Public Comments Show How 7-OH Ban Would Harm Pain Patients

By Crystal Lindell

Leigh Ann Matthews is a 51 year old woman with chronic pain. She lives alone, makes less than $2,000 per month, and can’t afford health insurance.

She relies on 7-OH for pain relief, and doesn’t know how she’ll be able to work if it’s banned.   

“Please don’t make me suffer with chronic pain by taking away the ONLY thing that has helped me tremendously,” she wrote. “I have no family or friends to lean on or help me. I don’t abuse 7-OH. I’m so afraid.”

Matthews is one of the thousands of people who have shared their stories in the Federal Register in response to the DEA announcing plans to make concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) an illegal Schedule 1 controlled substance.

As of July 24, more than 20,000 comments had been submitted to the Department of Health and Human Services (HHS).  Reading through them makes some common themes jump out. There are thousands of personal, individual stories that are clearly coming from real people with real fears. 

Many are chronic pain patients, who say that 7-OH has given them their lives back. In fact, a search for the phrase "my life back" turns up 290 comments. A search for "chronic pain" returns 2,608 results.

"I'm a 50-year-old male with multiple sclerosis. I live my life with chronic pain,” wrote Gabriel Duley. “It is so hard to get out of bed to even take a shower. Doctors do not prescribe pain medications. Please do not take 7-OH away. It's the only thing that has given my life back to me."

Tyler Bartone is 30 years old and lives in Ohio. He wrote that he has suffered from chronic pain since he was 22, after a motorcycle accident broke both of his legs.

"Oxycodone, hydrocodone, Suboxone, and tramadol all got tried over those years, and none of them let me function the way I needed to,” Bartone wrote. “When I found 7-OH, that changed. I can walk my dogs now. I can play with my kids. I stopped relying on opioid pain medication because this actually worked for my pain in a way [that] those didn't."

He shared that he takes 30 to 60 mg of 7-OH spread across 4 to 5 doses a day, and that amount has stayed steady for the 1 to 2 years he has used it. 

"What scares me is what happens after a ban like this. People in my situation, and others I know who rely on 7-OH daily just to function, would be left with two options: go back to opioid prescriptions that didn't work as well, or turn to street drugs,” Bartone explained. “I know people would die from that second option. That is the real hazard here, not the milligrams in a tested tablet.”

Bartone said he would support rules that “keep this market honest.” Rules like a 21 and up age requirement, mandatory lab testing with published results, child-resistant packaging, and clear dosage labeling. 

Unrealistic Threshold

The DEA’s scheduling order limits the amount of 7-OH to no more than 0.05% of a product by weight or volume, the equivalent of about 0.5 mg 7-OH per tablet. Virtually all 7-OH products currently on the market have much higher dosages. Bartone thinks it’s an unrealistic threshold.

“I'm asking HHS to set any threshold based on how people actually take this, not a number that erases the product entirely,” Bartone said. 

Katherine Loperena, a 33 year old who works in sales and suffers from chronic pain, also shared her story. She said for the past 1 to 2 years she has used more than 60 mg of 7-OH a day, split across 2 to 3 doses. 

"What scares me most is going back to the days when chronic pain decided whether I could work or not," she wrote. "I lost jobs because the pain became too much to push through, and I spent years choosing between showing up in agony or protecting my income. Before 7-OH, I had tried oxycodone, alcohol, cannabis, and over the counter pain relievers, and none of [them] gave me a real way to manage day to day life."

Lindsay Huffman also shared how 7-OH has helped her manage the chronic pain she’s had for five years.

“Without it, I would have no way to treat my pain,” she writes. “It has been massively beneficial to my quality of life. Banning it would affect thousands of people who just want to be able to function and have finally found some hope."

Kyle Whitman wrote just one sentence: "Please don’t do this."

Lane Reeves said simply, "This (7-OH) should be available for chronic pain patients with no insurance!"

Rolando Smith shared how he uses 25 to 50 mg of 7-OH daily, which he says “has made my life so much more enjoyable through the ability to no longer feel immense pain all day long.”

“I take 7-OH not to feel anything such as a high, but rather to just eliminate the feeling of pain that usually lasts hours each day,” Smith explained. “7-OH is a perfect substance for my pain compared to other painkillers I have received as I am not a fan of overly euphoric or ‘high’ feeling drugs.”

Smith said he’s had no issues with withdrawal or dependence from using 7-OH.

“I've been an on and off user for about a year now, and find it easy to quit when I want to lower my tolerance or run out of supply and feel too lazy to get more. Personally I have not felt negative effects physically or mentally with using this substance and I never feel the need to take any more than what makes my pain disappear,” he wrote.

Patricia Metz shared how she takes 7-OH a few times a week to help with chronic pain from a serious injury. Without it, she doesn’t think she’d be able to work and provide for her child.

"This product has given me back a quality of life I couldn't otherwise have," Metz writes. "I have had six surgeries, countless hours of physical therapy, and spent years working with pain management with no meaningful result. 7-hydroxymitragynine is far safer than prescription pain management and far more accessible.

“There are thousands of people with a similar story who rely on 7-OH, many of whom are scared to death right now because they feel the rug being pulled from under their feet and see a future of pain ahead. I fear that removing access to this valuable resource will drive a good number of those people to dangerous and deadly street drugs."

The American Kratom Association (AKA), which represents natural leaf kratom vendors who have lost market share to 7-OH, is in favor of banning 7-OH products. It recently sent a letter to HHS, claiming many of the public comments in support of 7-OH are ”Coordinated, Duplicate, Fictitious, and Financially Incentivized.”

According to the AKA, many of the comments are anecdotal personal stories that should not be considered as part of the scientific analysis of an appropriate 7-OH threshold. The letter also said some 7-OH vendors are offering discounts to consumers who show that they have left a comment. 

There is still time to leave a public comment on the scheduling of 7-OH before the July 31 deadline. 

In 2016, the DEA dropped another effort to ban kratom after a public outcry. At the time, the DEA received over 22,000 public comments in the Federal Register, a record number on any issue. It seems likely that record will be broken again.

Swimming Reduces Disability From Chronic Low Back Pain

By Mark Hancock and Deborah Wareham

As we age, low back pain becomes more common. Between the ages 20 and 59, persistent low back pain (lasting more than three months) affects nearly one in five.

While you may be tempted to reach for heat packs, medication or a massage, new evidence suggests that the common advice to go for a swim is much more effective.

Until recently, there was no research to back up this advice. Our new trial shows for the first time that swimming can improve low back pain.

What We Did

We recruited 76 adults aged 26 to 74 who experienced persistent and bothersome low back pain for more than three months. They needed to be able to swim 25 meters (82 feet) independently, but didn’t swim regularly.

The participants were randomly allocated to receive either a swimming and education program (the intervention group) or education only (the control group).

The intervention involved an eight-week individualised swimming program, supported by four telehealth sessions with a physiotherapist, and free access to a local indoor or outdoor swimming pool.

The amount of swimming was tailored to each participant’s ability and fitness level, with the goal of completing three 30–45 minute swimming sessions per week by the end of the program. Participants were encouraged to continue swimming after the program completed.

The education, provided by a physiotherapist, aimed to help them better understand their pain, reduce the fear associated with movement and exercise, and increase confidence to manage their back pain.

While many people with back pain believe they should avoid activity to protect their back, a large body of evidence shows remaining active is better.

Participants in the education-only (control) group had one to two sessions with a physiotherapist to cover the same key messages about back pain, but otherwise continued their usual treatment and activity.

What Did We Find?

Participants in the swimming group reported improved function, less pain and more confidence to manage future back pain.

Their disability reduced by more than 50% at the end of the eight-week program. This could mean that a person improved their ability to do daily activities such as standing from a chair, walking or sleeping.

The swimming group’s improvements were 30% greater than those who received education only (control) group.

Participants told us swimming appealed to them because it was low-impact, it reduced weight-bearing and strain, and it enabled them to exercise more confidently and with less pain. They also reported additional health benefits, including better mood.

Swimming can be used as a way for people with back pain to start exercising and break the cycle of pain and limited activity.

At the end of the eight-week program, some people kept swimming, others swapped to another form of exercise and some stopped exercising.

Although most participants reported enjoyed swimming, some found accessing a pool and the time required a barrier to keep going in the longer term.

Twelve months after starting the program, there were still benefits for the swimming group for disability, function and confidence. But the difference between groups became smaller over time.

Our study’s sample size was relatively small, so these findings need to be confirmed in future, larger studies.

Further trials are also needed to test whether the results still hold for people with more severe or disabling back pain.

Finally, the volunteers in our study knew we were investigating swimming and had positive expectations of swimming before starting. This is a limitation that could affect the findings.

Swimming vs Other Exercises

A range of different exercises – including Pilates, functional exercises (a type of strength training that helps you perform daily activities) and structured walking – have been shown to be beneficial for treating disability and preventing low back pain recurrences.

While we didn’t compare swimming to another type of exercise, the benefits we identified were as large or larger than previously reported for other exercises.

People with chronic low back pain can now consider swimming as an evidence-based exercise option and be more confident in choosing it as part of their long-term management.

But if you find it a hassle to get to a pool, or don’t like swimming, it may help get your back pain under control before moving to a type of exercise you prefer or can more easily access.

Mark Hancock, PhD, is a Professor of Physiotherapy, Faculty of Medicine and Health Science, at Macquarie University in Australia. 

Deborah Wareham, PhD, is a Research Fellow at the Spinal Pain Research Centre at Macquarie University.

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

There’s Still Time to Fight the 7-OH Ban

By Crystal Lindell

It’s a bizarre experience to know that something you take on a daily basis is probably about to become an illegal Schedule 1 controlled substance.

If I take a tablet of the concentrated kratom alkaloid 7-OH on July 31, I’ll just be taking an OTC supplement. 

But assuming the proposed ban goes through, simply possessing the same tablet in August will technically mean I am committing a felony. 

The Drug Enforcement Administration says the 7-OH that I take to manage my chronic pain is so dangerous and medically worthless that it belongs in the same category as LSD and heroin. But they also think it’s fine to leave it legal for one last month.

None of it makes any sense.

Don’t get me wrong, I’m eternally grateful that 7-OH was not instantly made illegal. It gives tens of thousands of people like me time to taper off it.  

But nothing will change about 7-OH in August to suddenly make it more dangerous, other than the way the Trump administration has decided to classify it.

It’s difficult to manage life during such an abrupt transition. I will have to basically teach my brain that one of my supplements is now the kind of thing that could trigger a police raid on my home and get me fired from my job. 

Yes, I have been tapering myself off 7-OH. Of course I have been tapering. Anything less would be irresponsible.

I have successfully tapered from about 80 mg a day down to 25 mg a day. It was not very difficult to drop down my dose that much. I did a little more each day and had almost no withdrawal symptoms. There were a couple days when I was a little more anxious, but that was it.

When I was still living under the impression that 7-OH would remain widely available and legal, I took it whenever I had pain. But now, since I know that it will likely be illegal soon, I only take it when the pain is so severe that I cannot function without it.

Unfortunately, that presents a pretty big problem: What am I going to do when it’s illegal and my pain is so severe that I cannot function without it?

Despite the fact that I have lowered my dose so much – it’s the next 10 days that I’m really scared of. Because that’s when I have to figure out how to live with zero 7-OH. 

I still need it to get through a shift at work, even when using it in combination with opioid medication and  OTC pain relievers. In fact, I still need 7-OH to get through the physical strain of taking a shower.

One thing I love most about 7-OH is that it works immediately whenever I take it. And it’s a chewable tablet, which means I don’t even need a drink of water to swallow a pill.

That makes it an amazing pain reliever for when I’m working. And it makes it super helpful for when I’m on a strict time schedule. Needing to wait 30-40 minutes for a medication to kick in steals so much time out of my day.

There just is no alternative that helps me as much as 7-OH. As such, writing this column genuinely saddens me.

It’s not just grief for myself and what I will have to endure when I can no longer take the most effective pain reliever I’ve ever had. It’s the fact that tens of thousands of other people will also be losing the same thing at the same time. 

Advocacy groups think the total number of Americans who have used 7-OH is as high as one million. That’s a lot of potential felons. Some of them are my loved ones. 

I have seen firsthand how 7-OH has relieved their pain and given them their lives back – in ways I never could have dreamed just two years ago.

I don’t want people to get a false hope that the DEA could backtrack on this, like they did with the kratom ban in 2016. But I also know that doesn’t mean we should just give up.

We have to keep fighting, not just for ourselves, but for all the people who could be helped by this soon-to-be illegal substance.

If you support legal 7-OH, please go leave a public comment on the Federal Registrar. Here are links to the public comment page and the comment portal. Over 17-thousand people have commented already. The deadline is July 31.

Personal comments will have more of an impact. It’s important to remember that they are only asking for a threshold amount of 7-OH that should remain legal. So you should share what dosage you safely take on a daily basis.

We have not lost yet. As such, we can’t stop fighting for this either. 

Palmitoylethanolamide (PEA): A Natural Treatment for Intractable Pain

By Dr. Forest Tennant and Ingrid Hollis 

Palmitoylethanolamide (PEA) is a naturally occurring biochemical produced by the body for pain and inflammation control. It is also available as an over-the-counter dietary supplement. 

This article is presented with our belief that essentially every person with intractable pain should try a PEA supplement in a therapeutic trial.  Several companies market PEA supplements and researchers have determined effective dosages. 

PEA is the only medicinal that simultaneously fights inflammation at the site of an injury, as well as neuroinflammation in the central nervous system (CNS).  It helps heal damaged glial cells that are responsible for intractable or constant pain. 

About two dozen double-blind clinical studies have shown that PEA is more than just a placebo. German researchers say PEA is an effective and well-tolerated treatment for hundreds of patients with chronic pain.    

Our experience is not as extensive, but we have found that about 80% of patients experience good results if PEA is used for four to six weeks, providing relief for both chronic and intractable pain.  In most patients, PEA progressively wears down baseline pain. 

Starting dosage is 600 to 1200 mg twice a day.  This dosage can be increased if needed.  

Some PEA products contain luteolin, a polyphenol found in many fruits, vegetables and herbs that has anti-oxidant and anti-inflammatory properties. This is excellent as luteolin boosts the effectiveness of PEA, and also helps prevent the reactivation of the Epstein-Barr virus. 

One can simply add PEA to their current pain relief program.  Opioids and other pain medications need not be stopped. 

No serious side effects have been reported from taking PEA. As a natural biochemical, it is quite safe to take.  

If you have chronic or intractable pain, try a 1-to-2-month therapeutic trial of PEA. You have much to gain and nothing to lose. 

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 bulletins here.

Ingrid Hollis is a person in pain, patient advocate, and advisor to the Tennant Foundation.

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

Hydrocodone Is Better Than Oxycodone for Post-Operative Pain

By Pat Anson

When it comes to treating post-operative pain, hydrocodone works better than oxycodone in relieving pain and does it with smaller doses, according to a new study that compared the effectiveness of the two opioids.

A team of researchers evaluated health data for 663 patients who had elective joint arthroplasty on their hips or knees, a major surgical procedure where a damaged or arthritic joint is removed and replaced with an artificial one. About a third of the patients took oxycodone for post-operative pain, while the rest received hydrocodone. 

Nearly 1.25 million joint arthroplasty procedures are performed annually in the US, and many patients experience significant pain during recovery. Oxycodone is generally considered more potent than hydrocodone, and is typically prescribed more often for post-operative pain.

The study findings, published in JAMA Network Open, show that patients on hydrocodone had slightly lower pain scores 10 days after surgery than those who took oxycodone. 

They also needed significantly less morphine milligram equivalents (MMEs) over the course of their post-op recovery (93.2 MME for hydrocodone vs 134.8 MME for oxycodone).  

“We observed that patients prescribed hydrocodone had lower composite pain scores over the 10-day postoperative period, and their total opioid consumption (in MME) was significantly lower, compared with patients prescribed oxycodone. Therefore, we rejected our initial hypothesis that oxycodone provides better pain control than hydrocodone,” wrote lead author Julie Johnson, PharmD, Director of the Clinical and Translational Science Institute at The Ohio State University. 

It’s important to note that all of the participants in this study had the CYP2D6 gene, which makes them normal metabolizers (NMs) of opioids. Had they had a variation of the gene, oxycodone may have performed better, according to researchers. About 10% to 15% of individuals have those variants.

“Our findings have practical implications for postoperative pain management, especially in the context of personalized medicine and opioid-sparing strategies. For patients who are CYP2D6 NMs, a multimodal approach with hydrocodone appears to be a safe and effective option for managing acute post–total joint arthroplasty pain, achieving pain relief that was comparable to or better than oxycodone, with a lower MME,” Johnson wrote.

The hydrocodone and oxycodone formulations used in the study contained acetaminophen. Both groups also utilized other pain relievers, such as NSAIDs, nerve blocks and tramadol during their recovery. There were no significant differences in mobility, anxiety, and depression between the hydrocodone and oxycodone groups.

First Successful Treatment of Arachnoditis Published

By Dr. Forest Tennant

For the first time since arachnoiditis was identified and defined in medical dictionaries in 1873, patients and physicians now have a successful peer-reviewed treatment for chronic adhesive arachnoiditis (AA). 

I and my associates, Dr. Martin J. Porcelli, and Jennifer Sands, RN, have just published the results of a small study, “Low Dose Methylprednisolone and Ketorolac Treatment for Adhesive Arachnoiditis” in the International Journal of Emergency Medicine & Pain Management.

AA is a progressive inflammatory spinal disease in which cauda equina nerve roots become bound by adhesions to the arachnoid membrane, often resulting in severe intractable pain, neurologic impairment, loss of mobility, bowel and bladder dysfunction, and profound functional decline.

In our study, 20 patients with AA achieved symptomatic pain relief with low, intermittent dosages of the corticosteroid methylpredisolone and ketorolac, a non-steroidal anti-inflammatory drug (NSAID). The key goal in using these two drugs is to suppress inflammation. 

Low doses of methylpredisolone 4mg and oral ketorolac 10mg (or injectable ketorolac 15-30mg) were given to patients 1 to 3 days a week. Participants took the combination for 30 to 180 days.  

Seventeen of the 20 patients reported improved pain control, 13 reported improved physical activity, and 9 reported fewer bedbound days. Most patients also reported fewer pain flares and a decreased intensity of their flares. 

It is fitting that the first published treatment for AA is ketorolac and methylprednisolone. These two drugs have been the most reliable and consistent medicinals for AA. 

The absence of a published treatment for AA for 153 years has left patients in a dangerous vacuum. Into that vacuum came dismissal, therapeutic nihilism, medical abandonment, and the repeated phrase so many patients have heard: "There is nothing that can be done." This publication changes that conversation.

This does not mean the search for AA treatment is complete. It means the era of saying that nothing has ever been published must end, and a new treatment-development era has begun.   

Going forward, we believe the new treatment can be combined with neurosteroids, biologic pain relievers, neurohormones, and peptides for even better results. Let’s hope that this first study is just the beginning.

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 bulletins here.

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

Non-Opioid Journavx Is Being Prescribed Off Label for Chronic Pain

By Crystal Lindell 

Here’s some news that many pain patients could have predicted: A non-opioid medication recently approved for acute, short-term pain is already being prescribed off-label for chronic pain. In fact, it’s prescribed more often for chronic pain than opioids!

Suzetrigine, which goes by the brand name Journavx, was approved by the Food and Drug Administration in January 2025. Unlike opioids, Journavx blocks pain signals in the peripheral nervous system, not in the brain, so it doesn’t have the same “liking” effects of opioids, which can lead to dependence or addiction.

Developed by Vertex Pharmaceuticals, Journavx was the first new medication for acute pain in over two decades, and is primarily intended for post-operative pain or emergency trauma care. 

But 15 months later, new data published in Epic Research shows that Journavx is often being prescribed for chronic, long-term pain instead.

The researchers studied health records for more than 3.6 million U.S. adults who received a new prescription for either Journavx or an opioid between February 2025 and April 2026.

They found that chronic pain accounted for 33% of the Journavx prescriptions. By comparison, opioids were prescribed just 6.7% of the time for chronic pain.

Opioid prescribing was concentrated in patients who had surgery (48.8%) or acute pain (19.8%), which together accounted for over two-thirds of the opioid prescriptions.

Only 10.2% of the Journavx prescriptions were for surgery and 31.8% were for acute pain.

"Suzetrigine adoption has been concentrated in specialties that manage chronic and surgical pain longitudinally rather than in the acute-care settings where opioids are most commonly initiated," the study found.

The Epic researchers found that patients prescribed Journavx were often older and more likely to be female than patients prescribed opioids. Specifically, 43% of Journavx patients were 65 or older, compared with 31.4% of opioid recipients. 

Off-label prescribing of a medication is perfectly legal and, in some cases, appropriate. But drugs are rarely put through clinical trials for those off-label purposes.

Results from clinical trials suggest that Journavx is a mild pain reliever, at best, for acute or chronic pain.

In Phase 3 clinical studies of acute pain after minimally invasive surgeries, Journavx was no more effective than a low-dose combination of hydrocodone and acetaminophen, more commonly known as Vicodin.

In a Phase 2 study, Journavx was essentially no better than a placebo in relieving chronic back and hip pain caused by lumbosacral radiculopathy.

Journavx is priced by Vertex Pharmaceuticals at a wholesale cost of $15.50 for a 50mg pill. When taken twice a day for acute pain, that works out to $420 for a one-week supply. By comparison, a supply of 100 Vicodin tablets costs about $142.

Journavx is currently only available in an oral formulation, which severely limits its use for post-surgical pain, where injectable or intravenous analgesics are often preferred. 

No One Called Kratom an Opioid Until They Wanted It Banned

By Pat Anson

The DEA’s recent decision to classify concentrated forms of the kratom alkaloid 7-OH as an illegal controlled substance has resurrected an old argument: Is kratom itself an opioid? 

Kratom comes from the leaves of the Mitragyna speciosa tree in southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Kratom is a botanical cousin of the coffee plant, which relieves pain through a natural alkaloid we all know: caffeine.

No one calls caffeine or coffee an opioid, do they? 

Only in recent years has the “opioid” label been attached to kratom, mainly by government regulators and the addiction treatment industry. Former FDA commissioner Scott Gottlieb, MD, was the first to do so, warning in 2018 that kratom should not be used to treat pain or any other medical condition. 

“Claiming that kratom is benign because it’s ‘just a plant’ is shortsighted and dangerous,” said Gottlieb, who now serves on the board of directors for Pfizer. “It’s an opioid that’s associated with novel risks because of the variability in how it’s being formulated, sold and used recreationally.”  

Gottlieb’s remarks were based on an FDA computer analysis of kratom, which found that 7-hydroxymitragynine (7-OH), mitragynine and other kratom alkaloids share similarities with opioid analgesics.

Like morphine and oxycodone, the alkaloids bind to mu-opioid receptors in the brain and relieve pain. But unlike opioids, they are partial agonists that do not cause respiratory depression. The vast majority of kratom-related “overdoses” occur because people mixed kratom with other substances that depress breathing, such as alcohol or benzodiazepines.  

Nevertheless, Gottlieb insisted on calling kratom an opioid.

“Based on the scientific information in the literature and further supported by our computational modeling and the reports of its adverse effects in humans, we feel confident in calling compounds found in kratom, opioids,” Gottlieb said.

Critics called the FDA analysis “junk science,” citing numerous errors and signs of bias. 

One such critic was Brett Girior, MD, Assistant Secretary for Health and Senior Advisor for Opioid Policy at HHS, who said the FDA analysis of kratom was based on "embarrassingly poor evidence.” It was Girior who put a temporary end to the FDA’s efforts to have the DEA classify kratom’s alkaloids as Schedule One controlled substances.

“While mitragynine and 7-hydroxymitragynine have many properties of an opioid, scheduling these chemicals at this time in light of the underdeveloped state of the science would be premature,” Girior wrote in a 2018 letter to the DEA administrator. “There is significant risk of immediate adverse public health consequences for potentially millions of users if kratom or its components are included in Schedule I.”

‘The DEA Should Control Kratom’

Flash forward 8 years, and the FDA is once again trying to schedule 7-OH and kratom is being called an opioid, although the science behind that claim really hasn’t changed. 

“Like other opioids, kratom is highly addictive: Repeated use leads to tolerance, dependence and the need for progressively higher doses,” wrote Andrew Kolodny, MD, an addiction treatment psychiatrist, in a recent op/ed in the The Washington Post. 

“The DEA should control kratom in all its forms. Until it does, an opioid will be available for purchase without a prescription, the number of Americans suffering from opioid use disorder will keep rising, and there will be no end to the opioid crisis in sight.”

Kolodny is a familiar name to many pain sufferers. He is the founder and president of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group that played an influential role in getting the CDC to draft its controversial 2016 opioid prescribing guideline.

The CDC’s recommendations led to millions of patients being abruptly taken off opioids or reduced to ineffective doses. Some died by suicide or turned to the black market for relief, which helped fuel the fentanyl crisis.

Meanwhile, Kolodny and several other PROP members went on to make millions of dollars testifying as “expert witnesses” in opioid litigation cases. Their demonization of opioid medication is what led many Americans to start using kratom as a pain reliever.

That irony isn’t lost on pain patients, who left some choice comments about Kolodny and his op/ed on PNN’s Facebook page.

“He's a pain grifter making his $$$$ off people suffering from chronic pain,” said one. 

“He'll naturally piss on any treatment for chronic pain that doesn't include Suboxone or a shrink trying to gaslight you into saying nothing is wrong!” said another.

“If kratom hadn't saved my life over 20 years ago, I wouldn't be alive to be able to type this comment and call this article out as blatant misinformation,” wrote another pain sufferer.

Koldony testified in federal court a few years ago that he stopped treating patients when he became Medical Director for Opioid Policy Research at Brandeis University. In his op/ed, Kolodny said he was treating addiction again and that “a growing share” of his patients developed opioid use disorder by consuming kratom. 

At a recent public hearing in Georgia, Kolodny went further, claiming “all of the patients” he was treating had become addicted to kratom. He said a substance doesn’t have to come from the opium plant to be an opioid, citing the skin of the waxy monkey tree frog, which contains “an extremely potent opioid” that is stronger than morphine.

Kolodny also cites a misleading CDC study that found “poisonings and hospitalizations involving kratom have risen 1,200 percent over the past decade.” 

That 1,200% increase sounds horrific, but it is based on fairly small numbers. The total number of “adverse events” involving kratom was 538 in 2025, compared to 43 cases in 2014. That’s where the 1,200% figure comes from. About half of those reports were considered “intentional misuse” or suspected suicide attempts.

The 1,200% spike in cases reflects the simple fact that more Americans are using kratom today than in 2014. Conservative estimates put the number at 2 million, although the kratom industry has a much higher estimate of 20 million. Either way you slice it, 538 cases out of 2 or 20 million kratom users is a very low rate for adverse events. 

Coincidentally, in 2025 the FDA received 538 reports of adverse events involving Suboxone, a medication used to treat opioid use disorder. And there were over 4,800 adverse events involving aspirin that same year. 

No one talks about banning Suboxone or aspirin, or protecting us from waxy monkey tree frogs.  

Kratom Treats Addiction 

Just like the labeling of kratom as an opioid, the term "kratom use disorder" is also a recent invention, first used in 2021 by a group of addiction psychiatrists seeking to establish a clinical consensus for diagnosing and treating kratom addiction with Suboxone. 

One of the ironies in that framing of kratom is that the National Institute of Health recently announced plans to investigate the kratom alkaloid mitragynine as a treatment for addiction.

Many kratom users are already doing so. In a 2016 PNN survey of over 6,000 kratom consumers, about one in ten said they used kratom to reduce their cravings for opioids or alcohol, with over 90% saying it was “very effective.”

“This is an herbal blessing that has kept me from drinking,” said one. “If it becomes illegal, I fear we may never truly be able to study and treat ailments that kratom helps with.”

A more recent survey by 7-Hope Alliance, a 7-OH advocacy group, found that 23% of 7-OH consumers use it to self-treat opioid addiction. The vast majority – 74% – use it to relieve chronic pain.

Mac Haddow, a lobbyist and spokesman for the American Kratom Association (AKA), thinks the effort to frame kratom as an opioid is being driven by the addiction treatment industry.

“I think the more difficult problem is with addiction recovery centers because they’ve become very active in the kratom space, and they're calling it an opioid. They want to say that because they have to be able to qualify a so-called kratom addicted person in order to be reimbursed for the treatments that they provide,” Haddow told PNN.

“To me, that's problematic because that's a profit-centered assessment as opposed to a medical assessment, and clearly they are in the business of calling it an opioid so they can get reimbursement.”

‘7-OH Opioid Products’

One of the weirder ironies in the labeling of kratom is that the AKA, which represents natural leaf kratom vendors, is leading the fight to have concentrated 7-OH products banned. The AKA has even resorted to calling 7-OH an opioid, just like Kolodny and Gottlieb.

In a recent PNN op/ed, Haddow said 7-OH manufacturers have created “7-OH opioid products.” 

“They took a naturally occurring trace alkaloid found in kratom leaf and chemically manipulated it into highly concentrated 7-OH-dominant opioid products, then pushed those products into the marketplace without the guardrails that would apply to any legitimate opioid drug product,” Haddow wrote.

7-OH advocates say the AKA is trying to drive out competitors who have cornered a large share of the kratom market with a superior product. Asked to explain how 7-OH could be an alkaloid in small amounts but an opioid in larger doses, Haddow said 7-OH manufacturers turn it into a “completely different compound.”

“I could be wrong, but I think that the conversion from its trace amounts into a highly concentrated amount, then its activity on the new opioid receptors, is what distinguishes it,” Haddow explained. “It's not natural. There's nothing natural about the 7-OH that's sold in these highly concentrated forms because it's been chemically managed.” 

The DEA disagrees. In its scheduling order for 7-OH products in the Federal Register, the DEA says the 7-OH molecule chemically remains the same – whether in natural leaf kratom or in concentrated versions.

“Despite the different origins of 7-hydroxymitragynine, the chemical structures of synthetic and naturally occurring 7-hydroxymitragynine are identical. Consequently, the intrinsic pharmacological profile, receptor affinity, and mechanism of action of 7-hydroxymitragynine molecule remain unchanged regardless of its source.”   

They may share the same molecule, but the DEA is not seeking to ban natural leaf kratom, only the concentrated 7-OH formulations. It says those products “pose significant safety risk to unsuspecting consumers by exposing them to high doses of opioids.”

There’s that pejorative word again: opioids.

To be clear, 7-OH products are potent analgesics. And like any drug, when used excessively or irresponsibly, they can pose safety risks. 7-OH manufacturers haven’t done themselves any favors by selling their products without warning labels and in child friendly packaging that resembles candy.

7-OH products have been easy to get in gas stations, smoke shops and online, but that era is rapidly coming to a close. Several states and dozens of cities and counties have already banned 7-OH products, and soon there will be a nationwide ban on them.  

Like other attempts at prohibition, whether for alcohol, marijuana or prescription opioids, there will be unintended consequences. 7-OH products seem destined to become hot items on the black market and it’s reasonable to assume that drug cartels will start selling counterfeit 7-OH tablets or exotic new formulations of kratom alkaloids.

The DEA will have new drugs to target and more people to arrest. And the addiction treatment industry will have millions of new patients to prescribe Suboxone to.

No one called kratom an opioid until they wanted it banned. And figured out a way to make money from it. 

“That's a fair assessment. I agree,” says Haddow.

The Stress of Being Drug Tested by My Own Doctor

By Crystal Lindell

I went for one of my regularly scheduled appointments with my primary care physician yesterday, and as soon as I got there the nurse plopped a urine sample cup and a new drug contract on the table.

I had not been drug tested in a while, and actually started to wonder if they had seen the light and stopped doing them. Alas, that was not the case. 

Drug testing causes stress and anxiety for patients, even when we’re doing everything right. It also erodes the patient-provider relationship and makes it harder to be completely honest with them about our substance use.  

And then they also have the audacity to bill you for the privilege!

The whole thing gives criminal probation vibes so strong, I half expected a police officer to show up and watch me pee.

They also don’t tell you in advance what they are even testing for – or how the results might affect your care. Like, will they immediately cut you off if you test positive for kratom? Are they even testing for kratom?

What happens if you get a false positive? Do you get another chance to take a drug test? And who pays for it?

Asking anything like that in advance only makes you sound super suspicious. 

Mostly they want to make sure you are taking the drugs you are prescribed, but beyond that you have to hope you haven’t accidentally taken anything that could make you fail, like poppy seeds.

Thankfully, I passed. And when the results showed up in MyChart, I saw that they did not test for kratom. 

In addition to testing for stimulants and opioids, they also tested for naloxone and naltrexone – which was strange. Naloxone is used to reverse opioid overdoses, while naltrexone is primarily used to treat alcohol and opioid use disorders. 

It seems odd that they would check to see if either drug was in my urine, and I have no idea how my doctor would respond if they had turned up positive. Would he think I was having issues managing my opioid use? Or perhaps hiding an overdose from him? I really don’t know.

But peeing in the cup is only half the stress. They also have a new patient contract I had to sign, which lists 21 specific conditions for my treatment to continue.

No. 14 reads in part: “I will not ask for early refills. I understand that lost or stolen prescriptions will not be replaced.”

It ends with, “I will report stolen medicines right away to my clinician and to the police. This report does not mean that my stolen medicine(s) will be replaced.”

I was surprised to see that stolen prescriptions might not be replaced. Even with a police report?

That’s very disheartening to read, especially since I recently had my cell phone stolen, so I know how easy it is for a theft to occur.

No. 14 also includes a demand that I keep "my controlled medicines in a safe and secure place, such as a locked cabinet or safe."

No. 18 gives them permission to conduct pill counts: “I authorize my clinician to order counts of my controlled medicines to check that I am taking them properly. I agree to bring in my medicines in their original containers to be counted.”

What if I get robbed on the way to the doctor? What then? I’m just completely screwed for the rest of the month? Am I supposed to travel with my locked cabinet or safe in this hypothetical situation?

Then there’s No. 11, which reads: "I may not use emergency or urgent care visits to get more controlled medicine for my chronic pain. If I do, my clinician may decide to stop prescribing controlled medicines."

Early on in my chronic pain journey, I would often have horrible breakthrough pain that was only resolved when I went to the emergency room. They would give me a shot of Dilaudid to get the pain back under control.

Apparently, I’m no longer allowed to do that. It’s not a huge issue for me these days because my pain is now well controlled and I have learned lots of ways to manage it. But my heart goes out to other pain sufferers who may not be so lucky.

The contract also specifies in No. 8 that, "I will get my controlled medicines from one pharmacy."

God forbid there’s a drug shortage or the pharmacist tells me they’re out-of-stock, an all too common experience. I can’t go to another pharmacy?

I have been with my primary care physician for over a decade now, and we have a relatively strong relationship. So if I ever actually needed exceptions to any of these rules, I would hope that he would be accommodating. But that's a lot of faith to put in a doctor, and it’s not something most patients can count on.

While I understand that opioid hysteria has led a lot of providers to respond with drug tests and patient contracts over the last few years, I think it’s time we got rid of them.

If you actually want to know if your patient is using forbidden substances, or if they aren’t taking all of their prescribed medications, the best solution is the one nobody wants to do: Build a trust-based relationship with them so they feel comfortable telling you themselves!

As it stands, with urine drug screens and intimidating contracts that feel like criminal probation requirements, the only real result is that patients will see their doctors as cops. And everyone knows you never, ever talk to cops. 

‘Patients Do Worse’ After Common Knee Surgery

By Elisabeth Rosenthal, KFF Health News

Thousands of Americans who undergo a common knee surgery might be making their problems worse rather than better.

Researchers who followed patients for 10 years after they received either the actual procedure, arthroscopic knee surgery to trim degenerative cartilage tears, or merely “sham surgery” — a skin incision — for knee pain, found that the surgery provided little or no benefit and was, in fact, associated with accelerated osteoarthritis and higher rates of reoperation. That generally meant a total knee replacement.

“I don’t know how I would defend this procedure at all,” said one of the study’s authors, Teppo Järvinen, an orthopedist and the head of the Finnish Centre for Evidence-Based Orthopaedics. “What has been shown dramatically is that patients who have this procedure have more pain — they do worse. All the scores pointed in the same direction.”

Järvinen said the Finnish study, published in April in the New England Journal of Medicine, was the first to show the surgery left many patients worse off. Though the study was small, the results were compelling, he said, because his team picked the patients “most likely to benefit.”

The study does not apply to cartilage tears incurred from an acute pain-causing injury. It included subjects middle-aged or older who were experiencing knee pain and whose MRIs showed cartilage tears.

Evidence has been accumulating steadily for over a decade that arthroscopic knee surgery to shave torn, degenerative cartilage does not help more than physical therapy. Arthroscopic rates in Finland have dropped 90%, Järvinen said. They have been falling in the U.S., too, but at a far slower rate.

One study of commercial claims in the U.S., which counted over 2 million meniscus surgeries from 2010 to 2020, found the number decreased by about 4% each year. Most procedures were performed on women and patients in their 50s.

In the traditional Medicare fee-for-service program, the number of procedures has declined steadily in recent years, from about 169,000 in 2014 to 91,000 in 2024, federal data shows. These figures do not include beneficiaries in Medicare Advantage, private insurance plans that cover more than half of Medicare enrollees.

Prior studies of scans have found that such tears are common in people over 50, the result of wear and tear and often not painful.

“Nothing supports the idea that a patient’s pain comes from the meniscus,” Järvinen said.

Robert Brophy, director of the Orthopaedic Clinical Research Center at Washington University in St. Louis, said that “evidence is growing for judicious use of this surgery in this population.” But, he noted, “many patients do benefit.”

All the same, he acknowledged that current practice among his peers is “all over the map.” For example, data shows that surgery for meniscus tears in the Medicare population is far more common in the South than in the Northeast.

‘Save the Meniscus’

A massive study committee of orthopedic societies in Europe and the U.S. last June released a consensus statement noting that “degenerative meniscus lesions can be treated with comparable results with either non-operative (including physical therapy) or surgical approach.” It recommended a trial of physical therapy before surgery but still endorsed the operation.

A concerted campaign by orthopedic specialty societies called the Save the Meniscus Society has been ongoing for years. The group advocates for protecting and maintaining long-term knee health through nonsurgical treatments, surgical repair, and other therapies.

One inherent issue in all medical specialties is that appropriate treatment is often in the eye of the physician beholder, meaning that specialists create the guidelines for when a treatment is in order. And financial considerations may influence that decision, Järvinen said.  

In the U.S., physician payments are decided by the Relative Value Scale Update Committee, or RUC, a committee of the American Medical Association composed largely of specialists. 

Department of Health and Human Services Secretary Robert F. Kennedy Jr. and his advisers have reportedly looked into wresting control of that committee from the association, though it’s not clear how that could be done, since the AMA owns the billing codes used to calculate patients’ charges.

Arthroscopic knee surgery takes 30 to 60 minutes in the operating room, and the patients spend a few hours recovering in a surgery center or in a hospital outpatient department. Medicare allots on average $2,159 to $3,875 for the procedure, depending on where it is performed; patients pay 20% of the fee as coinsurance. There may be additional costs, for example, if more than one doctor is involved in the procedure. 

Commercial insurers average well more than twice that, said Marcus Dorstel, a senior vice president at the data analytics firm Turquoise Health, adding that the amount providers charge for the procedure varies widely. Those charges do not include the fees of the surgeons and the anesthesiologist.

Treating chronic knee pain has a variegated history.

Fifty years ago, the treatment for cartilage tears, from acute injury or from wear and tear, was to remove the entire piece of cartilage. At that time, doctors did not consider it a shock absorber but a useless, vestigial piece of tissue like the appendix.

Today, the first-line therapy for a painful knee with degenerative tears is physical therapy and, for some people, weight loss. Then there is arthroscopic surgery, depending on the view of the surgeon about its utility.

There is also a menu of injections: Steroids have proved scientifically valuable in the short term. And injections of stem cells and plasma-rich protein are widely offered but are controversial — and not covered by most insurance — because studies have been at best inconclusive about their benefit.

And as orthopedists are backing away from shaving off meniscus tears, they are highlighting a newer procedure — sewing the torn cartilage back into a whole. But that is typically an option for patients under 50 with acute injuries and clean tears, and it is unclear exactly which patients might benefit.

When all else fails, there’s a different surgery that’s also a big moneymaker for hospitals and doctors: knee replacement.

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

A Brief History of Human Pain

By Lars Arendt-Nielsen 

Pain is one of the few things all of us experience, from stubbing a toe to waking up with an aching back; we can all relate to the feeling of being in pain.

Although pain is a universal experience, the way we understand it has changed dramatically over time.

Ancient societies might have blamed pain on demons entering the body through the nose or ears, but we now know pain to be more about nerve endings and biology.

Cures have also moved on a lot. While our ancestors may have tried to sneeze, vomit, or even urinate out their pain, these days we’re much more likely to take medications to ease our suffering.

Strange as these ancient “treatments” sound today, they do reveal something important about pain: that it’s never just a physical sensation. Because throughout history, culture, religion and social beliefs have shaped how people talk about and respond to suffering — and many of those ideas still influence us to this day.

Indeed, after more than 30 years studying pain, one thing has become clear to me: while pain is universal, our experience of it is anything but.

Ancient Pain

To understand the roots of how we think about pain today, it helps to go back and see how earlier cultures made sense of it.

In many ancient cultures, for example, people believed pain was caused by external forces. Treatments relied on occult rituals, amulets, or trying to drain “bewitched” fluids from the body to expel such forces.

The ancient Egyptians believed that if you hadn’t obviously hurt yourself (so no broken bones, no visible wound), then clearly something more sinister was at play. This could be the gods or perhaps a wandering spirit of death, which had decided to pay your body an unwelcome visit.

Others tried to explain pain in more bodily, rather than spiritual, terms. The ancient Greeks, including physicians like Hippocrates, believed pain and disease arose when the body’s “four humours” — blood, phlegm, yellow bile and black bile — fell out of balance. Healers would use plant and animal remedies to try to restore harmony.

Moral Judgement

By the middle ages, pain had taken on a moral and religious meaning.

Across Europe, convents and monasteries often served as early hospitals and had access to powerful pain-relieving substances such as opium. Yet pain was not always treated.

This is because many Christians believed suffering to be a test of faith, while others saw it as a path to spiritual purification.

As a result, enduring pain was viewed as virtuous. So rather than seeking relief, sufferers were often encouraged to bear their discomfort with patience and devotion.

Echoes of these beliefs can still be seen today. For example, some women choose to go without pain relief during childbirth because of the idea that labour pain is a meaningful or a necessary part of the experience.

Toughing It Out

Indeed, the idea that suffering should be endured hasn’t disappeared as religion’s influence has waned. In many societies, it has simply found a new home in philosophy.

If you’ve ever felt pressure to “tough it out” when you’re ill or injured, you may recognise the influence of stoicism. At its core is the idea that we cannot always control pain, but we can control how we respond to it.

In many parts of the world, to this day, enduring pain quietly can be seen as a sign of resilience and self-control, with people often encouraged to minimise their discomfort and avoid making a fuss. This is despite the fact that vocalisations of pain are a common way for humans to bond, with research showing that human exclamations of pain are similar across the world.

So whether you like to express your pain or keep it on the down low, one thing is certain: the way we think about and even feel our pain has been directly influenced by human history.

And although most of us no longer blame demons or divine punishment for our aches and illnesses, we are still, in many ways, just trying to make sense of our suffering — much in the same way as our ancestors did.

Lars Arendt-Nielsen, PhD, is a Professor and Head of Pain Research at Aalborg University in Denmark.

He served as the President of the International Association for the Study of Pain (IASP) from 2018 to 2020, and is an active member of the IASP council. 

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

First Cannabis-Based Medication for Chronic Pain to Launch in Europe

By Pat Anson

The world’s first cannabis-based medication for chronic pain is expected to launch in Germany and Austria next month after getting marketing authorization from regulators.

Exilby is a full spectrum extract derived from THC, CBD and terpenes found in cannabis sativa, a strain of cannabis that has pain relieving properties. Exilby was approved for treatment of chronic lower back pain, although it’s likely to be prescribed for other chronic pain conditions.

“There is an extra or additional law in Germany, which says for all patients who do not have any adequate treatment left, our drug can be prescribed as well, whether they have low back pain or any other chronic pain condition,” said Dr. Clemens Fischer, founder of Vertanical, which makes Exilby. “We launch at the end of August in Germany and Austria, and then we go to Europe step by step.”

In the United States, Exilby recently received a Breakthrough Therapy designation from the FDA, which will speed up its development and review. But even with that designation, Exilby is not expected to get full FDA approval until 2028 or 2029, due to the slow regulatory process in the U.S.

Much of it hinges on the outcome of a Phase 3 placebo-controlled clinical trial that will evaluate Exilby as a treatment for chronic back pain caused by lumbosacral radiculopathy (sciatica).

Recruitment of 810 patients at various locations in the U.S. is expected to begin in the next few weeks, with the estimated completion date for the study in 2028. If the results are positive, then Vertancal will submit a new drug application to the FDA.

VERTANICAL IMAGE

The recent legalization of medical marijuana in the U.S. creates a faster potential pathway for Exilby. Medical cannabis products already approved at the state level are being reclassified by the DEA as Schedule 3 controlled substances, which allows for some medical use.   

If Exilby were available in state-licensed marijuana dispensaries, it could enter the U.S. market much sooner and without FDA approval. Fischer says he’s tempted, but unlikely to take that approach. 

“We really want to go to the track of having a pharmaceutical and an FDA-approved drug, so this is actually the track we are following. But I think about it. Why not, right? It might be easier,” Fischer told PNN.

In addition to chronic low back pain, Vertanical hopes to eventually get FDA approval for Exilby as a treatment for osteoarthritis and peripheral neuropathy.

In two completed Phase 3 studies in Europe, Exilby was more effective than moderate doses of opioids (27-32 MME) in treating chronic low back pain. Patients taking Exilby also had better sleep quality and were less likely to be constipated. Each dose contains a modest 2.5 mg of THC, but patients did not become “high” or intoxicated.

Chronic Pain Can Happen to Anyone

By Crystal Lindell

There’s this thing about chronic pain that people without it like to ignore: It could happen to anyone.

When you’re still healthy, the very concept of “pain that never ends” feels impossible.

Unfortunately, not only is it possible, it’s likely.

Between injuries, illness, genetics and bad luck, you never know how long you’ll have your health. You could be in a car accident tomorrow that permanently damages your back. You could get cancer and the treatment permanently damages your nerves. You could fall off your bike. Stumble on a Lego. Slip on some ice. 

Suddenly, the body you thought you could count on doesn’t function like it used to. You can’t do the activities you once did, you have no energy, and the medical bills are piling up. Even the concept of time feels different because you’ve lost your stamina and simple tasks take forever.

In an instant, you could lose your job, your social life, and even your personality.  

People spend decades trying to prevent such fates. They eat healthy, stay active, take vitamins, practice yoga -- all in an attempt to avoid the inevitable.  

Perhaps some of those efforts would be better spent making the world a better place for people living with chronic pain or chronic illness. After all, if you know it will likely happen to you, shouldn’t you prepare for the day you will join them?

There are so many ways society could better serve people with chronic pain and illness.

There’s the obvious ones, like universal healthcare and universal basic income. But there are also the things you don’t even notice when you’re still healthy. Things like a better public transit system for when you’re in too much pain to drive. Or government funded food delivery programs for when you’re in too much pain to cook.

There’s also the fight for better pain care. Access to opioid medication or even 7-OH might sound frivolous today, when you’re still walking around in a healthy body. But one day, when you need them, you’ll regret that it took so long for you to care.

I understand why people live in denial about their body’s eventual decline. It’s much easier to get through the day that way. But if you take the time to care about things like affordable healthcare and disability rights today, it will be that much easier to get through your painful tomorrows.

We should be building a world that plans for our bodies to age and get injured, instead of building a world around denial of that fact. It’s only when we truly accept our fate, that we can actually make our lives better.

Banning 7-OH Will Make Consumers Less Safe

By Jeff Smith

The DEA’s rushed proposal to ban 7-OH is a horrendous mistake.

7-hydroxymitragynine, or 7-OH, is an alkaloid from the kratom plant. Many adults use it for serious chronic pain and to help with withdrawal from dangerous opioids. A lot of them say they use 7-OH because whole-leaf kratom was not enough to alleviate their chronic pain. 

Despite initially opposing the scheduling of concentrated 7-OH products, Mac Haddow and his American Kratom Association (AKA), which represent the whole-leaf kratom industry, have spent the last year trying to ban them with fanatical zeal.

In his recent PNN op/ed, Haddow finally acknowledges that these pain patients exist and that their suffering should not be dismissed. But belated sympathy is not enough when the policy he supports, and – indeed – has been spending millions of dollars to lobby, would eliminate access, expose consumers to the consequences of illegal possession, and push people toward products no regulator can inspect. 

This should trouble anyone who cares about ending the opioid crisis. Untreated and undertreated pain are a core reason so many people turn to prescription opioids. When they cannot get adequate pain care, some look for relief wherever they can find it, including the black market – which comes with the risk of illicit fentanyl. 

For some chronic pain patients, 7-OH has been one of the few tools that allow them to work, care for family, avoid withdrawal, and stay away from more dangerous substances.Those consumers deserve transparency, real standards, and the freedom to make informed decisions.

The Holistic Alternative Recovery Trust (HART) has long supported rules around 7-OH, including requiring accurate labels, independent testing, age restrictions, serving limits, contaminant screening, responsible packaging, and enforcement against false medical claims.

Haddow and the AKA have chosen another path. They offer no comparable solution for chronic pain patients. They are trying to make sure adults cannot use 7-OH at all, regardless of the consequences for thousands of people.

Let’s be clear about what classifying 7-OH as a Schedule One controlled substance will mean. Legal access to 7-OH would be cut off for ordinary consumers, potentially for years. The DEA’s own statement says covered 7-OH products would be subject to criminal, civil, and administrative provisions of the Controlled Substances Act, including those for possession.

Haddow has claimed that this prospective ban is mainly about manufacturers, not consumers. But that is disingenuous. Consumers would still face the legal consequences of possession, and many would lose one of the few tools they say has helped them manage pain.

Those who keep using 7-OH anyway will not be safer. Indeed, they will be in much more danger than they are now. Schedule One will not create labels, require testing, set serving limits, punish only bad manufacturers, build a lawful pathway for adult access, or help consumers speak openly with doctors. Instead, it will push consumers toward unregulated supply chains, unknown products, and sellers no regulator can inspect.

Haddow and the AKA have pursued this course by painting 7-OH as a public health emergency. But their evidence does not support the solution they prescribe. They often point to adverse-event reports involving 7-OH or kratom-related products. But many of those reports do not clearly establish what product was used, how much was taken, whether it contained 7-OH, or what other substances were involved. 

Further, many reports involve more than one substance, underlying health conditions, products of unknown strength or composition, or labels that do not identify what the person consumed. It is almost impossible to determine whether whole-leaf kratom was involved in an overdose or a concentrated 7-OH product. 

Regardless, Haddow and the AKA have traveled to one state after another, filling the heads of state legislators and regulators with unprovable scary stories more characteristic of a moral panic than a public health issue.

But the truth is, this was never about safety. As recently as early 2025, Haddow did not call for a  ban on 7-OH. The reason for his 180 degree shift was explored in a recent piece in The New York Times. The article described an influence campaign by kratom companies and their allies to protect their whole-leaf products by urging federal action against 7-OH competitors. 

According to The Times, Secretary of Homeland Security Markwayne Mullin disclosed an investment worth as much as $1 million in Botanic Tonics, the company behind Feel Free, which has consistently urged a 7-OH ban. 

The Times also reported that Botanic Tonics donated $1 million to a political committee associated with Health and Human Services Secretary Robert F. Kennedy Jr., and that company founder Jerry W. Ross used access to Vice President JD Vance to urge a 7-OH crackdown.

That is the context in which consumers should read Haddow’s argument. This is about money, market share, and one part of the kratom industry trying to use federal power against another.

Even opponents of 7-OH should be wary of the ramifications of their strategy. Haddow says banning concentrated 7-OH will protect natural kratom leaf, but history gives consumers little reason to trust that prohibition will stop there. 

In 2016, the DEA tried to place both mitragynine and 7-OH into Schedule One before backing down after public backlash. The arguments now being used against 7-OH are the same arguments used against whole-leaf kratom for years, and there can be little doubt that they will resurface again.

That spillover is already happening. The AKA’s campaign against 7-OH has helped create a political environment in which some legislators now see all kratom as a liability. Kansas recently made kratom and 7-OH Schedule One controlled substances, and Tennessee enacted a new criminal law governing kratom.

There is still time to stop this. The DEA should stand down, Congress should hold hearings, and the Trump administration should replace the ban with a responsible adult-use framework for 7-OH. 

Adults should not be abandoned to withdrawal, untreated pain, lost work, and illicit drug markets because one part of the kratom industry decided that protecting its own products mattered more than protecting the consumers it claims to represent. 

Jeff Smith is National Policy Director of the Holistic Alternative Recovery Trust (HART), an advocacy group funded by 7-OH manufacturers.  

Short-Term Opioid Prescribing Should Be Tailored to Patient Needs

By Crystal Lindell

A new study has found something that every pain patient already knows: Opioid prescriptions “should be tailored to address individual patients’ needs.”

The research findings, which were published in JAMA, looked at how well opioids worked for 1,708 patients with short-term acute pain from a wide variety of conditions; from dental procedures and knee replacements to low back pain and cesarean sections.

The findings debunk common myths that many patients quickly become dependent on opioids and are unable to regulate their opioid use.

Overall, most of the patients used opioids for only a short amount of time – about 7 days –  and at low doses (10 MME). Only 10% of patients used opioids for 90 days or more, which is generally considered the threshold for acute pain becoming chronic.  

Overall, opioids were effective at relieving pain, with patients reporting a 55% reduction in pain on average. The median time to pain resolution was 20 days, although patients with low back pain or recovering from surgery took longer than that.

Most patients continued to use non-opioid pain relievers such as acetaminophen or ibuprofen, and also used ice or heat as part of a “multimodal treatment” approach.

About two-thirds of patients had leftover opioids. Interestingly, they were often patients with the longest-lasting pain conditions, which suggests they chose “not to continue using the opioids they had available” even when their pain persisted.   

Current guidelines from the CDC and FDA for acute pain recommend opioids only for severe pain or when non-opioid pain medications are ineffective.

Given the wide variety in outcomes and patient preferences, researchers say their findings demonstrate that guidelines for short-term opioids should be tailored to each patient. Most patients in the study were pretty good about moderating their opioid use. 

“Patients generally reported taking opioids on their worst pain days, in small amounts, for short periods, and in combination with other pharmacologic and nonpharmacologic treatments, with many patients limiting their opioid use to less than the amount prescribed by their clinician,” wrote lead author Molly Moore Jeffery, PhD, of the Mayo Clinic.  

“The findings suggest current guidelines for multimodal treatment and short-duration opioid prescriptions, if needed, will serve many patients but not all and that treatment should be tailored to address individual patients’ needs.” 

A recent study found that opioids are effective for many acute pain conditions and come with little risk. In a review of 59 clinical studies, researchers at the University of Sydney found that opioids were effective for “the vast majority of acute pain conditions,” with no significant risk of serious adverse events.