The Lifesaving Legacy of Dr. Forest Tennant

By Pat Anson

Humanitarian. Philanthropist. Author. Historian. Friend.

Those are some of the words that come to mind when I think of Dr. Forest Tennant, who died Thursday from complications of kidney failure. He was 85.

Here are a few other words that describe him: Real estate investor. Mayor. Professor. Civic Leader. Veteran.

Forest Tennant was many things to many people, but he is best known for his long career as a doctor, which made him one of the world’s leading experts in pain management and substance abuse treatment. His commitment to thousands of chronic pain sufferers – including many who were turned away by other doctors – made Forest a beloved figure in the pain community.

“I will be forever grateful to Dr. Tennant,” says Anne Fuqua, who lives with adhesive arachnoiditis (AA) and other painful conditions. “I wouldn't be here today without the treatment I received from Dr. Tennant. Beyond prescribing opioids, he was able to find the cause for things that other doctors had not and then treat them successfully. Dr. Tennant will always be a hero in my eyes.”

AA is a progressive inflammatory spinal disease that causes severe intractable pain and profound functional decline. Without effective treatment, patients face a lifetime of disability, with very little quality of life.

But thanks to Tennant’s willingness to prescribe opioids and his innovative therapies using hormones and neurosteroids, many AA patients are now able to live happy, productive lives.

In that sense, Tennant really was a lifesaver. Becoming his patient was a seminal moment for AA patients, who often traveled long distances to his small pain clinic in West Covina, California, which Forest and his wife Miriam essentially operated as a charity.  

Forest, Anne and miriam

“It is difficult to fully express our deep gratitude to Dr. Forest Tennant, whose exceptional care saved my son’s life along with many others,” said Ingrid Hollis, who collaborated with Tennant on many projects. “We are profoundly grateful for the hope and healing provided our son at a time when we had exhausted all other options. 

“Over this past decade, his support and expertise were a constant presence in our lives, and we tried to give back by offering him support and guidance in his research and writing endeavors. We will miss his almost daily phone calls to discuss projects and ideas. What a delight and honor this was all these years. Collaborating with him on numerous writing projects and conferences throughout the years was such a privilege and responsibility we didn’t take lightly.”  

Tennant’s compassion for patients turned him into a target. In 2018, he retired from clinical practice after his clinic and home were raided by DEA agents who were suspicious about his prescribing and the distances patients traveled to see him. Tennant was accused of running a “drug trafficking organization” by a rookie DEA investigator, but was never charged with a crime. On the advice of counsel and his doctors, Tennant thought it best to retire.

“It’s hard to continue operating when they never closed my case, and so I’m going to retire and move on,” Tennant said at the time. ““We very much regret this situation as the clinic is filled with patients we consider beloved family and friends.” 

Tennant stopped practicing medicine, but continued his groundbreaking research into AA and other intractable pain conditions. He wrote several books on diverse topics such as Elvis Presley and John F. Kennedy, and was a PNN columnist. Forest and Miriam also redoubled the efforts of their foundation, renaming it Arachnoiditis Hope.

Although he was in poor health over the last few months, Tennant continued to write, appear in podcasts and counsel pain patients, sometimes from his hospital bed.

One of his proudest achievements came a few weeks ago, when he was able to get the first study of a successful arachnoiditis treatment published in a peer-reviewed medical journal. 

Remarkably, Tennant also wrote another book, “Subduing the Inflammation of Adhesive Arachnoidtis: Secret to Relief and Recovery.” The handbook is designed to educate doctors and patients about the benefits of using hormones to restore damaged nerve tissue.  

Even in his final days, Tennant was sharing his knowledge and compassion for the sickest among us.

“This humble physician from Kansas devoted his career to alleviating the pain and suffering of people all over the world (65 countries).  He lovingly answered several hundred emails a month personally. Treating each person as a special individual worthy of respect and the best care and advice he could offer,” the Arachnoiditis Hope staff said in a statement.

“All of us at Arachnoiditis Hope feel privileged to have known and worked with this great man.  Dr. Forest Tennant set an example not only for all of us, but for medical practitioners everywhere to do their utmost best to help relieve the suffering of those in pain in their community.”

‘He Gave Us All Hope’

There are many wonderful tributes online to Forest and Miriam, posted by the patients they helped save.

“He gave us all hope when we could not find it anywhere. When our own doctors either didn’t care or wouldn’t listen, Dr. Tennant gave us a voice. Without Dr. Tennant, many of us would not be alive today, me included,” wrote Denise Domnick-Molohon. “The day he accepted me as his patient was one of the very best days of my entire life.”

“I was one of his patients for about 10 years and he profoundly changed my life. Because of him, I am able to be a very active person again — a social worker with a relatively normal life these days. His care was a miracle to me at a time when it felt like nobody gave a damn if I lived or died,” said Heather Grace. 

“Dr. Forest Tennant was a mentor, my friend, and someone I loved like a grandfather. What I will remember most is that he listened,” wrote Sarah Lewis, a registered nurse who lives with AA. 

“He never dismissed me or made me feel my voice mattered less. He listened, encouraged me to think bigger… But what Forest left me was more than knowledge. He left me ambition. The ambition to keep asking questions, keep challenging old assumptions, and keep pushing until adhesive arachnoiditis is understood in mainstream medicine.”

Forest Tennant was indeed a good listener. He was also non-judgemental, inquisitive and generous to a fault. If it wasn’t for his encouragement and financial support, Pain News Network probably would have stopped publishing years ago. It was a privilege to be called his friend.

Do you have a story to share about Dr. Tennant? Please leave a comment below.

Is Dry Needling Effective for Muscle Pain?

By The Conversation

Physiotherapists, chiropractors and osteopaths commonly use dry needling to treat neck, shoulder, back and other types of muscle pain.

It involves inserting thin needles into sensitive parts of a person’s muscle, often termed “myofascial trigger points”. The needles remain in the muscle for a few minutes and can be gently moved to create a twitch response in the muscle.

This therapy is thought to relax the muscle, reduce inflammation, promote healing and reduce pain. But does it actually work? And what are the risks?

Similar to Acupuncture

Dry needling is similar to acupuncture: they’re both applied to reduce pain.

Both treatments use solid, single use needles. They’re commonly 30–75mm long and 0.2–0.3mm thick, although longer needles may be used for deeper muscles. Unlike injection needles, they aren’t hollow and don’t inject medication.

A key difference is how the needle locations are chosen. Traditional acupuncture selects points based on symptoms and Chinese medicine concepts, including balancing qi as it flows through pathways called meridians. Dry needling is applied directly to tissue that’s thought to be the cause of symptoms.

Gaining Popularity

People seeing a physiotherapist for aches and pains are increasingly being offered dry needling. A 2023 survey of 203 Australian physiotherapists found 64% use dry needling on their patients.

The surveyed physiotherapists believed dry needling was an effective pain reliever and thought it was particularly effective alongside treatments such as exercise or manual therapy (which encompasses massage and manipulation or “joint cracking”).

In Australia, registered physiotherapists, chiropractors and osteopaths meet the safety standards required to use dry needling if they have completed training. The training usually involves a short (weekend) course.

Does Dry Needling Work?

Several research studies have collated the available evidence on dry needling. Most conclude it provides short-term pain relief for conditions such as neck pain, shoulder pain and low back pain, but is no better than other common treatments such as exercise.

Clinical practice guidelines are what health-care providers should use to dictate which treatments to provide and not provide. However, few clinical practice guidelines recommend dry needling.

There are two main reasons why.

Nearly all studies investigating the benefits of dry needling have serious concerns about how they’re conducted. This includes not being able to determine whether the benefits of dry needling are genuine or simply reflect placebo effects – when your health improves after receiving a fake treatment.

So it remains unclear whether dry needling provides benefits beyond a placebo.

Another reason is the potential risks of dry needling.

What Are the Risks?

Inserting thin and extremely sharp needles into the body requires an excellent understanding of anatomy.

Health-care providers need to be extremely careful to avoid major arteries, veins and nerves when dry needling around the neck and avoid puncturing the lungs when dry needling around the “traps” (trapezius muscles) and torso.

There have been cases of providers puncturing their patients’ lungs during dry needling, prompting a medical emergency.

In June, it was revealed that a Western Australian physiotherapist had her registration suspended for three months after puncturing a patient’s lungs, causing bilateral pneumothoraxes – the collapse of both lungs.

In November, Pittsburgh Steelers NFL player TJ Watts had to undergo emergency surgery after a similar injury caused a partial lung collapse.

Despite the risks, half of the studies on dry needling don’t mention if any adverse events occurred.

The studies that do report risks suggest serious risks such as a collapsed lung, infection or broken needle that gets stuck in a person’s body are very rare.

But we don’t know exactly how rare this is. Data from a large study on acupuncture suggests these adverse events occur in approximately one in 100,000 patients. But it’s unclear if the risk is the same for dry needling.

Less-serious side effects such as minor bleeding, bruising, soreness at the needling site or temporary symptom aggravation seem to be common.

Some factors also increase some risks, such as taking blood thinning medication or having an immune disorder.

Talk to Your Provider

Because the evidence on dry needling is uncertain and risks have not been adequately reported in the research, it’s important to discuss the benefits, risks and practicalities of dry needling with your health-care provider.

If your goal is short-term pain relief, consider asking your provider if there are other options that could provide similar relief.

If you have a fear of needles or have fainted when undergoing a needling procedure previously, such as a blood test, then dry needling might not be the best treatment for you.

Before undergoing dry needling, it’s important you have had a chance to ask questions and been given sufficient information about the treatment before providing informed consent.

Questions you might ask your health-care provider include:

1. What are my treatment options?

2. What are the potential benefits and risks of these options?

3. How likely is it that those benefits and risks could happen to me?

Although other treatments are as effective or more effective with fewer potential side effects, dry needling might be useful for some people. But a discussion of risks and benefits should always be transparent and ongoing.

Luke Jenkins, PhD, is Lecturer in Physiotherapy at Western Sydney University.

Giovanni Ferreira, PhD, is a Research Fellow, Institute of Musculoskeletal Health, at the University of Sydney.

Joshua Zadro, PhD, is an Associate Professor of Physiotherapy at the University of Sydney.

Peter Stubbs, PhD, is an Associate Professor of Physiotherapy at the University of Technology Sydney.

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

The Unusual Link Between Two Rare Chronic Pain Conditions

By Crystal Lindell

People who have Ehlers-Danlos Syndrome (EDS), a genetic connective tissue disorder, are more likely to have Complex Regional Pain Syndrome (CRPS) – a chronic inflammatory nerve pain condition that is usually triggered by an acute arm or leg injury.

That’s according to a new study by researchers at the Icahn School of Medicine and the Hospital for Special Surgery in New York, who documented the unusual link between the two seemingly unrelated and rare pain conditions.  

Their findings, published in the journal Regional Anesthesia & Pain Medicine, show the risk of having CRPS was 11-times higher for patients with EDS, compared to those without EDS.

That’s based on an analysis of national insurance claims for more than 54 million patients. Among those patients, 26,053 had EDS, while 51,424 had CRPS. 

Using that data, researchers calculated that 1.05% of people with EDS also have CRPS – meaning there’s about a 1 in 100 chance of having both conditions. Those are small odds, but they are substantially higher than the chance of someone without EDS having CRPS – which is only 0.09%.  

“These findings provide the first large-scale population-based evidence consistent with prior case series suggesting a diagnostic co-occurrence between EDS and CRPS,” researchers concluded.

“Patients with EDS had a substantially higher proportion of recorded CRPS diagnoses than patients without EDS in this national claims dataset. These findings support further investigation into the observed association between EDS and CRPS diagnostic coding.”

The study did not look into how the two conditions may be linked, but one possible explanation is that weak connective tissue, joint instability, and the frequent injuries of people with EDS may put extra stress on the nervous system, which can trigger the chronic and severe nerve pain characteristic of CRPS.

There is also some overlap in symptoms of EDS and CRPS, such as slower healing of damaged tissue and dysregulation of the nervous system, which affects blood flow, sweating, and skin temperature.

Another explanation is a greater use of healthcare resources. People with EDS may be more aware of their symptoms and see doctors more often, which may increase the likelihood of diagnosing other health problems, such as CRPS.

How ‘Toxic Narratives’ Fueled the Opioid Crisis

By Pat Anson

Dr. Lynn Webster has a unique perspective on the opioid crisis. As a pain management expert and prolific researcher, Webster was elected by his peers as president of the American Academy of Pain Medicine (AAPM) and developed the first Opioid Risk Tool, a questionnaire designed to assess a pain sufferer’s risk of opioid abuse.

Like many other doctors involved in pain management, Webster was also named as a defendant in dozens of lawsuits, alleging he was a “key opinion leader” in helping drug companies use deceptive tactics to market opioids – allegations that Webster says are inaccurate and misleading.

All of this happened over a decade ago, but many of the myths about the causes of the opioid crisis still persist today – what Webster calls “toxic narratives.” And they are still harming patients and doctors.

“A toxic narrative is a narrative that, when repeated continuously, can lead to harm. And the example here is that our opioid crisis was entirely due to excessive supply or overprescribing opioids,” Webster explains.

“As a result, the policies that were implemented led to patient abandonment, patients not having access to medicine, and in some cases patients committing suicide or going to the street to get more harmful substances. So it is a narrative that is incomplete, sometimes false, but it takes on such a hold that it leads to harmful outcomes.”

Dr. Webster and co-author Sarah Eichberg, PhD, recently released a new book called “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis.”

As the name suggests, Webster and Eichberg analyze how we got to where we are today, with the pain of millions of patients going untreated, doctors reluctant to prescribe opioids, and an overdose crisis largely fueled by illicit fentanyl and stimulants, not pain medication.

Behind it all is the simple fact that many people who struggle with addiction are trying to escape from a changing and challenging world that doesn’t seem to have a place for them.  

These are complex issues that have been poorly explained by the media, regulators, politicians and litigators – who all latched onto the theme that opioid pain medication was the root cause for soaring rates of addiction and overdoses.

“Everyone wanted a simple answer. And if people want a simple answer, then pharmaceutical companies are a good target and physicians are a good target, and they're pretty identifiable,” Webster told PNN. “As I write in my book, it's easier to say something that is kind of interesting, sexy, and fits a narrative that people want to believe, and then it becomes repeated without any challenge or with very little challenge. It's a simple way to address a very complex problem, which has been harmful.”

Asked to explain who was most responsible for spreading this incomplete narrative, Webster identifies two: the Center for Disease Control and Prevention (CDC), which released its disastrous opioid prescribing guideline in 2016, and Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group that played an influential role in the drafting the CDC guideline.

“The CDC is very much responsible for initiating the narratives. I mean, the head of the CDC said this was a physician-driven crisis exclusively, and then the Surgeon General at the same time basically was focusing on physicians and overprescribing without taking a look at the more complex part of the problem,” says Webster.

“There are other organizations, like PROP, that continued that narrative because it fulfilled their belief. I don't think most of the people in PROP intentionally meant to harm people, but it led to harm because of the incomplete story that their position took.”

‘That’s How You Make Money’

Others with financial interests took advantage of the situation, such as medical device makers and drug companies who hurriedly developed and marketed “non-opioid” pain treatments that were often more expensive and don’t work nearly as well.

“I think it really gets back to a deeper issue, which is free market capitalism and the lack of guardrails, basically free market capitalism. I call it neoliberalism, and that started back in the 1980s, primarily where the incentive is to make money,” said Webster. “The money to be made on finding an alternative to opioids was certainly an incentive to create and help sustain the toxic narrative.

“We've learned that false narratives are reinforcing to the people who want to believe them, and that's how you make money. It is not that we've been able to convey more accurate stories or truth. It is a means by which people can elevate themselves, be promoted, and make money.”

Free market capitalism also extended to the news media, which discovered that the opioid crisis was catnip for readers, viewers and listeners.

“Without a doubt, that's what's happened. There are thousands of examples where people see what was written in the Washington Post, New York Times, Time Magazine, Newsweek, anywhere, and because of the stature of those platforms, people just assume everything that they said has been researched and is accurate. But it's not,” says Webster, who adds that it was common for news organizations to conflate illicit opioids with prescription opioids, without explaining the difference.  

“That was repeated in every publication that talked about this. I cannot think of an exception where they separated the two. And in fact, I remember reviewing a couple of medical journal articles for publications, academic publications, where they did the same thing.”

Webster and Eichberg’s book is deeply researched and fact-based. Chapters explore various aspects of the opioid crisis; from addiction trends, patient stigma, and the criminalization of medicine to socioeconomic factors, childhood trauma, and the CDC’s misclassification of illicit fentanyl.

In effect, they’re trying to set the record straight on decades of incomplete and inaccurate information – and hoping clinicians, researchers, journalists and public health experts will learn from a more nuanced view of the opioid crisis.  

“The way in which we have been addressing it is to look at how to reduce access to drugs. That’s not going to solve the problem. The only way that we can dramatically reduce harm is for us to look upstream, to look at those factors that really contribute to the vulnerability of people,” Webster explained.

“We're at a difficult time, you know. The country is divided politically, and that feeds into almost every topic. We want to be emotionally rewarded for our anger about different things, rather than trying to understand the nuance and the truth behind a topic, and that's very, very much true with regard to addiction and pain treatment.”

When a Pain Flare Steals a Special Day

By Crystal Lindell

Sunday was a boringly normal day for me — as someone who deals with chronic pain on a daily basis. 

When I woke up, it felt like someone had replaced my ligaments with concrete and I was being stabbed in the ribs. I limped to the bathroom. And for breakfast, I had four different pain-relieving drugs and a bottle of water.

After that, I laid back down and slept for another three hours.

I got up just long enough to eat lunch, which of course included a side of more pills. I grabbed my pillow and laid down on the couch in the living room, where I slept for another 2 hours.

It was a pretty routine pre-thunderstorm pain flare for me. Thankfully, I was off work, so I was able to spend the day resting.

The only problem was, Sunday was also my fiancé’s birthday.

He loves me. And he also deals with chronic pain. So he was more than happy to hang out with me on the couch all day while we watched bad 90’s movies.

He was also cool with going to pick up the toilet paper we needed and the Chinese food we got for dinner to celebrate his special day.

But I felt like crap about all of it.

I hate that I spent his entire birthday dealing with a pain flare.

He always does the dishes, and I wanted to do them for him on Sunday to give him a break, but I couldn’t. He also feeds all of the cats first thing every morning, and I wanted to do that for him as well. But again, I couldn’t.

He loves going to play basketball at the court behind our house, but I couldn’t do that with him either.

It sucked. All of it.

Eventually, the thunderstorm came, the pain relieving drugs I was taking started working, and I was able to function a little bit – but by then it was 10 pm and my fiancé was ready for bed.

Part of the issue is that I’m also tapering down on 7-OH in anticipation of the upcoming ban. Before the ban was announced, I was able to take as much 7-OH as I needed on bad pain days.

But these days, I have to use it sparingly, if at all.  The goal is to get off of it before the DEA declares it an illegal Schedule One controlled substance. The only thing worse than losing access to 7-OH would be to also have to go off of it cold turkey.

But that means I’m losing days of my life again to pain. Sometimes, it’s just a random Tuesday that I lose, and it’s no big deal. 

But other times, it’s an “August 9th” that I lose – and then I miss out on a special day.

Why Hot Weather Makes Pain Worse

By Gulnaz Anjum and Mudassar Aziz

This summer’s amber heat warnings have brought with them many risks to health.

Many people have experienced these health effects first-hand: brain fog, physical fatigue, restless nights and reduced productivity. If that sounds familiar, you’re not imagining it. Science shows that high temperatures can affect both our bodies and our brains – even before they reach extreme levels.

But one consequence of hot weather that many people may not know about is that it can also affect physical pain.

Our research analysed data from a large, nationally representative survey from the global analytics firm Gallup, which recorded daily measures of pain from more than two million US residents. We found that as temperatures increased so did the likelihood of people reporting they were experiencing some type of generalised physical pain.

The largest increases occurred on very hot days – around 32°C (89.6°F) or above. Middle-aged adults and people from lower socioeconomic backgrounds were most likely to report experiencing pain on very hot days.

Scientists have identified several possible explanations for why you’re more likely to experience worse pain on hot days.

Some of these causes are direct triggers of pain – including dehydration caused by the heat, inflammation and other physiological processes, such as blood pressure changes which can make existing pain worse.

Other causes are indirect triggers. For instance, hot weather can increase stress, disrupt sleep, reduce wellbeing and limit our ability to perform our usual daily activities, such as exercise. All of these factors are known to amplify experiences of pain.

The relationship between pain and these potential triggers can go both ways as well. Sleep is a good example of this.

Poor sleep makes people more sensitive to pain, while pain itself makes it harder to sleep. During heatwaves, many people struggle to get a good night’s sleep, creating a vicious cycle in which poor sleep increases pain and pain further disrupts sleep. Over time, this cycle can take a toll on people’s wellbeing and quality of life.

The effects of pain extend beyond physical discomfort, as well. Pain competes for our brain’s attention. When the body hurts, attention is diverted towards coping with that pain, leaving fewer resources available for concentration, memory and decision-making. This can affect performance at work, learning in school and even everyday decision-making.

In some situations heat can be beneficial for pain – for example, applying a heating pad to help relieve lower back pain after a long day on your feet.

But there’s an important difference between using targeted heat to treat a specific area of the body and being exposed to sustained high temperatures that affect the entire body. The latter places stress on multiple physiological systems and can worsen, rather than relieve, physical pain.

The consequences of heat’s effects on pain are not only personal – they’re also economic.

In our study, we estimate that hotter temperatures already cost the United States’ economy around US$2 billion (£1.5bn) every year through higher levels of pain. If temperatures continue to rise and no action is taken to help people adapt to extreme heat, these costs could exceed US$9 billion annually by 2050.

The increasingly frequent and intense heatwaves experienced in recent UK summers suggest that comparable losses in healthcare costs, reduced productivity and diminished quality of life could become an important challenge if hot summers become the new normal.

Bodily pain should therefore be recognised as another hidden health consequence of extreme heat.

Heat affects us in more ways than we often realise. The good news is that there are practical steps we can take to reduce these effects. Staying well hydrated, avoiding strenuous activity during the hottest hours of the day, seeking cool indoor spaces and planning outdoor activities for the morning or evening can all help reduce heat-related pain and discomfort.

Gulnaz Anjum, PhD, is an Assistant Professor of Climate Psychology at the University of Limerick.

Mudassar Aziz, PhD, is an Associate Professor of Psychology at the University of Oslo.

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

South Korea Stops Sales of Trader Joe’s Seasoning Due to Opioid Contamination

By Pat Anson

A popular seasoning blend sold at Trader Joe’s is a bit too spicy as far as police in South Korea are concerned.

“Everything but the Bagel Sesame Seasoning Blend” is made with sesame seeds, dried garlic and onion, sea salt, and poppy seeds. 

It also comes with “trace amounts of morphine and codeine” according to forensics tests, which is a violation of South Korea’s Narcotics Control Act. When not washed thoroughly, poppy seeds can become contaminated with opium alkaloids from the sap of poppy plants during harvesting.

While the amount of opium is minuscule, it’s enough to worry South Korean police, who recently warned the online marketplace Karrot to stop reselling the Trader’s Joe’s seasoning. 

The seasoning blend was banned in South Korea in 2022, but some South Korean tourists visiting the U.S. buy it as a souvenir and when they get home list the seasoning for sale on Karrot, often at inflated prices due to its notoriety.    

“Even if a product is legally sold overseas, it may be classified as a narcotic substance or a prohibited import in Korea, so particular caution is required,” a Seoul police official told The Korea Herald. "Not only sellers but also buyers can be subject to criminal punishment."

Karrot agreed to remove all listings for the seasoning blend on July 27, and its website now displays warning pop-ups when users try to list it for sale.

In 2019, the U.S. Drug Enforcement Administration classified unwashed poppy seeds as Schedule II controlled substances, claiming they were “qualitatively similar” to opioid pain medications. 

Poppy seeds that are properly washed and used as food are legal in the United States, but contaminated seeds occasionally slip through and cause trouble.  

Eating a muffin or bagel with poppy seeds is risky for someone about to take a drug test, since it takes only a few poorly washed seeds to result in a positive drug test for opiates. That could lead to a patient being dismissed by their doctor or an employer refusing to hire someone.

Some patients with poorly treated pain grow their own poppies and make a tea from the seeds to use as an analgesic. It’s a risky process, since it's hard to control the opioid strength of the tea – which has led to addiction and even some fatal overdoses. Potentially lethal dose of morphine have been found in some poppy seed teas.

The Center for Science and Public Interest (CSPI) has been urging the FDA for years to more tightly regulate poppy seeds by setting a limit for opiate contamination, but so far the agency has yet to set any guidelines.

“FDA is not advising consumers to avoid consuming poppy seed-containing foods. Although FDA is aware of some reports of consumption of poppy seed-containing foods being associated with negative health effects, FDA is particularly concerned about the misuse of poppy seeds,” the agency says on its website. “To date, FDA has received 11 reports of deaths purportedly associated with the consumption of homemade poppy seed tea.” 

Most Chronic Pain Conditions Never Get Better

By Crystal Lindell

Most chronic pain conditions remain stable over time, with few patients getting worse and even fewer getting better. 

That’s according to a new study in JAMA Network Open that tracked over 1,477 patients with long-term non-cancer pain. The patients were being treated at specialized pain clinics in France.

The researchers used a cell phone app to track patients’ self-reported bodily comfort, sleep, and mood every week for six months. They excluded “pain intensity” from the list of things they tracked because it is "increasingly recognized as an incomplete proxy for the chronic pain experience.”

Most of the participants were middle-aged, overweight, professional women. About a fifth were on sick leave due to pain. 

Most had been dealing with pain for over five years, mainly from conditions like fibromyalgia and musculoskeletal pain. A large majority had a history of other medical conditions, including anxiety, depression and substance use disorders.

The primary medications that patients took were antidepressants, paracetamol (acetaminophen) and antiepileptic drugs; while the main nonpharmacological treatments were neuromodulation and physical therapy. 

The study authors were trying to find ways to predict which patients would improve and which ones may get worse. They hoped to use responses to basic questions at the start of the study, such as age, sex, pain severity and medical history, to help develop models that would predict how patients would fare.

Unexpectedly, most of the patients remained the same throughout the course of the study, with bodily comfort, sleep and mood remaining unchanged. Only 4.1% of patients improved, and just 10.2% got worse.

Researchers concluded that the most realistic outcome for the remaining 85% is to keep them stable. 

"These findings suggest that chronic pain… is better conceptualized as a stable digital state with rare transitions,” the researchers said. “In tertiary care, where patients are referred precisely because prior treatments have failed, preventing further deterioration over 6 months represents a meaningful therapeutic achievement.” 

Ideally, this type of research could be used to help doctors more realistically assess and treat chronic pain. For example, if their chronic pain is stable, patients shouldn’t have to see a pain specialist every four weeks to get their prescriptions renewed. And treatments should focus on keeping patients comfortable.

Sadly though, the results also suggest that most chronic pain conditions are never really cured or get better, even when treated at a specialized pain clinic.

My hope is that we will continue to find treatments and therapies that meaningfully improve chronic pain. After all, in an ideal world, chronic pain would not remain stable – it would go away.

Study Finds 85% of Kratom-Derived Products Mislabeled

By Pat Anson

A new study at the University of Florida is likely to increase the growing scrutiny of kratom, 7-OH and other kratom alkaloid products.

Researchers found that the vast majority of kratom-derived tablets, edibles and extracts contain alkaloid and chemical compounds that differ substantially from their product labels, potentially putting consumers at risk.

Some have been altered so significantly during the manufacturing process that researchers concluded “these products are definitively not kratom.”

Kratom comes from the leaves of the Mitragyna speciosa tree in southeast Asia, where it has been used for centuries as a natural pain reliever and stimulant. In recent years, demand for kratom products has risen sharply in the United States, reaching an estimated market size of $2.56 billion in 2025.

As the kratom market has grown, so has the variety of products available, including concentrated formulations of 7-hydroxymitragynine (7-OH) and other kratom alkaloids that have “opioid-like” effects and are far more potent than natural leaf kratom.     

Researchers at the University of Florida College of Pharmacy conducted a laboratory analysis of 44 commercially available kratom-derived products purchased online and in stores in several U.S. states.

The study findings, published in the journal of Drug Testing and Analysis, show that 85% of the kratom products had ingredients and concentrations that did not match their labels. In some cases, products were labeled as having a single alkaloid, but multiple alkaloids were detected. Other products contained compounds that were not disclosed on their labels or were listed but not detected.

“The findings are of strong relevance to public health and underscore regulatory actions needed for proper labeling requirements by manufacturers for consumers to know what they are purchasing,” said co-author Christopher McCurdy, PhD, a Professor and Associate Dean for Faculty Development in the UF College of Pharmacy. 

“Right now, consumers are part of a large experiment in which they are taking products that they believe are properly labeled as to the composition of ingredients, yet they are being deceived intentionally or unintentionally by the manufacturers, putting the public at risk.”

McCurdy and his colleagues have spearheaded much of the U.S. research into kratom, with McCurdy serving as an expert witness in kratom litigation cases on both the plaintiff and defendant sides. 

Their research has grown more complicated in recent years, as the kratom market has been flooded by new semi-synthetic products that are often marketed as “natural kratom.” The DEA is currently planning to classify 7-OH and other concentrated kratom products as illegal Schedule One controlled substances, while keeping natural leaf kratom largely unregulated as a dietary supplement..

“Products containing semisynthetic, kratom-derived compounds should be clearly distinguished from natural kratom products,” says lead author Abhisheak Sharma, PhD, an Assistant Professor of Pharmaceutics in the UF College of Pharmacy. “Stronger manufacturing standards, comprehensive testing and transparent labeling are needed to help people make informed decisions and reduce potential safety risks.”

Kratom Litigation

Advocacy organizations for both natural leaf kratom and 7-OH products support stronger labeling, age restrictions and transparent marketing, but there is little effort to enforce those standards at the federal level. That has left most kratom regulation to individual states and local governments.

In a move reminiscent of the opioid litigation cases that cost the pharmaceutical industry over $50 billion dollars, the city of Baltimore recently filed a complaint against several manufacturers and distributors of kratom products, accusing them of “engaging in unfair, abusive, or deceptive trade practices.” 

Maryland has banned the sale of all synthetic or artificially altered kratom products under the state’s Kratom Consumer Protection Act, which also requires product labels to be accurate.

The Baltimore case focuses on several kratom entrepreneurs behind Optimized Plant Mediated Solutions (OPMS), a kratom brand that sells a potent kratom extract called Black Liquid Kratom that’s been linked to several deaths.

“Defendants have employed a web of shell companies and alter egos, and use multiple business names, assumed names, and trade names to hide the scope of their operation and to avoid liability for their actions… while falsely stating or implying in their labeling, packaging, advertising, and marketing of the Kratom Products that the Kratom Products are safe for consumption or offer therapeutic and health benefits that they do not have,” the complaint alleges.

In 2024, the FDA warned consumers not to use Black Liquid Kratom after it was linked to several adverse events. But the OPMS extracts are still available in smoke shops, vape shops and online, where they are often marketed as “all natural” kratom products.

OPMS is one of the “qualified vendors” registered with the American Kratom Association’s good manufacturing standards program, which requires vendors to have labeling that “provides all the information required for consumers to make an informed purchasing decision.”

In their analysis of Black Liquid Kratom, University of Florida researchers found the OPMS extracts “showed variability in their chemical composition, with measured content different from the values stated on the product labels.”  A laboratory analysis found more alkaloids in Black Liquid Kratom than what was indicated on the product label.

‘Enormous Confusion’ as Deadline Nears for 7-OH Kratom Ban

By Pat Anson

Supporters of a DEA plan to classify 7-OH and other concentrated kratom alkaloids as illegal Schedule One controlled substances are worried an impending ban may affect kratom itself. 

The American Kratom Association (AKA), a group of natural leaf kratom vendors, led the effort to ban what it calls synthetic kratom alkaloids, claiming they are dangerous “opioid products.”  

But now the AKA is worried the DEA scheduling may backfire, saying there is “enormous confusion among some members of Congress and even staff at the DEA” about the differences between natural leaf kratom, 7-OH, and other kratom alkaloids.

At issue is mitragynine pseudoindoxyl, one of many naturally occurring kratom alkaloids. A proposed DEA order would ban all pseudoindoxyl products, which are potent analgesics sold as dietary supplements. 

But because there is no current way to measure pseudoindoxyl levels, the AKA is worried that natural levels of pseudoindoxyl will be banned too – in effect a ban on natural leaf kratom. 

“That’s part of the problem, the confusion,” explained Mac Haddow, an AKA lobbyist who says a “zero tolerance” approach to pseudoindoxyl could theoretically lead to bans on kratom. He wants a “carveout” for pseudoindoxyl and natural leaf kratom, exempting them from any DEA bans.     

“That’s why we made the recommendation to the DEA that they should clarify the distinction. The same kind of carveout for pseudoindoxyl would be appropriate, even though it might not be quantifiable at normal testing levels,” he said.

Haddow blames much of the confusion on 7-OH manufacturers, who say their products are just as natural as kratom. 

“The 7-OH that the body metabolizes from a whole leaf product is really indistinguishable from 7-OH that is in a 7-OH product,” says Jeff Smith, Executive Director of the Holistic Alternative Recovery Trust (HART), an advocacy group funded by 7-OH manufacturers.     

“I frankly don't understand why the traditional kratom people have pushed so hard (for a 7-OH ban) when their products have to be considered a precursor.” 

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. In recent years, natural leaf kratom, 7-OH and other kratom alkaloid products have become popular in the United States, where they are used by millions of people to self-treat their pain, anxiety, depression, and substance use problems.  

Fearing they may also lead to addiction and overdoses, several states and dozens of cities and counties have banned 7-OH, and some have included kratom. 

The latest example is North Dakota, where the governor today declared a 30-day public health emergency banning all kratom products. Gov. Kelly Armstrong called for a special session of the legislature next month to make the ban permanent under state law.

“Doing nothing is not an option,” said Armstrong. “Right now, it's the Wild West when it comes to kratom and 7-OH sales in North Dakota: no regulations, no age limits, no accountability.  

“We’re taking emergency action to press pause and get these products off the shelves until the Legislature can address the issue.”   

A nationwide ban on 7-OH may be imminent. The DEA announced last month that it planned an emergency scheduling of 7-OH products as Schedule One controlled substances, the same classification as heroin and LSD. 

The scheduling order could take effect as soon as Wednesday, August 5. That has led to a run on 7-OH products in recent weeks, with 7-OH vendors slashing prices to dispose of as much inventory as possible before the ban takes effect. 

New Non-Opioid Analgesic Works Better Than Vicodin

By Crystal Lindell

An experimental non-opioid pain medication appears to outperform a low dose of Vicodin for patients who just had tummy-tuck surgery.

Latigo Biotherapeutics recently published results from its Phase 2 clinical trial in The New England Journal of Medicine, looking at the effectiveness of their new analgesic, which goes by the name LTG-001.

Like other new non-opioid analgesics, LTG-001 works differently than opioids because it blocks pain signals in the body’s peripheral nervous system before they reach the brain. Opioids act on nerve receptors in the brain, where they can slow down breathing and have a “euphoric” effect at high doses.    

In the clinical trial, 343 patients with moderate-to-severe post-operative pain after abdominoplasty surgery were randomly assigned to four groups. One group received low-dose LTG-001; another took high-dose LTG-001; a third took tablets of 5 mg hydrocodone and 325 mg acetaminophen (Vicodin); and the fourth group received a placebo. 

The LTG-001 doses were given orally every 12 hours, while the Vicodin tablets were taken every six hours, for a daily dose of 20 MMEs (morphine milligram equivalents). Patients also had the option to request oxycodone if their pain was getting too severe.  

When researchers asked patients about their pain levels, they found that the high-dose LTG-001 had a 50% greater analgesic effect than Vicodin. “Meaningful pain relief” was also achieved faster with high-dose LTG-001 than with Vicodin (52 minutes vs. 83 minutes).

But many in the high dose LTG-001 group were not able to stay “opioid free.” In a press release, Latigo highlighted the fact that over half (52%) of the patients taking LTG-001 didn’t need the oxycodone “rescue” medication.

Another way to look at that statistic is that the other 48% of patients did not have pain that was well controlled and wound up using opioids anyway. On average, patients in the high dose LTG-001 group still needed 11 MME of oxycodone for pain relief.

Despite the lackluster results, company officials said the clinical trial was “an important milestone for Latigo.”

“The publication of these findings adds to the growing scientific understanding of non-opioid approaches to pain management and comes at a time when there is broad recognition of the need for additional treatment options in the context of the ongoing opioid crisis,” Neil Singla, MD, Chief Medical Officer of Latigo, said in a statement.

Based on discussions with the FDA, Latigo believes the study may serve as one of the well-controlled trials needed to demonstrate the efficacy of LTG-001 to support its approval as a treatment of moderate to severe acute pain, including postoperative pain. 

The company’s next step is to initiate a placebo-controlled Phase 3 trial in participants undergoing bunionectomy and an open-label Phase 3 safety trial. Latigo is also investigating LTG-001 as a pain reliever after wisdom tooth removal.

Last year the FDA approved a similar non-opioid analgesic, Journavx. Although it is only approved for moderate to severe acute pain, it didn’t take long for Jourvanx  to be used off label for chronic pain.  A recent analysis of prescription data found that Jourvanx is prescribed about 33% of the time for chronic pain. In fact, it’s prescribed more often for chronic pain than opioids are.  

THC and CBD Edibles More Effective at Pain Relief Than CBD Alone

By Pat Anson

Yet another study has found that cannabis products containing both THC and CBD are more effective in treating chronic pain than products made with CBD alone.  

Researchers at the University of Colorado Boulder enrolled 243 people with chronic low back pain to evaluate the pain relieving effects of marijuana edibles over a 14-day period. Participants visited a dispensary of their choice and selected a THC-dominant edible, a CBD-dominant edible, or an edible that contained both CBD and THC.

Of the 243 participants, 97 selected CBD-dominant products, 112 chose THC/CBD products, and only 36 selected a THC-dominant product. They were told to take the edibles as often as they wanted for two weeks.

The study findings, published in the journal Biomedicines, show that pain levels were modestly lower for participants who selected THC-dominant products or edibles containing both THC and CBD. No comparable reduction was reported among those using CBD-dominant products.

After 14 days, the most significant reduction in pain intensity was -14.4% for those who took THC/CBD edibles, followed by THC-dominant edibles (-7.9%), and CBD-dominant edibles (-1.9%).

Because there was no uniformity in the frequency or doses of THC and CBD that participants took, researchers say their findings should be viewed with caution. 

But overall, there was a greater benefit from using products with both THC and CBD, suggesting there is a synergistic effect between the two substances in reducing inflammation, one of the primary causes of chronic pain.

“These findings indicate a complex interrelationship between THC and CBD, with THC-associated reductions in daily pain intensity attenuated by increasing doses of CBD, and products containing both THC and CBD associated with longitudinal reductions in pain intensity,” researchers said. 

“Statistically, the use of CBD-dominant products was not associated with any reductions in pain intensity at the daily or longitudinal levels, and these associations did not change regardless of how often participants used their products.” 

THC (tetrahydrocannabinol) is the psychoactive ingredient in cannabis, while CBD (cannabidiol) is a non-psychoactive compound believed to have health benefits. About 3 times as many participants in the study chose CBD-dominant edibles over THC-dominant ones, suggesting they wanted to avoid sensations of getting “high.”

“Many individuals see CBD as an attractive alternative therapy for mitigating chronic pain compared to THC. This may be the result of CBD not producing the intoxicating effects that are associated with THC. Yet, the use of CBD-dominant products and increasing doses of CBD were not associated with reductions in pain intensity in the present study,” researchers concluded.   

Previous studies of cannabis products have shown that the pain-relieving benefits of CBD alone are minimal, at best. 

A recent review of studies found that cannabis products with relatively high levels of THC provide small improvements in chronic pain, while those with high levels of CBD have minimal or no effect on pain.         

In a 2019 study of self-reported data from over 3,300 cannabis users, researchers said THC was more effective than CBD alone in treating chronic pain, insomnia and other medical conditions. Cannabis products containing higher doses of THC provided the most relief.

Another small study conducted in Israel found that microdosing small amounts of THC significantly reduced pain levels in patients suffering from neuropathy.

New Pain Reliever Combines Tylenol and Naproxen

By Crystal Lindell

Pain sufferers will soon be able to buy a new over-the-counter medication that combines acetaminophen with naproxen. 

That’s thanks to the FDA approving new “Tylenol with Naproxen.” A two-tablet dose contains 650 mg of acetaminophen and 220 mg of naproxen sodium. Many consumers know acetaminophen as the brand name Tylenol, while naproxen is known by the brand name Aleve. 

The non-prescription pain reliever is approved for minor aches and pains such as headaches, backaches, sore muscles, toothaches, menstrual cramps, and arthritis pain in adults and children 12 years and older. 

The new tablets start working within about 30 minutes because of the acetaminophen, while the non-steroidal anti-inflammatory drug (NSAID) naproxen provides 12 hours of extended pain relief.

Acetaminophen is believed to work more quickly to reduce pain signals, while naproxen provides longer-lasting relief by targeting pain caused by inflammation.

The FDA granted Kenvue, which makes the Tylenol brand, a three-year period of exclusivity for this new OTC formulation. That means there will be no generic alternative available in that time.

In a press release, Kenvue cited a recent company survey showing that 75% of pain sufferers report dissatisfaction with their current options.

“Persistent pain often leaves people trapped in a cycle of trial and error, navigating between choosing short-term relief or more complex treatment options,” said Rajesh Mishra, MD, Chief Medical Officer of Kenvue. “Tylenol with Naproxen simplifies that choice, offering fast onset, 12-hour duration, and the safety profile of two well-established non-opioid ingredients in one fixed-dose.”

The company said its research showed that Tylenol with Naproxen demonstrated superior pain relief versus using either medication alone. It didn’t provide a price or date for when the tablets will be available, only that they are “coming soon to major U.S. retailers nationwide.”

Company Touts ‘Opioid-Free’ Label

The press release touts the fact that the medication is "opioid-free" multiple times and claims "up to 1 in 4 patients prescribed opioids are at risk of addiction."

"Tylenol with Naproxen addresses this gap by combining two well-established non-opioid pain relievers into a single, clinically proven OTC therapeutic solution that requires no prescription and carries no opioid risk," the company said.

Most studies show the risk of opioid addiction is very low. Neither Kenvue or the FDA shared any research on whether the new medication was comparable to pain relief from opioids.

And just because there is no opioid-related risk, that doesn't mean there is zero risk. The FDA warned consumers not to use Tylenol with Naproxen with other drugs containing acetaminophen, as doing so may cause liver damage.

And, as with all NSAID-containing products, the labeling includes warnings for stomach bleeding and for increased risk of heart attack, heart failure, and stroke — risks that are higher when NSAIDs are used more than directed or for longer than directed.

While this is the first OTC combination of Tylenol with Naproxen, it is not the first time acetaminophen has been combined with an NSAID in an OTC medication. In 2020, the FDA approved the first over-the-counter pain reliever that combines acetaminophen with ibuprofen, Advil Dual Action.

Researchers Find Genetic Variants That Increase Risk of Fibromyalgia

By Pat Anson

The origins and causes of fibromyalgia have long baffled patients, doctors and researchers. Over the years, fibromylagia has been blamed on everything from gut bacteria and childhood trauma to a brain disorder and weakened immune system.

Through it all, fibromyalgia remains a poorly understood disorder characterized by deep tissue pain, headaches, fatigue, anxiety, depression and insomnia. Nearly 3% of the world’s population has fibromyalgia, with females making up 75% of cases 

An international team of researchers has now identified over two dozen genetic variants that play a role in the development of fibromyalgia. Their findings, published in Nature Medicine, suggest the nervous system plays an important causal role.

The team analyzed genetic data from more than 2.5 million adults around the world, including 55,000 who had been diagnosed with fibromyalgia. Researchers looked for genetic differences in people with and without fibromyalgia to find the genes that were most common in those with the condition.

This helped them identify genetic variants in 26 regions of the DNA genome that appear to play a role in fibromyalgia’s development. Many of the genes implicated in these regions are involved in brain and nerve function, and are associated with fibromyalgia’s physical and psychiatric traits.

"This work changes how we think about fibromyalgia at a fundamental level. For decades, patients have been dismissed or told their pain is simply psychological. Our findings confirm the condition has a clear biological basis," said co-senior author Michael Wainberg, PhD, an investigator at the Lunenfeld-Tanenbaum Research Institute and Assistant Professor of Psychiatry at the University of Toronto.

Of the 26 genetic variants identified, the one most strongly linked to fibromyalgia risk was within the gene HTT. Different mutations in the HTT gene cause Huntington's disease, a severe, progressive and fatal neurodegenerative disorder.

Further genetic analysis revealed moderate-to-strong positive associations between fibromyalgia and several psychiatric disorders, namely depression, suicidality, ADHD and PTSD. These correlations help explain the high comorbidity between fibromyalgia and these emotional states.

The study also revealed substantial genetic overlap between fibromyalgia and a range of painful conditions, including low back pain, migraine and irritable bowel syndrome. The researchers think shared biological mechanisms within the nervous system may make people susceptible to several of these conditions, explaining why they often appear together.

"We know that chronic pain syndromes cluster together in individuals and families and are genetically similar. Targeting the shared mechanisms underlying them could potentially benefit a whole cluster of disorders," said co-senior author Frances Williams, PhD, Professor of Genomic Epidemiology at King's College London.

"The findings also help us better understand why fibromyalgia so often occurs alongside conditions such as anxiety and depression, bringing us closer to understanding the condition as a whole."

Genetics alone do not determine whether someone develops fibromyalgia. Researchers suspect that even people who carry many of fibromyalgia’s genetic variants require other risk factors, such as arthritis, to trigger fibromyalgia.

"This study provides important new insights into why some people develop fibromyalgia syndrome and identifies biological pathways that could lead to new treatment approaches. One of these pathways is already the focus of drug trials for Huntington's disease, raising the possibility that existing pharmaceutical research could eventually benefit people with fibromyalgia,” said Williams.

Williams and her colleagues have founded the Chronic Pain Genomics Consortium to investigate other chronic pain syndromes, starting with pelvic pain. The consortium sees fibromyalgia as only the beginning of a broader exploration of the landscape of chronic pain conditions.

7-OH Retailers Slash Prices as DEA Deadline Looms

By Pat Anson

Online sellers of 7-OH products are offering major discounts on tablets, gummies and shots as a potential August 5 deadline nears for concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) become illegal Schedule One controlled substances.

“Once they are gone, they are gone for good,” is how Payless Kratom is promoting its 7-OH clearance sale. Other online 7-OH promotions include multi-buy discounts and steep price breaks on bulk purchases.

“This is really the last chance to stock up,” said another 7-OH retailer.

KURES APOTHECARY

The DEA announced on July 6 in the Federal Register that it planned an emergency scheduling of all concentrated forms of 7-OH as illegal Schedule One controlled substances, the same classification as heroin and LSD.  

The scheduling order “will not be issued before August 5,” according to the DEA, and will remain in effect for at least two years, with a possible extension of an additional year.

Stockpiling 7-OH

With the August deadline fast approaching, retailers are getting rid of 7-OH products they will soon be prohibited from selling, and 7-OH consumers are stockpiling products while they can.  

“There is a fire sale going on at the website I get my 7 from,” said one Reddit poster. “They even have a countdown timer that's got the days, hours and seconds until they will no longer be taking orders if/when this goes into effect…. I just placed a massive order a few days ago and it's already on the way. It is probably my last order ever.”

“Prohibition is about to happen and I don’t know that it’s happened with something this popular in a while. We’re gonna see how addictive it is when it becomes a street drug. Turns a lot of otherwise law-abiding citizens into felons,” wrote another Reddit poster. “They’ll be arresting normal folks and destroying their families with drug court for something that was legal to purchase in a gas station 6 months ago.”

“With 7-OH becoming Schedule I in the coming days, I think we're approaching an inflection point. Healthcare workers should be prepared for a spike in both withdrawal presentations and ODs (overdoses),” warned a medical student. “Keep an eye out for both extremes over the next few weeks. Those that stockpiled and unintentionally OD or suddenly lose access and present in severe withdrawal that can resemble heroin or fentanyl withdrawal.”

Whether concentrated 7-OH is an “opioid” like fentanyl is disputed, but most 7-OH consumers acknowledge that it has opioid-like effects and is a good pain reliever.

“The effects of 7-OH on a person's body bear no resemblance to those of heroin or fentanyl,” says Jeff Smith, National Policy Director of the Holistic Alternative Recovery Trust (HART), an advocacy group funded by 7-OH manufacturers.    

Smith has chronic pain from two significant back injuries. The pain was so severe he couldn’t sleep more than 20 minutes at a time, until he started using 7-OH.  

“I've been using it for over a year, and it's helped me immensely with chronic pain and helps me sleep through the pain,” Smith told PNN. “So it has been transformative for me, and I know for tons of other people who I've met when I've gone and testified in different state capitals.  

“No other painkillers have helped. No other sleep medication has helped. I've tried 15 different things probably over the course of a decade or more, and this has really been the first thing that's helped meaningfully.”

HART has produced a documentary to counter what it calls false and misleading narratives about 7-OH. It features 7-OH consumers sharing personal stories of how 7-OH helped them overcome pain, anxiety and PTSD.

Local Bans Already in Effect

In some states, cities and counties, sales of 7-OH and kratom itself are already banned.

In recent months, California has seized nearly 7,000 kratom and 7-OH products, achieving what the state’s Alcoholic Beverage Control (ABC) agency calls a “98% compliance rate.”  

Ironically, many California retailers agreed to stop selling 7-OH and kratom products rather than run the risk of losing their licenses to sell alcohol – a substance that causes substantially more public health and safety problems. 

“After five months of targeted kratom and 7-OH enforcement efforts, nearly 98 percent of ABC-licensed locations are in compliance,” ABC Director Paul Tupy said in a statement. “This is possible through the collaboration of our licensees, who are making sure these harmful products aren’t available on store shelves.” 

Jeff Smith is unsure what will happen after August 5, a date when a window opens 30 days after the DEA’s scheduling order was published.

“The whole process has been so bizarre and herky-jerky that it's difficult to predict,” Smith said. “There is no outer time bound to this process, so 30 days is a minimum, but it's not a maximum. So they could take 60 days, or 90 days, or 180 days, or 365 days. I mean, they could take as long as they want to to address this. We just don't know what they'll do.”