” by misstating its position on kratom product formulations.

Salmon, a former congressman, also accused the GKC of launching a smear campaign against Mac Haddow, an AKA lobbyist who had his own run-ins with the law. Salmon’s letter is nearly three years old, but helps explain what is happening today.

“The most recent attacks against AKA and the personal attacks on Mac Haddow came after several ambush interviews orchestrated by Mr. Ross and his PR team providing incomplete, mischaracterized, and demonstrably false information to reporters,” said Salmon.

Kratom vs 7-OH

All three kratom groups accuse each other of jeopardizing what has become a lucrative business opportunity: selling a popular herbal supplement that is still largely unregulated by the federal government. Currently estimated to be worth over $2 billion, the global kratom industry is projected to grow to nearly $8 billion by 2032.

The latest example in this turf war is a self-styled “consumer alert” by the AKA warning about the “growing proliferation of dangerous products” containing 7-OH and other kratom extracts.   

“Consumers deserve to know the truth,” said Haddow, Senior Fellow on Public Policy for the AKA, in a press release. “These 7-OH products are not traditional kratom. They are being engineered, concentrated, and marketed in ways that create risks that are not associated with natural kratom leaf.” 

As evidence, the AKA cites lab results commissioned by the Texas Attorney General, which found that several 7-OH products contain alkaloid concentrations that exceed safety limits under state laws modeled after the Kratom Consumer Protection Act (KCPA) – legislation that the AKA has lobbied Texas and 20 other states to enact.    

One such product, Opia 7-OH tablets, contain over 16mg of 7-OH – which is 96% of their total alkaloid content – well above the 2% limit under the KCPA.  

AKA IMAGE

Critics of the KCPA say the law is misleading, doesn’t protect consumers, and is designed primarily to protect the financial interests of the AKA and other vendors who sell natural leaf kratom.    

Not surprisingly, the AKA disagrees. It wants 7-OH scheduled as a controlled substance and a ban on 7-OH being marketed as “kratom” –  moves that would preserve the legal status of natural leaf kratom.

“This is not a debate about kratom,” says Haddow. “This is about stopping a new class of unregulated, opioid-like substances from being disguised as something they are not.” 

The Holistic Alternative Recovery Trust takes issue with the portrayal of 7-OH as a dangerous opioid.

“7-OH is not a synthetic substance or a novel additive, it is a naturally occurring alkaloid found in the kratom leaf itself. Calling it anything else misrepresents the science,” a HART spokesperson said in a statement to PNN.

“This is part of a broader pattern we’ve seen from the American Kratom Association and the Global Kratom Coalition, misrepresenting the science in ways that benefit certain segments of the market, particularly whole-leaf producers, while dismissing or sidelining millions of consumers who rely on 7-OH products.”

‘Kratom Is an Opioid’

The AKA’s latest attack on 7-OH comes on the heels of the GKC’s endorsement of a bill in Congress that would target “lab-made opioids” by amending the Controlled Substance Act to include 7-OH as a Schedule One substance, in the same category as heroin.

The association with opioids is a bit of a canard, but it makes for a good headline. Kratom comes from the leaves of the Mitragyna speciosa tree, which has more in common with coffee trees than it does with poppy plants, from which opioids such as heroin are produced. 

Like kratom, coffee and other comfort foods such as chocolate stimulate endorphin nerve receptors and have “feel good” effects. You might even say they have mild “opioid-like” effects. But that doesn’t make Hershey’s Kisses opioids or Mrs. Olson a drug dealer for peddling Folgers coffee.  

Squabbling over the safety of each other’s products has not benefited kratom consumers and has contributed to sensational reporting about kratom and 7-OH causing addiction and overdoses. 

The latest example appears in The Conversation, which commissioned Dr. Andrew Kolodny to write an op/ed about kratom. Kolodny is the founder and president of Physicians for Responsible Opioid Prescribing (PROP), an influential anti-opioid activist group. 

Kolodny used a misleading CDC study about calls to poison control centers to paint a misleading portrait of kratom as just another opioid.

“For now, the evidence shows that kratom is an opioid with real risks – not a harmless supplement,” wrote Kolodny, while shamelessly ignoring his own role in restrictions on the use of opioid medication, which led to greater use of kratom. “Kratom’s rising use over the past decade coincided with the opioid crisis, as people searched for alternatives to prescription opioids.

“Some in the kratom industry argue that only newer products with boosted levels of 7OH are dangerous. But the evidence does not support that claim. Deaths linked to kratom were already rising before the newer 7OH products appeared on the market in late 2023.”  

The three kratom advocacy groups – who all favor limited regulation – would be wise to consider that demonizing each other’s products only contributes to state after state and city after city enacting kratom bans. 

“There are legitimate concerns in the marketplace, particularly around inconsistent products, unclear labeling, and lack of transparency. Those issues deserve attention. Consumers should know exactly what they are purchasing through clear labeling, verified third-party testing, and honest disclosure of potency and contents,” says HART.

“But the solution is not to single out or ban one compound based on flawed narratives. Policymakers should instead focus on enforceable manufacturing standards and practical safeguards, such as milligram-per-serving limits, standardized labeling, and quality controls, rather than arbitrary caps that risk eliminating products people currently rely on.”

Last summer, the FDA said it would ask the DEA to have 7-OH – but not whole leaf kratom – classified as an illegal Schedule One controlled substance.

The DEA, which doesn’t even mention kratom or 7-OH in its most recent National Drug Threat Assessment, has yet to move forward on the FDA’s request. Perhaps federal agencies are just as divided about kratom as kratom advocates are.

EDS Means a Life Filled With Ankle Sprains

By Crystal Lindell

I sprained my ankle again last week. If you have ever sprained your ankle, you know that swearing is more than warranted. 

After stepping on a crack in our driveway, my stupid goddamn left foot just immediately rolled right under me. Within seconds, it was the size of a baseball. 

I have spent the last few days doing RICE: Rest, Ice, Compression, Elevation. The bruises that developed have spread, making it look like I stepped in navy paint. 

I wish I could say it was the first time I sprained my ankle, but I have hypermobile Ehlers Danlos Syndrome (EDS). As such, I’ve been spraining my ankle on a regular basis since high school. I even have my own personal stash of crutches and ankle wraps always at the ready. 

The first time it happened, I was practicing a dance routine in socks on a wooden floor at my high school and – WHACK! — I hit the ground.

Another time, I tripped off the edge of a sidewalk.

I have also fallen down a flight of stairs; landed wrong during a jump sequence in my Jazzercise class; and face-planted while running into a Target store to shop.  

Just because it happens a lot though, doesn’t mean it hurts any less. The day after it happened this time, I could barely get myself to the bathroom, as the pain radiated through my body into my chest. And that was with pain meds! It was hell. 

Until recently, I always blamed myself for these falls. I thought I was just careless when I walked. I thought, somehow, I got distracted when I was going down steps. I figured that I should have worn better shoes. That I shouldn’t have been practicing a dance routine in socks.

I genuinely thought that I was an idiot.

I’ve also lost count of how many times someone accused me of spraining my ankle for attention. I don’t know how that would even work, but logistics don’t stop people from being cruel.

Anytime I needed crutches or a day off school or work to recover, I was also accused of being lazy, overdramatic or a wimp. 

But then on March 15, 2018, I was diagnosed with hypermobile EDS by a doctor at the University of Wisconsin-Madison.

While he was evaluating me he said, “I bet you sprain your ankles a lot, huh?”

“Ummm. Yes!  How did you know?”

“Well,” he said. “Your ankles bend way past the point where they should, so if they go just a little bit further, BAM! They just roll right under. And then you sprain them.”

It’s difficult to explain the emotions that come with such a revelation. I couldn’t believe there was finally a reason beyond “I’m bad at walking.”

It turns out, my ligaments just don’t work the way they are supposed to.

It wasn’t just ankle sprains that my EDS diagnosis shed light on. Another symptom of EDS is that I bruise much easier than other people. 

It doesn’t bother me much, but it did really bother the doctor I saw at the women’s health clinic in grad school, years before my diagnosis. She was certain that my body being covered in bruises meant that I was being abused by my then-boyfriend. She tried multiple times to get me to open up to her and call the abuse hotline. 

I most certainly was NOT being abused though. Not a single bruise had come from him. Thankfully, that doctor never involved the authorities without my consent.  

Unfortunately, that’s not the case for many parents who are wrongly accused of abusing their undiagnosed EDS children for the same reason though, i.e. lots of bruises. It’s just one reason that refusing to diagnose kids with EDS or their genetically connected parents can have very dangerous consequences. 

There’s a lot of discussion these days about whether or not it’s worth it to be diagnosed with EDS. A lot of doctors think it’s being over-diagnosed, claiming patients just want the label for attention or some other vague reason.

I’m in a different camp though. I think EDS is still exponentially under-diagnosed. There is value in understranding our bodies, and that’s what a diagnosis like EDS brings. After all, we can’t cope or treat things that we refuse to even name. 

I suspect that many of my family members also have EDS. While most haven’t had the resources to get their own diagnosis, mine was enough for them to start understanding. It helped shed light on the things that their own bodies have always done. Many of them have come to realize that their injuries and pain were also not their fault.  

Hypermobile EDS is a very real condition, with very real physical markers, and very real symptoms. It causes very real pain. 

Patients have a right to know when they have it – just like they have a right to know that they have any other medical condition. Any doctor who believes otherwise shouldn’t be working in medicine. 

As for my ankle, it’s slowly getting better. The swelling has gone down significantly, and I’m hoping that within the next couple days I’ll be able to fully walk on it. Now my goal is to just make it through the rest of 2026 without another sprain.

Ohio Nursing Homes Dump Patients at Homeless Shelters

By Crystal Lindell

A woman at a Columbus, Ohio nursing home who was suffering from a painful leg fracture, diabetes, and other health problems was dumped by the staff at a homeless shelter because she drank a beer in her room.

That’s according to a 2023 inspector’s report by the Centers for Medicare and Medicaid Services (CMS), which found other disturbing incidents of Ohio nursing homes discharging older and medically fragile residents to homeless shelters.  

The Columbus nursing home, Eastland Rehabilitation and Nursing Center, told CMS it tried to get the woman into a rehabilitation program for substance use but they couldn’t find a bed. 

At the time of her discharge, she was using a walker, incontinent, and carrying a large bag of medications, according to a news report from Ohio-based Signal. 

And the story only gets worse.

The nursing home staff didn’t even bother to call the homeless shelter ahead of time to let them know that they were dropping her off. So when they left her at the homeless shelter, staff there initially refused to take her in “leaving her outside in the late-summer heat." They said they had their own 100-person-long waiting list.

According to the CMS inspector, “The [homeless shelter] staff member revealed Resident #83 was unclear of what was going on, scared, and not sure who dropped her off there.”

Eventually the homeless shelter let her into the lobby, gave her a glass of cold water and allowed her to come inside, while they called the fire department and a social worker. 

But after that, her story just… ends. None of the people involved have since been able to track her down. Administrators at Eastland did not return phone calls about the incident, according to the Signal. 

It’s a truly disgusting tale. And anyone who deals with chronic pain or other health issues should sympathize with the woman.

Medicare gives Eastland just two out of five stars in its nursing home ratings system, which is considered below average. The facility, which gets only one star for “health inspections” and “staffing,” has been fined four times over the last few years for over $300,000. 

It’s not a one-off situation either. CMS has faulted Eastland and six other Ohio nursing homes in the last few years for discharging residents to homeless shelters.

“We are starting to deal with it more and more. The facilities are so closely monitored on discharges, but yet they still try and send them to hospitals and not take them back. Or drop them off at homeless shelters,” Chip Wilkins, who heads Dayton’s Long Term Care Ombudsman program, told the Signal. 

It’s inhumane and upsetting that the only consequences the nursing homes seem to face for such a cruel act was a fine. It’s not nearly enough to deter them from doing it again. 

It’s tempting to believe that people like Resident #83 are in some outlier group. As though such a situation could never happen to you or me or someone we love. 

But the scenario is indicative of how some nursing homes treat their patients. It can happen when a resident behaves aggressively, has a substance use problem, or even if they lose their Medicare or Medicaid coverage. If you can’t pay your bills or cause too much trouble, you’re out.

Personally, I’m lucky enough to have family who I can live with now, and I’m also lucky enough that my health issues have not yet required skilled nursing care. But I’m well aware of my deteriorating body and how easily I too could end up in such a situation.

We are supposed to be human beings. We are supposed to care for each other. It shouldn’t matter if Resident #83 was drinking three 24-packs of beer a day. She still deserved medical care. All of us do.

Unless we start truly regulating medical providers to force them to actually care for their patients, situations like this will only get more common. And one day, it could happen to us or someone we love.

I have thought about Resident #83 many times since first reading the Signal article last week. I hope that she found somewhere to go. That some distant relative took her in, or that she was able to get a bed in a hospital or a different nursing home. But I know that the most likely outcome is that she died, alone and scared. 

It’s horrifying and it should never be allowed to happen.

DOJ Legalizes Medical Marijuana But Stops Short of Rescheduling Cannabis

By Pat Anson

In a major shift in U.S. drug policy, the Department of Justice is legalizing medical marijuana at the federal level by moving it from an illegal Schedule I controlled substance to a less restrictive Schedule III status, which allows for some medical use. Medical marijuana is most commonly used to treat pain, anxiety, insomnia and other health conditions. 

The move by Acting Attorney General Todd Blanche affects medical marijuana sold under qualifying state issued licenses and a handful of FDA-approved drugs containing synthetic marijuana. It also makes it much easier for researchers to study cannabis and for cannabis companies to develop new products for medical use.

“The Department of Justice is delivering on President Trump’s promise to expand Americans’ access to medical treatment options,” Blanche said in a statement. “This rescheduling action allows for research on the safety and efficacy of this substance, ultimately providing patients with better care and doctors with more reliable information.”

Medical marijuana is already legal in 40 states and the District of Columbia, and 24 of these states and DC have also legalized recreational cannabis for adult use.

Blanche’s order stops short of legalizing recreational cannabis, which remains in the Schedule I category – for the time being. Hearings will begin this summer to consider rescheduling all cannabis from Schedule I to Schedule III. Until then, federal criminal laws still apply and interstate trafficking of cannabis remains illegal. 

"While today's move is a historic step forward, it still falls well short of the comprehensive changes necessary to bring federal marijuana policy into the 21st century. Specifically, rescheduling fails to fully harmonize federal marijuana policy with the cannabis laws of many states, particularly the 24 states that have legalized its use and sale to adults," said Paul Armentano , Deputy Director of NORML, a marijuana advocacy group. 

"In order to rectify this state/federal conflict, and in order to provide state governments with the explicit authority to establish their own cannabis regulatory policies — like they already possess with respect to alcohol — cannabis must be removed from the Controlled Substances Act altogether." 

Blanche’s order also removes federal tax penalties from state-licensed marijuana dispensaries and operators, which inflated prices and restricted how businesses could operate financially. Many dispensaries are unable to get loans and can only accept cash payments because banks are reluctant to do business with them. 

"This change levels the playing field and lowers these entities’ costs of doing business," Armentano said. "This change also likely benefits patients by resulting in lower overall prices for state-licensed retail medical products."

Rescheduling Slow Walked

Some marijuana advocates say the DOJ order doesn’t go far enough, and that federal agencies continue to slow walk meaningful reform. 

“We should be clear-eyed about what this is and what it is not,” said Betty Aldworth, Chair of The Marijuana Policy Project. “Rescheduling is a step in the right direction, not a solution. It does not resolve the fundamental contradictions between federal and state law.

“It does not protect people from the legal consequences of cannabis use embedded in housing, immigration, employment, or family law. And it does not create a pathway for patients to access cannabis through insurance coverage, even when it may be safer or more effective than legal options.”

It was President Biden who initiated the rescheduling process four years ago, when he told the Department of Health and Human Services (HHS) to review the scientific evidence on cannabis and make a recommendation for rescheduling. 

It took HHS nearly a year to complete its review, but further action was delayed by DOJ and DEA decisions to postpone public hearings until after the 2024 presidential election. 

Last week, four months after signing an executive order instructing his administration to reschedule cannabis, President Trump was still complaining about how slow the process was.

“Will you get the rescheduling done, please?” Trump asked a federal health official. “They’re slow-walking me on rescheduling. OK, you’re going to get it done, right?”   

The FDA has already approved four synthetic marijuana drug products: Epidiolex (cannabidiol), Marinol (dronabinol), Syndros (dronabinol), and Cesamet (nabilone). They require a prescription and are used to treat seizures, nausea, vomiting, and loss of appetite in select patients.

Combining Opioids With a Cannabis-Based Medicine Doesn’t Add to Pain Relief

By Pat Anson

Combining a low dose of opioids with a cannabis-based medicine did not improve acute pain for people with arthritis, according to results of a small clinical study published in the journal Anesthesiology.

Animal studies have suggested that the two drugs might have a synergistic effect and provide better pain relief, but the study of 21 people with knee osteoarthritis found no added benefit. 

“Some patients believe combining cannabis with opioids can help with pain, and clinicians may recommend or prescribe it in states where cannabis is legal,” said lead author Katrina Hamilton, PhD, a Psychiatry Professor at Johns Hopkins School of Medicine. “Our study suggests that isn’t the case and patients may experience more side effects when the drugs are combined.”

There are some important caveats to the study that diminish its findings.

One is the design of the study and its small size – just 21 patients – who received placebo pills, hydromorphone alone, dronabinol alone, and a combination of hydromorphone and dronabinol. 

Participants received all four combinations prior to having pain induced by sticking their hands in cold water or having their skin rubbed with a “hot” capsaicin cream. That means the researchers were evaluating acute pain induced in a laboratory, not the chronic pain caused by arthritis.

Second, dronabinol (Marinol) is not cannabis. Dronabinol is a synthetic version of THC, the active ingredient in cannabis. It is FDA-approved to treat nausea and vomiting in chemotherapy patients, and to improve appetite in AIDS patients. Dronabinol was never intended to provide pain relief and has little in common with the various forms of cannabis (edibles, smoking, vaping) used in the real world. 

Third, while hydromorphone is a potent opioid, the oral dose (2 mg) that was used is relatively low – about 10 morphine milligram equivalents (MME). The research team had previously conducted a similar study using 4mg of hydromorphone. That also produced little pain relief for participants, so it’s not surprising that 2mg didn’t help either, although researchers say the lower dose has a “better safety profile.” 

The researchers found that taking hydromorphone and dronabinol, either alone or in combination, did not provide significant relief from acute pain. The opioid alone reduced pain sensitivity, while dronabinol did not, but neither meaningfully reduced participants’ self-reported pain.

When the two drugs were combined, side effects such as drowsiness, dizziness and impaired thinking were stronger and more noticeable, but without added pain relief.

“Opioid and cannabinoid medications failed to produce robust analgesia in experimentally induced pain among patients with knee osteoarthritis. In contrast to preclinical studies, there was no evidence of synergistic analgesic effects by combining hydromorphone and dronabinol,” researchers concluded.

While the dose of hydromorphone was low, the 10mg dose of dronabinol that was used in the study is a hefty amount. Interestingly, participants reported more of a “high” sensation from the dronabinol than from hydromorphone. But again, dronabinol is a synthetic version of cannabis and has little in common with what most cannabis consumers use.    

“In the real world, people often use cannabis differently, including lower starting doses, using gradually stronger doses, which may affect both benefits and side effects,” said Hamilton, acknowledging the limits of her study. “More research is needed to better understand how cannabis affects pain when used in real-world settings.”

Physical Therapy Provides Only Modest Relief For Chronic Lower Back Pain

By Pat Anson

Physical therapy, cognitive behavioral therapy (CBT), and mindfulness are often recommended as non-pharmacological treatments for chronic lower back pain. The World Health Organization even calls them first-line treatments in a 2023 guideline for low back pain that discourages the use of most pain medications. 

But which therapy works better?

A new study, published in the Annals of Internal Medicine, found that physical therapy provides minor improvement in physical function for patients with chronic low back pain, but no change in pain intensity compared to CBT and mindfulness.

A research team led by the University of Utah enrolled 749 adults with chronic low back pain (cLBP) to compare the effectiveness of physical therapy with other non-pharmacological treatments.

Participants were randomly assigned to 8 weeks of either physical therapy or CBT. Those who did not improve were reassigned to a second treatment, either switching therapies or trying mindfulness-based care for another 8 weeks.

The physical therapy was provided by licensed therapists, while mental health care professionals provided CBT and mindfulness training. CBT is a form of psychotherapy, in which a therapist works with a patient to reduce unhelpful thinking and behavior; while mindfulness focuses on increasing awareness and acceptance of physical discomfort to minimize its impact on daily life.

After 10 weeks, participants who started with physical therapy showed a small improvement in function, while pain levels were similar between groups. After one year, no meaningful differences were seen among the second-stage treatments. 

The findings suggest physical therapy (PT) may be a reasonable first option for chronic low back pain, but switching or adding other psychological therapies may not change long-term outcomes.

“We found some benefits to PT as the first treatment offered to patients, but we could not detect subgroup differences and effect sizes were small. Our results support PT as a first-line option for cLBP and no differences in potential benefits of second-line care with mindfulness or switching for nonresponders,” researchers concluded.

The study does not mean that CBT and/or mindfulness are ineffective, just that their impact is minor. That finding is similar to another recent study of patients with chronic low back pain, which found that CBT and mindfulness reduced pain levels by about 10% after a year. 

That’s nice, but not the kind of pain relief most people are looking for. 

Chronic low back pain is the leading cause of disability worldwide. It usually begins with acute pain caused by muscle strain or musculoskeletal injuries, and becomes chronic over time when it fails to resolve. Chronic low back pain mostly affects adults of working age in lower socioeconomic groups, who often have physically demanding jobs.  

For such a common disorder, affecting about 500 million people at any given time, there is little consensus on how to treat it. 

A 2018 review in The Lancet by an international team of researchers found that cLBP is often treated with bad advice, inappropriate tests, risky surgeries and painkillers. The authors said there was limited evidence to support the use of opioids for chronic low back pain, and epidural steroid injections and acetaminophen (paracetamol) were not recommended at all.

Medical Cannabis Significantly Reduced Use of Opioids and Other Rx Drugs

By Pat Anson 

A new survey of cannabis users in Germany found a significant reduction in their use of painkillers, sleep medications, anti-depressants and other prescription drugs after starting medical cannabis treatment.

Over 3,500 cannabis patients participated in the online survey, published by Bloomwell, which found an average 84.5% decrease in the use of medications overall. Over half of respondents (58.9%) said they stopped taking at least one medication completely.

The reduced consumption of prescription drugs led to a corresponding change in side effects. Over 60% of patients said they no longer had any medication-related side effects, while nearly 38% said their side effects were reduced. 

Less than 2% said their side effects remained the same or intensified after they started using medical cannabis.

“Cannabis is often portrayed as dangerous and addictive, even though the most severe side effects and addiction potential have only been proven with other prescription medications,” said Julian Wichmann, MD, co-founder and CEO of Bloomwell, one of the leading providers of medical cannabis in Europe.

The reduced use of prescription drugs was associated with major improvements in quality of life and productivity. Most patients reported better concentration (67.8%), more social interactions (61.9%), and fewer days of missed work (53.9%) after they started using medical cannabis.

“Patients benefit significantly when they are able to replace other prescription drugs with medical cannabis. The often completely absent side effects are also associated with a marked improvement in quality of life and work performance. This is likely the most important finding of our survey,” said Wichmann.

The steepest reduction in the use of a prescription drug class was for sleep medications; 93.6% were able to reduce their use of sleeping pills by at least half, and 75.5% were able to discontinue them completely. 

Patients who took the stimulant methylphenidate (Ritalin) reported an average reduction of 88.4% after starting medical cannabis, while 77.3% were able to discontinue it completely. 

Patients were able to reduce their use of opioids by an average of 83.9%, while 61% were able to completely discontinue opioids.

That finding mirrors those of other studies in the US and UK. 

A large 2022 survey of medical cannabis users in Florida found that those who have chronic pain were able to reduce or even stop their use of opioids. Patients reported less pain and better physical and social functioning once they started using medical cannabis. 

A recent survey of UK adults prescribed medical cannabis for anxiety, depression, insomnia, PTSD and other mental health conditions found that 97% said it improved their well-being and happiness, while 68% said it enabled them to work.

Germany first legalized medical cannabis in 2017, allowing patients with certain medical conditions to access it with a prescription. In 2024, the German Narcotics Act declassified cannabis as a narcotic and allowed adults to possess and cultivate limited amounts for recreational use.

According to Bloomwell, cannabis reforms in Germany have led to significant reductions in the price of cannabis flowers and an increase in cannabis prescriptions.  

Vertanical, a German pharmaceutical company, hopes to soon get regulatory approval in Europe and the UK for the first cannabis-based medicine for chronic pain. In clinical trials, the full spectrum cannabis extract provided better pain relief for low back pain in a head-to-head comparison with low doses of opioids.

Psilocybin Is Going Mainstream, but Research and Regulation Lag

(Editor’s Note: President Trump has signed an executive order directing his administration to speed up the review of psychedelic drugs. Although the order focuses on treating mental health conditions, psychedelics such as psilocybin mushrooms have shown promise as treatments for chronic pain.)

By Hollis Karoly and Kent Hutchison

Amid a renaissance in the science of psychedelics, public interest in psilocybin – or magic mushrooms, as they’ve long been known – is surging.

One study found that rates of psilocybin use increased 44% among adults ages 18-29 from 2019 to 2023, and 188% among those over age 30. This amounts to more than 5 million adults using psilocybin in 2023 alone. And those numbers are rising: A study published in early 2026 found that about 11 million adults in the United States used psilocybin in the previous year.

In many ways, the growing scientific and public interest in psilocybin mirrors the early days of recreational cannabis legalization in the U.S. Much like how cannabis commercialization quickly outpaced the development of regulations necessary to protect public health, the expanding psilocybin market and surging public interest are moving faster than the science and regulations needed to ensure it is used safely.

We are substance use researchers who have spent more than a decade studying the many new, high-THC cannabis products that have flooded the legal-market.

Now, we similarly aim to bridge the gap between public enthusiasm for psilocybin and the limited scientific evidence available about its potential benefits and risks. Currently, this type of real-world data on the effects of psilocybin mushrooms is almost nonexistent.

How Do Psilocybin Mushrooms Work?

Psilocybin is a prodrug, which means that it has very low activity until the body converts it into psilocin. Psilocin is the compound primarily responsible for the psychoactive effects of psilocybin mushrooms.

Psilocin resembles the chemical messenger serotonin, which is involved in regulating a range of physiological and psychological functions, including mood, appetite, cognition and sensory perception. As a result, when psilocin binds to serotonin receptors, it alters how people think, feel and experience the world.

Importantly, research suggests that psilocin also alters the brain’s ability to strengthen or weaken neural connections, referred to as synaptic plasticity. This process likely underlies the profound and sometimes long-lasting effects psilocybin mushrooms can have on thoughts, emotions and perception.

Psilocybin mushrooms contain numerous other compounds, together known as tryptamines, such as baeocystin, norbaeocystin and aeruginascin. Research on rodents shows that mushrooms containing these compounds may elicit stronger and longer-lasting effects than psilocybin alone.

But very little is known about how these other tryptamines affect humans. This is because federal regulations require researchers to use an isolated, synthetic version of psilocybin in clinical studies rather than the entire mushroom.

Thus, the many ongoing clinical trials testing psilocybin as a treatment for various mental health conditions use synthetic psilocybin that does not contain these other tryptamines.

A Legal Gray Area

Psilocybin is more accessible than ever before.

In 2019, Denver, Colorado, became the first American city to decriminalize psilocybin mushrooms. This means that possession becomes the lowest law enforcement priority and criminal penalties are reduced or eliminated, but it does not fully legalize them.

Over the next two years, several other U.S. cities including Oakland and Santa Cruz, California; Seattle, Washington; and Detroit, Michigan, followed suit. In 2020, Oregon legalized psilocybin for supervised use in licensed settings, and Colorado did the same in 2022. These legal, supervised-use programs allow access to psilocybin mushrooms in regulated environments without a prescription.

Even for people living outside those states and cities, the barriers to accessing psilocybin mushrooms are low. With a quick Google search and around US$35, anyone can legally purchase kits containing the materials needed to grow psilocybin-containing mushrooms.

These kits are legal to buy and sell because they contain only mushroom spores, which are tiny reproductive cells from which mushrooms grow. Once these spores begin growing into mushrooms, they can produce psilocybin, making the mushrooms a federal Schedule 1 substance.

Because psilocybin mushrooms exist in this legal gray area and are governed by different rules across states, psilocybin mushrooms are essentially unregulated across most of the U.S.

As a result, consumers lack reliable information about what their mushrooms contain, how much they should take and how to use them safely.

Psilocybin Potency Is Increasing

Much like the cannabis industry, which has seen a steady increase in product variety and product strength since legalization, the psilocybin mushroom market is experiencing rapid growth.

For instance, psilocybin edibles are now available and increasingly popular.

In addition, selective cultivation practices are being used by individual and commercial growers to systematically increase the amount of psilocybin contained in their mushroom strains. For example, the Oakland Hyphae Cup, a community contest intended to identify the best mushroom strains, has shown wide variability in psilocybin content across samples.

Researchers are identifying a similar pattern of widely variable psilocybin content in scientific studies of psychedelic mushrooms from around the world.

Potential Harms of Psilocybin

Despite psilocybin’s therapeutic promise, it also carries risks. Psilocybin can cause headaches, nausea, dizziness and changes in blood pressure.

Less commonly, some people experience psychotic symptoms, suicidal thoughts, anxiety, paranoia, confusion or emotional distress.

Another serious potential side effect of psychedelic drugs is what’s known as hallucinogen persisting perception disorder. It involves ongoing perceptual distortions similar to those experienced while directly under the influence of psilocybin, which can persist for weeks, months or years, even once the psilocybin has left the body.

Harms are more likely when people take high doses.

As mushroom potency increases without market regulation, consumers may inadvertently ingest more psilocybin than intended, increasing the risk of harm. Without sufficient research on modern psilocybin products, consumers have little guidance on how to reduce potential harms.

Next Steps in Research and Regulation

Studying psilocybin in the real world requires creative research approaches.

Our team hopes to work within federal restrictions to study people using their own psilocybin mushroom products at home, while providing real-time data to our research team using app-based surveys.

Independent laboratories using state-of-the-art measurement techniques can aid researchers like us by providing information about the potency of the mushroom products that people are using.

While ongoing clinical trials provide important data about the effects of psilocybin under tightly controlled conditions, real-world data is needed to understand how modern psilocybin mushrooms are used and experienced by consumers.

These insights matter not only for scientists and policymakers but for the growing number of people trying psilocybin mushrooms for relief, self-improvement or out of curiosity. In a largely unregulated market, and with few clear guidelines on safe use, consumers are left to simply figure it out on their own.

Hollis Karoly, PhD, is a clinical psychologist, neuroscientist and Associate Professor of Psychiatry at the University of Colorado Anschutz Medical Campus. Her research is funded by the National Institutes of Health.

Kent Hutchison, PhD, is a Professor of Psychology and Neuroscience at the University of Colorado in Boulder and the Founder of the Center for Research and Education Addressing Cannabis and Health. His research is also funded by the National Institutes of Health.

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

Getting a Second Opinion From a Doctor Isn’t Always Practical

By Crystal Lindell

The first thing I did when I started dealing with debilitating chronic pain was go to the emergency room. The second thing I did was follow up with a local primary care physician.

But when nothing improved after a few months and multiple appointments with the doctor, I did what I had always been told to do in such a situation: I sought out a “second opinion.”

Alas, the second doctor wasn’t any help either. Neither were the third, fourth, or fifth.

If you’re dealing with any sort of complex health issue, odds are high that you’ve also had a bad experience with a doctor. Perhaps they dismissed your symptoms, refused to treat your pain, or maybe they were just plain mean.

A common refrain from healthy people in such a situation is: “Just get a second opinion.”

It comes across like common sense, especially in a consumer-culture where it’s smart to shop around. And while I wouldn’t advise against getting a second opinion – I have obviously done it myself on many occasions – there are some very important warnings that need to be included here.

One, getting a second opinion is both expensive and time consuming – assuming it’s even possible in the first place.

You can’t just leave your doctor’s office, walk next store and ask for a different doctor. You have to call around, find someone willing to take your insurance, and hope to get an appointment sometime in the next six months.  A lot of people, understandably, just don’t have the resources for such a task, especially when they aren’t feeling well.

Plus, when you do finally get in to see them, there’s a good chance they won’t be any help. So, you’re just out the time, the money, and the energy it took to get to their office.

Not to mention the fact that if you live in a rural area, a second opinion could be next to  impossible. There are many places in the United States where there literally is no second doctor within 100 miles to opine. 

Personally, I spent thousands of dollars traveling around the Midwest seeking out second opinions – including two fruitless trips to the Mayo Clinic. In the end, I was left with insurmountable medical debt and medical system burnout.

While I was eventually diagnosed with Ehlers-Danlos Syndrome, that did not happen because I sought a second opinion. It happened because multiple readers emailed me to suggest I look into it, so I brought it up to my doctor, and they sent me to a specialist to confirm it. 

Second opinions don’t just drain you though. There’s another, more hidden aspect to them as well. 

If you go to a different doctor to get a second opinion, you could be accused of something called “doctor shopping.”

The term is specifically used to dismiss patients who seek out second opinions, and most commonly, pain patients. 

It’s a code doctors use to frame a patient's desire for a second opinion as an effort to “score” opioid pain meds like a criminal.

Of course, in real life, if you’re actually dealing with horrible pain and the doctor you see is refusing to treat it, it makes total sense to look for a physician who will treat it. Any human in that situation would do the same thing. Pain refuses to be ignored. 

But common sense is not a factor if you are given the label of “doctor shopping” in your chart. Such a note will be used to dismiss all of your pain going forward.

Plus, in the age of easily transferable electronic health records, once anything like that gets put in your file, every doctor you visit will likely see it. 

So, while it’s entirely understandable that loved ones will often advise their sick family and friends to get a second opinion if they aren’t finding relief or answers from their doctor, it’s important to remember that it’s not always that simple. 

Of course, in a perfect world, patients wouldn’t even need to worry about second opinions, because the first doctor they saw would be kind, thorough and effective. We don’t live in that world though, so patients are left to navigate a lot of imperfect choices.