Do Native Americans Need a Pain App?

By Crystal Lindell

The University of Oklahoma has received a $3.4 million dollar federal grant to help Native Americans with chronic pain – and they’re going to spend all of it on an app.

The money, which is coming from a five-year National Institutes of Health grant, will go towards building the first chronic pain mobile health (mHealth) app designed by and for Native Americans. Nearly one in three Native Americans live with chronic pain, more than any other segment of the U.S. population.

In a news release about the project, the university makes clear the app will only provide behavioral and psychological assistance for pain, because “medications, while commonly prescribed for chronic pain, are also easily abused.” 

Neither of those things are true. Many Americans with chronic pain find it nearly impossible to get opioid pain medication, so they are definitely not “commonly prescribed.” And most pain patients do not abuse their medication.

The researchers referenced our country's history of horrific treatment of Native Americans — including the fact that Oklahoma was the end of the Trail of Tears — to justify this whole endeavor.

“Native American communities have experienced intergenerational trauma, and they continue to experience contemporary traumas,” said Jamie Rhudy, PhD, a professor in the OU Department of Health Promotion Sciences. “These are the types of experiences that can place our brains on high alert and amplify pain.”

It’s infuriating to read that rationale, knowing that programs like this only serve to keep an effective pain treatment away from people who need it: opioids.  

Researchers say the app will focus on things like stress management, anxiety, sleep hygiene, physical health and diet.

“All of these can be drivers and amplifiers of pain,” said Rhudy. Then, in a quote only someone without chronic pain would say, he added this:

“Chronic pain is largely a construct of the brain. We’ve been taught that we have pain because maybe our joints wear out, or we have tissue damage, but everyone experiences pain differently, which our mHealth therapies will recognize and respond to,” said Rhudy.

In short, it’s all in your head.

Then he adds: “Sleep, stress and discrimination are not variables easily targeted by medications, but they do respond well to targeted psychological and behavioral interventions.”

Actually, as a chronic pain patient myself, I can tell you that sleep and stress are both easily targeted by medications. It’s just that many of those medications are controlled substances that have been blamed for our nation’s drug problem.

We asked Tamera Lynn Stewart, an Oklahoma patient advocate, what she thought of the app. She’s glad it's being developed with direct input from Native Americans, but says it “misses the mark pretty badly” in removing barriers they face in getting pain care.  

“My problem isn’t that they’re offering behavioral tools; it’s that we’ve spent years restricting, stigmatizing, or taking away treatments that actually help people, and now we’re approaching an already underserved population with an app while heavily emphasizing discrimination and psychology as drivers of their pain,” said Stewart, National Director of the P3 Alliance, a patient advocacy group. 

“We say they are disadvantaged in receiving quality care for their pain without admitting much of it was caused by the same policies incentivizing this study. All while forgetting to mention that many historical and current drug war policies criminalized or removed the very tools the indigenous population once relied on to treat their pain.” 

Stewart is worried that a pain app designed for a very specific high-risk population will eventually be deployed as a treatment for everyone else – something the pain community has seen before.

“I’m all for adding options. I’m much less enthusiastic when ‘adding an option’ starts looking like another way to redefine the problem so the healthcare system can offer less actual care,” Stewart told PNN.

After building and testing the app, OU researchers plan to have a randomized controlled trial to see how well it works.

“With the team we have in place we’ll be able to bring all the necessary components together to develop, test and deploy a novel, culturally tailored chronic pain intervention that will be scalable,” said Rhudy.

I will definitely be keeping an eye out for the trial results – especially if the app is then pushed on the larger chronic pain community. I’ll be especially interested to see how effective the app is compared to opioid pain medication – although I doubt they will include any data on that.

It’s so disappointing to see money and energy going to projects like this, which are clearly a result of opioid-phobia. Every time a project like this is funded, it means less money and effort going toward interventions that probably have much a higher chance of actually helping people in pain.

How a Professional Advocate Can Help Patients

By Jennifer Schlinger 

Imagine your mom has just been discharged from the hospital to a rehabilitation center after hip replacement surgery. She has the paperwork, the facility’s address – and a long list of questions. 

Will her insurance cover her entire rehab stay? Does she have enough pain medication until she gets settled? Will the hospital transfer her prescriptions? Are they accurate?

Scenarios like this are exactly what patient advocates are trained to help with. They understand patients’ and families’ concerns, ensure their voices are heard by medical staff and interface with care teams, insurance companies and facility administrators. They also coordinate care, set up follow-up appointments and address potential gaps or blind spots in care.

I train social workers – who often serve as patient advocates – to help people in a variety of settings, including hospitals and nursing homes. Earlier in my career, I served as a professional patient advocate supporting people in hospitals, home health and hospice.

A trained patient advocate can provide much-needed support for people on their healthcare journey. Here’s what you need to know to work with one most effectively.

The Evolving Field of Patient Advocacy

Patient advocacy emerged out of the Civil Rights Movement’s focus on individual protections and rights. In 1966, healthcare advocacy pioneer Ruth Ravich founded the Department of Patient Representation at Mount Sinai Hospital in New York – widely considered the beginning of the patient advocate role.

Historically, doctors made decisions for patients without fully involving them in their own care. But during the 1960s and in subsequent decades, a growing patient rights movement embraced the importance of informed consent for honoring patients’ autonomy. Patient advocates arose as an important voice in this movement by educating patients about their rights and helping them participate more fully in decisions about their healthcare.

For decades, “patient advocate” was a self-described title, not a standardized role. As the healthcare system became increasingly complicated, the need emerged for national standards on skills, ethics and best practices. In 2018, the Patient Advocate Certification Board established basic requirements for patient advocates and created a professional certification, which is the only one available for this role in the U.S.

Certification is not required to be a patient advocate, but it indicates that a person has received specific training for the role. To become certified, patient advocates must pass an exam demonstrating a knowledge of health and medical concepts, issues relating to paying for care, an understanding of the healthcare system, how to work collaboratively with patients and other areas of competency. They must complete continuing education to maintain certification.

Some healthcare professionals who serve as patient advocates are not certified and instead have learned relevant skills through their education or professional experiences. They may work in rural healthcare facilities, for instance, where they wear multiple hats as nurses or social workers who are also advocates.

What Does a Patient Advocate Do?

Patient advocates are trained to support, inform and guide patients through the healthcare system. They help explain medical information, such as a medication’s side effects or treatment options. They also make sure patients’ questions are answered and their concerns are addressed.

When a patient receives a referral to a specialist, a patient advocate can connect care across various healthcare providers, making sure details about the patient’s condition or care priorities don’t fall through the cracks and helping to arrange transportation to appointments.

Early in my career, for instance, I worked at a hospital with patients who were being discharged to their home or to a long-term care facility. I started by understanding each patient’s goals, assessing their living arrangements and the type of care they needed and identifying any concerns they had about their discharge plan. 

Before they left the hospital, I coordinated community support or additional care they might need, such as home-delivered meals, home healthcare, and physical, occupational or speech therapy.

Patients often have family members who are advocating on their behalf – and family support is invaluable. Working with a patient advocate can provide something different: a grounded, objective perspective, expert knowledge of the healthcare system and knowledge of resources that patients and family members may not be aware of.

Indeed, patient advocates interact closely with family members and friends who are involved in the patient’s care. As liaisons between the patient, family and healthcare providers, their job is to keep the patient’s needs, preferences, goals and values at the center of their care.

Working with a patient advocate can help patients feel more confident in making informed decisions. According to a 2023 survey by a nonprofit alliance called the Coalition of Healthcare Advocacy, 92% of patients and healthcare providers reported that working with a patient advocate positively affected patients’ care.

Understanding Bills and Insurance Coverage

Managing financial aspects of healthcare can be overwhelming for patients and family members, particularly in the midst of a health crisis. Medical bills are often impenetrable documents littered with complex codes and terminology, and sorting through charges and details about insurance coverage can feel intimidating, if not downright paralyzing.

A patient advocate can provide a knowledgeable outside perspective on these issues that’s not clouded by the urgency and emotional weight of illness.

Some patient advocates have specialized knowledge in medical billing, coding, insurance and other financial matters. They can answer questions about medical terms or clarify charges on a patient’s bill, review the bill for errors such as incorrect or duplicate charges and assist with figuring out insurance coverage and reimbursement.

A healthcare advocate can help make sure that patient’s needs, preferences, goals and values remain at the center of their care.

If necessary, they can also appeal claims by acting as a liaison between the patient, the healthcare facility and the insurance company. Patient advocates can also help patients work with a hospital to set up a payment plan, explore additional financial support or coordinate access to community resources.

If a finance-related question falls outside an advocate’s knowledge or expertise, they can help the patient identify the right people to talk to.

Finding and Working with a Patient Advocate

Finding a patient advocate is not always as straightforward as it should be.

If you are unsure where to start, ask to speak with a hospital social worker or case manager. In some cases, an advocate’s services are provided by the healthcare organization or are covered by insurance, but in others, the patient or family must pay for them out-of-pocket.

Many healthcare facilities, including Veterans Affairs, have patient advocates on staff. You can contact your local hospital or clinic and ask to be connected to their patient advocate. 

Alternatively, you can search for a patient advocate in your area through the Centers for Medicare and Medicaid Services website or the National Association of Healthcare Advocacy.

If a certified patient advocate is not available within your healthcare facility, request to speak with a social worker. Social workers have the education and expertise to support patients and families, to connect them with resources and to advocate for patients’ needs.

Before meeting with a patient advocate, identify your main objectives – for example, preparing for a transition home, clarifying a treatment plan or understanding medication changes. Then, write down your main concerns and questions. The Care Partner Project offers checklists for questions to ask healthcare providers, prepare for doctor visits, evaluate senior living communities and more. Gather any relevant information, such as medication lists, medical records, insurance documents and medical bills.

When you meet a patient advocate you’re considering working with, you can feel out whether they are a good fit by asking about their professional background, areas of expertise, experience and credentials. Some questions you might start with include:

• What is your experience with cases like mine? (For example, patients being transferred to a rehabilitation center, if that is your situation.)

• Can you provide an example of how you helped a patient or family work though a difficult healthcare situation?

• How do you typically communicate with patients and families, and how often can I expect to hear from you?

• How do you help patients speak up about their concerns and preferences to their healthcare providers?

Finding a healthcare advocate you trust can make navigating a complex health situation much less overwhelming.

Jennifer Schlinger, PhD,  is a Clinical Associate Professor of Social Work at the University of North Dakota

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

I Was Shocked How Effective Shockwave Therapy Can Be

By Madora Pennington

I have an old knee injury. You probably have one, too. 

Or maybe it’s your hip, ankle or elbow.  Something that flares up from time-to-time and makes you say in frustration, “This old thing. Again?”

Decades ago, I slipped. Wearing heels as I was climbing into an SUV in the rain, my kneecap came down on the running board, stretching out the tendon. My knee swelled to the size of a baseball. Tendons stretched like that do not snap into their old shape. I have been limping ever since.

There is no simple surgery for a patella alta (high kneecap) injury. Over the years, I tried physical therapy, knee braces, taping the kneecap in place, prolotherapy (sugar injections) and platelet-rich plasma injections (PRP therapy). 

All of those helped to some degree. But still my knee continued to bother me, often when I did activities that I love, like tennis and running. 

It became so annoying, I thought it was time to work on it again.

Healing Shocks That Reduce Pain

In looking around for new modalities, I found something I had never heard of: Extracorporeal Shockwave Therapy (ESWT).

ESWT is a noninvasive treatment that uses a device applied to the skin near injured areas that emits high-energy acoustic sound waves that promote healing and repair tissue. 

Shockwave therapy was originally developed to break up kidney stones without surgery. Once shattered into smaller sizes, kidney stone fragments pass out of the kidneys easier and exit the body with the urine. 

The treatment on kidney stones was successful, but there were concerns that the shockwaves were so intense they might damage nearby bones. It turns out the shocks actually stimulate new bone formation. Later investigations showed that shockwaves at a different dose could also stimulate cellular regeneration in soft tissue. 

In 2000, the FDA approved a shockwave device for chronic plantar fasciitis (pain in the soles of the feet). And in 2002, the FDA approved another device for the treatment of tennis elbow, a repetitive strain injury common to tennis players.

Like nearly all technology, today’s ESWT devices are smaller, cheaper and easier to operate effectively. Most protocols suggest several sessions separated by about a week. Unfortunately, they are usually not covered by insurance.

ESWT can be used on a wide variety of conditions that would normally send a patient to physical therapy, such as tendon injuries, slow-healing bones, arthritis, calcific tendonitis of the shoulder, and more. 

Shockwave therapy can encourage bone formation, new blood vessels, growth factors, healing in tendon cells, and collagen remodeling, while lowering inflammation and pain signaling.

Shocking My Knee 

Studies on ESWT for a kneecap injury such as mine showed mixed results and were not very promising. But that did not deter me. 

I was happy to try something besides an injection, especially something that could reawaken dormant healing processes. Having physical therapy along with ESWT was also recommended, so I did that, too.

Shockwave therapy sounds like it could be painful. A few times during my treatments, it was. The tech can turn down the machine if the zaps are too much. Because stronger pulses are more effective, I tried to endure them. 

The shocks were oddly pleasant, giving me a bit of an adrenaline rush and immediate relief. The tech did not isolate her treatment to just the joint. She used it around the neighboring tissue and muscles.

After my second treatment, to my utter delight, going up and down many flights of stairs was easy for my knee. It actually felt good. My kneecap held firmly in place, not snapping around as it can. 

This was a faster, more significant improvement than any treatment I have had in the past.

I purchased a package of shockwave treatments and had more sessions to use, but my knee felt like it didn’t need any more shocks. So I switched to having ESWT on overworked areas that have helped my body compensate for the deficiencies in my knee. The overused muscles in my pelvis and neighboring hamstring helped keep me balanced as I unconsciously favored the injured knee.

The shockwaves flowing through my back and glute muscles were intense, but just as soothing as they were on my knee. I could feel them all the way through to my hip joint. The treatment lifted feelings of stress that I was not aware of, perhaps by allowing more blood flow around the nerves caught under all my musculoskeletal stress. 

This other-side treatment accelerated my physical therapy progress. In fact, my physical therapist’s assessment was that the knee itself was in good shape — it was the old compensatory muscle patterns that were causing me pain, like the shortened thigh muscle pulling the kneecap and causing discomfort. 

Those other modalities I pursued in the past may have been effective, but I never had the full course of physical therapy the injury needed until now. Perhaps this is why the studies I read recommend physical therapy in addition to ESWT in order to get the best result. 

Time will tell if my old knee injury and the package of dysfunction surrounding it can be resolved. I am optimistic. My tennis has never been better, as formerly tight, overworked muscles are free to support my swings. Running is not bothering my knee at all. 

I would try ESWT again on other unhappy joints and tissue in the future.

Chronic Pain Patients Have Highest Rates of Stigmatizing Language in Medical Records

By Crystal Lindell

Chronic pain patients are the most likely group to find discriminating and judgmental language in their medical records, according to a new study published in JAMA.

The researchers also found that having a low income increased the likelihood of patients finding stigmatizing language in their records. Being older decreased the chances of finding it.

The research is based on a survey of 500 people from a nationally weighted sample of U.S. adults. The study was made possible by passage of the 21st Century Cures Act in 2021, which began a new era of transparency in healthcare by giving patients immediate access to their clinical notes in electronic health records.. 

About 1 in 6 patients (17.1%) reported discriminating or judgmental language (DJL) in their medical records or health care encounters. Such stigmatizing language was defined as any terminology that "conveys disbelief, disapproval, or implicit judgment about a patient’s character, behavior, or social identity.”

Researchers anticipated that medical providers would be more careful about their choice of words, knowing patients might see them. But five years after passage of the Cures Act, there was “little if any improvement” in stigmatizing language.  

“Our findings are consistent with a broader literature on stigma and health communication, demonstrating that DJL can undermine trust, reduce patient engagement, and negatively influence patient perceptions of health outcomes,” wrote lead author Natasha Steele, MD, Stanford University School of Medicine. 

A major limitation of the study is that only 16 of the 500 patients were diagnosed with having chronic pain, a very small sample size. Steele and her colleagues found that those sixteen patients were 3.25 times more likely to find stigmatizing language in their medical notes, compared to people who did not have chronic pain. It was the highest rate of any group in the study.

Low-income patients were 2.64 times more likely to find discriminating and judgmental language, compared to other income groups.

Interestingly, older people were slightly less likely to find stigmatizing language compared to other age groups. For each additional year of age, the odds of finding it dropped by about 2%.

Beyond that, the researchers did not find links between gender, race, ethnicity, or educational level and the likelihood of patients finding stigmatizing language.

Not surprisingly, finding negative language in their medical records made patients less likely to trust that their medical providers were doing a good job of documenting their health issues. 

About 85 percent of patients said they were less likely to see that clinician again and 75% worried it would influence their treatment. A similar percentage thought it would lead to worse health outcomes, including the possibility of medication or diagnostic errors. 

The stigmatizing language was also associated with nearly 6-fold higher odds of diminished trust in clinicians to write accurate and respectful notes.

The researchers said that while health record transparency is a good thing, clinicians need to change their note-take practices in response.

“Our study demonstrates the need for clear standards promoting respectful communication in both medical documentation and clinical interactions. Clinical training programs should emphasize person-centered language, particularly since written notes are increasingly visible to patients, with special attention to populations that may be subject to bias based on social identity,” they said.

Clinical Trials Begin in U.S. for First Cannabis-Based Medicine for Chronic Pain

By Pat Anson

The first clinical trials in the United States for a cannabis-based medicine for chronic pain are getting underway.

New York State has authorized a clinical trial of VER-01 in patients with chronic low back pain from lumbosacral radiculopathy, commonly known as sciatica. VER-01 was developed by Vertanical, a German biopharmaceutical company, and recently became available by prescription in Europe, where it is sold under the brand name Exilby.

Exilby is a full spectrum extract derived from THC, CBD and terpenes found in cannabis sativa. Unlike other cannabis-based medicines already on the market, such as Epidolex and Marinol, which are used to treat epilepsy and improve appetite, Exilby was specifically developed to treat chronic pain.

“This is an important moment for cannabis research in New York and for the future of evidence-based cannabis medicine,” John Kagia, executive director of New York Office of Cannabis Management (OCM), told The Marijuana Herald. “For decades prohibition and criminalization limited the ability of researchers to fully understand cannabis and its potential therapeutic applications.”   

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s longtime status as an illegal Schedule One controlled substance. Marijuana is now more readily available for research purposes, but there’s a lot of catching up to do with the rest of the world.

“Clinical research allows us to move beyond anecdote and evaluate cannabis-based medicines with the same rigor applied to any other therapy,” said Nakesha Abel, PhD, Director of Scientific Programs & Research Health & Scientific Affairs at OCM.

Vertanical has also begun recruiting patients in Texas for a Phase Three clinical trial of VER-01 with 810 participants. Researchers are looking for patients with chronic painful lumbosacral radiculopathy who have previously used non-opioid analgesics that were not sufficient for pain relief or caused unwanted side effects. 

In studies already completed in Europe, VER-01 provided better pain relief to patients with chronic low back pain in a head-to-head comparison with low doses of opioids. Vertanical is also studying VER-01 as a treatment for osteoarthritis and painful diabetic peripheral neuropathy 

Exilby became available in Germany and Austria in September, with approval in the United Kingdom expected by the end of the year.

In March, VER-01 received a Breakthrough Therapy designation from the FDA, which will speed up its development and review in the U.S. But even with “breakthrough” status, a new drug application for VER-01 to the FDA is not expected until 2028.  

I’ll Never Stop Advocating for 7-OH

By Crystal Lindell

It looks like the federal 7-OH ban is actually going to go through this time, and it’s probably going to happen right before Thanksgiving, on November 13.

I guess they just want to make sure everyone who uses 7-OH is miserable and in pain for the upcoming holiday season. Cheers!

RIP 7-OH. You changed my life, and died far too young.

The fact that they aren’t even taking public comments this time is gut-wrenching. They really don’t care about us at all. 

But I will say that I am grateful that we still have one last month with legal 7-OH. I have tapered down significantly, and have hope that I can get fully off it in the next few weeks with almost no physical withdrawal symptoms.

Unfortunately, as a chronic pain patient, it’s not just about avoiding physical withdrawal. I’m still not sure how I’m going to functionally live my life without it.

In fact, when I got the news on Friday that the DEA had updated their letter of intent, I had just taken my morning 7-OH dose, which I need to be able to get ready for the job I only have because of 7-OH.

I’m very worried that I’m going to lose my job when I lose 7-OH.

I started working full-time again in April, and it’s been great! I have already worked my way up to manager, and finally have health insurance again.

I also have called in sick zero days since I started, despite the fact that I have intercostal neuralgia in my ribs, which causes extremely debilitating pain throughout the right side of my torso.  

Over the 13 years I’ve suffered from it, it’s been very difficult to find any medications that help with that pain. Even strong opioids only did so much. I worked a corporate job from home for many of those years, and even with morphine and hydrocodone, I would have to miss work because of the pain.

But then 7-OH came along and changed my whole life.

The fact is, 7-OH works on my pain. It works really well. And, it even helps me with energy as well. I assume that is because 7-OH comes from kratom, which comes from the coffee family of plants.

There’s some controversy in the 7-OH community about whether or not it’s relevant that it comes from the coffee plant rather than poppy plants. Some people say it’s disingenuous to pretend that 7-OH doesn’t impact your brain’s opioid receptors, which it definitely does.

But so does coffee. And as a user, I think it’s disingenuous to try to separate 7-OH entirely from coffee.

It is clearly a coffee-related drug. Coffee is one of those things that you will naturally drink less of if you don’t need it, and in my experience it will even start to taste different. As it happens, this is also my experience with both kratom and 7-OH. My body does not want to take more when I don’t need it.

I used to drink 2 cups of espresso a day, but since I started taking 7-OH, I’ve quit coffee entirely. I just have no taste for it, and the 7-OH does a much better job of giving me the stable energy I need to get through the day.

Before I end this column, I do want to reiterate that I will never again be purchasing any products from any of the ”qualified vendors” that support the American Kratom Association. I would call on all fellow 7-OH users to boycott them as well.

The AKA fought for this 7-OH ban because they think it’s eating into their profits.  

So, instead of making their own products more competitive, they decided the best course of action was to prevent people like me from using their competitors’ products. 

Even worse, the U.S. government is going to enforce the ban, by imposing “administrative, civil, and criminal sanctions applicable” – not just on 7-OH manufacturers, distributors and retailers, but for simple possession. Even research about 7-OH will be a criminal offense!

Land of the not-so-free, I guess.

I don’t know what my future looks like without 7-OH – but I do know what my past looked like without it. Multiple days each month bed-bound, unable to reliably show up for work, no health insurance, and lots of really, really bad pain days.

I refuse to accept that I will be forced back into that life, and that there are no other options. 

I’ll never stop advocating for 7-OH to be legal, no matter how hopeless that fight feels. After all, if medical cannabis can be reclassified and taken out of Schedule One, anything is possible. 

The life I have rebuilt is too valuable to give up on now.

Nationwide 7-OH Ban Likely to Begin Nov. 13

By Pat Anson

The U.S. Drug Enforcement has amended its scheduling order for 7-hydroxymitragynine (7-OH), placing further restrictions on the manufacture, sale and possession of concentrated forms of the kratom alkaloid.  

Under the amended order, to be published next week in the Federal Register, 7-OH products and all other concentrated kratom alkaloids will be classified as illegal Schedule One controlled substances. The order will likely take effect November 13, with no opportunity for public comment.

Kratom leaves have been used for centuries in Southeast Asia as a natural stimulant and pain reliever. Their active ingredients – 7-OH and other alkaloids – occur naturally in kratom in trace amounts. But in recent years manufacturers have found ways to concentrate the alkaloids in new products – essentially turning a mild pain reliever into a potent product with opioid-like effects.

7-OH and other kratom derivatives were recently involved in the deaths of two college students, and there is concern about their potential to cause addiction and overdoses. Three U.S. Senators this week called for all kratom related products to be scheduled or banned – including leaf kratom.     

That created further pressure on the DEA and Justice Department to act. 

“Our nation’s children and communities deserve protection from harmful substances like 7-OH and other powerful synthetic drugs. The actions taken by the Department of Justice today reflect our commitment to keeping Americans safe and holding drug traffickers accountable,” Attorney General Todd Blanche said in a DOJ press release.

Left unsaid in the press release is that the DEA’s amended order is largely in response to a lawsuit by the American Kratom Association (AKA), which represents natural leaf kratom vendors. The AKA supported the scheduling of 7-OH, but wanted a “carveout” for mitragynine pseudoindoxyl, a kratom alkaloid that the DEA banned just two months ago.

The AKA filed a lawsuit against the DEA in July, asking a federal judge to intervene and get the DEA to amend its original orders banning sales of 7-OH and mitragynine pseudoindoxyl.

“They actually did two things that were important. One is they established a carveout for mitragynine pseudoindoxyl, and they changed the standard for 7-OH to a much more restrictive standard, which we fully support because it captures more of the potential synthetic products that they could tinker with,” explained Mac Haddow, an AKA lobbyist and spokesman.

Under the new order, the ban on mitragynine pseudoindoxyl is being lifted to keep it from potentially interfering with sales of leaf kratom. Only trace amounts of 7-OH and mitragynine pseudoindoxyl will be legally allowed in tablets, gummies and liquid shots (1 mg per serving). A 100 to 1 ratio of mitragynine to the other alkaloids – what occurs in nature – must also be preserved. 

AKA Lawsuit Withdrawn

The new DEA order amounts to a major legal victory for the AKA, and comes at the expense of 7-OH manufacturers and vendors, whose products were taking a substantial amount of business away from leaf kratom vendors. 

“We made an agreement to dismiss our lawsuit, but it's conditioned on their publishing under the schedule that they submitted to the court,” said Haddow. “The thresholds draw the line the AKA has been asking for, targeting chemically manipulated opioid products while protecting natural kratom leaf that may contain only incidental trace amounts of these compounds.”

Not surprisingly, 7-OH manufacturers and consumers were disappointed by the DEA’s new order, but held out hope that changes could be made before November 13. Tens of thousands of Americans use 7-OH to relieve their pain, anxiety and fatigue, allowing them to work, care for family, and stay away from more dangerous substances. 

“This is still a Notice of Intent, not a scheduling order,” the 7-HOPE Alliance said in a note to advocates. “It gives us more time to fight, more time to negotiate with the administration, more time that consumers can safely access products they rely on.

“The revised proposal would still threaten access to 7-OH products. We do not agree with how these new thresholds are being set. Once again, this approach favors certain product categories over others without fully considering the consumers who depend on them.”  

While leaf kratom remains legal under federal law, it has been banned by dozens of states, cities and counties. The AKA hopes those local jurisdictions follow the DEA’s example, by taking leaf kratom out of their wholesale bans on 7-OH and other kratom derivatives.

 

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

By Pat Anson

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

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

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

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

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

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

(Update: The DEA now intends to implement the ban on November 13.)

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

Confusion Over Letter

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

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

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

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

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

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

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

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

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

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

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

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

Fear and Worry Living in 7-OH Limbo

By Crystal Lindell

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

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

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

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

(Update: The DEA now intends to implement the ban on November 13.)

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

But it's all very stressful.

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

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

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

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

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

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

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

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

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

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

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

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

For now, all I can do is anxiously wait.

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

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ketamine Infusions Effective in Reducing Fibromyalgia Pain

By Pat Anson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Pat Anson

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

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

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

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

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

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

Lifespan Pain Projections for 11 Body Areas

NATURE MEDICINE

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

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

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

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

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

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

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

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

Exploring the Connection Between Chronic Pain and Dementia

By Cynthia Toussaint

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

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

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

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

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

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

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

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

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

lEONA AND CYNTHIA

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

I fear that I may be, too. 

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

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

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

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

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

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

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

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

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

But I can still help others in her name.

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

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

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

Most Cancer Survivors Have High-Impact Chronic Pain

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are More Seniors Addicted to Cannabis?

By Pat Anson

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

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

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

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

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

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

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

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

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

The 11 Cannabis Use Disorder Criteria

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

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

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

4. Experiencing intense urges, desires, or cravings

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

6. Continuing use despite recurring social or relationship problems

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

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

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

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

11. Experiencing withdrawal symptoms

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

‘Our Definition of CUD Is Broken’

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

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

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

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

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

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

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

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

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