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.

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.  

Banning 7-OH Will Save Lives

(Editor’s Note: Last week the DEA said it would classify concentrated versions of the kratom alkaloid 7-hydroxymitragynine (7-OH) as illegal Schedule One controlled substances. In response, PNN’s Crystal Lindell — a 7-OH consumer — wrote an op/ed sharply critical of the DEA’s decision and the role played by the American Kratom Association (AKA), which lobbied for the move. The column below is the AKA’s response.)  

By Mac Haddow

I do not question the sincerity of Ms. Lindell in her Op-Ed describing her personal experience or the seriousness of the pain she describes. No one should minimize the suffering of chronic pain patients, and no one should dismiss the fear that comes when a person believes the product they rely on may no longer be available.

But that does not change the core issue: the Controlled Substances Act was enacted to protect consumers from dangerous drug products — not to punish consumers. When manufacturers create, market, and sell products that present a significant threat to public safety, federal law exists to intervene. 

That is exactly what has happened with chemically manipulated 7-OH opioid products.

The blame for this situation does not rest with the American Kratom Association, natural kratom leaf consumers, regulators, or anyone advocating for responsible consumer protections. The blame lies entirely at the feet of the 7-OH manufacturers who deliberately bypassed federal law and basic safety requirements in pursuit of profits.

These companies did not follow the required pathways for market entry. They did not submit lawful safety data. They did not comply with the federal requirements that exist to protect consumers from dangerous drug 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.

Worse, they deceived hundreds of thousands of natural kratom leaf consumers into believing they were purchasing ordinary kratom products. They traded on the reputation of natural kratom leaf while selling products that are fundamentally different in formulation, potency, pharmacology, and risk. 

That deception has harmed consumers, undermined legitimate kratom regulation, and placed the entire natural kratom community at risk.

The American Kratom Association does not advocate for the purchase of any kratom product. The AKA advocates for consumer protection. That means support for policies requiring safely formulated natural kratom leaf products, proper labeling, age restrictions, contaminant testing, responsible manufacturing standards, and clear limits that prevent dangerous adulteration or chemical manipulation.

The companies you criticize for supporting the AKA are not being defended because they sell products. They are companies willing to support lobbying efforts to protect consumers through rational regulation. That is very different from the 7-OH manufacturers who chose to evade federal requirements, push chemically manipulated opioid products into gas stations and smoke shops, and then claim that enforcement against them is somehow an attack on personal freedom.

It is not.

No responsible public health policy would support allowing consumers to buy opioids from drug dealers on a street corner simply because some adults may want access to them. The same principle applies here. 

Chemically manipulated 7-OH products are opioids. They should not be easily available to anyone through retail channels with no medical supervision, no lawful drug approval, no verified safety profile, no abuse-liability controls, and no meaningful consumer protections.

This is not a debate over bodily autonomy in the abstract. It is a debate over whether manufacturers can bypass the law, create concentrated opioid products, market them as “kratom,” and sell them broadly to consumers without meeting the same safety standards that apply to other opioid products.

Alcohol and tobacco are not a justification for repeating another public health failure. The existence of dangerous legal products does not mean the government should ignore a new class of chemically manipulated opioid products being sold without adequate oversight. It means policymakers should act before the harm becomes larger.

The most important distinction is this: natural kratom leaf products and chemically manipulated 7-OH opioid products are not the same. The AKA has fought for years to protect access to natural kratom leaf for responsible adult consumers. That work is directly threatened by 7-OH manufacturers who blurred the line between kratom and opioids for profit.

Ms. Lindell's anger should be directed at the companies that created this crisis. They put consumers like her in this position. They entered the market unlawfully. They misled consumers. They ignored safety standards. They gambled with public health. And now they want natural kratom advocates to absorb the blame for the consequences of their own conduct.

The AKA will continue to support access to properly regulated natural kratom leaf products. But it will not defend chemically manipulated opioid products masquerading as kratom. Protecting consumers means drawing that line clearly — and enforcing it.

That is not betrayal.

That is responsible advocacy.

Mac Haddow is a Senior Fellow on Public Policy with the American Kratom Association.

Banning 7-OH Will Ruin My Life

 By Crystal Lindell

When I got the news that 7-OH will likely be illegal in the United States within the next month, I was on a break at the new job I was able to get because of 7-OH.

I opened my texts to see a message from PNN editor Pat Anson:

“7-OH to be banned nationwide in early August according to DEA filings.”

He’s always been great at breaking news. 

When I saw the words though, I wanted to throw up. I started shaking and was overcome by a cold sweat. Then I fought back tears because I had to get back to work.  

I had to get over the shock and dissociate to get through the rest of my shift at the gas station where I work. I spent the next few hours legally selling customers cigarettes, beer, and lottery tickets. 

Then I went into my car and cried.  

7-OH has truly been a life-changing drug for me and many people I know and love.

I have intercostal neuralgia, which is nerve damage in my ribs. When you have the same thing in your face it’s called trigeminal neuralgia – which is colloquially called the “suicide disease” because so many people who have it kill themselves or want to.

As someone with the intercostal variety, I’m here to tell you that having that kind of pain in your ribs doesn’t make it any less horrible. I have long considered suicide as a potential treatment option.

For many years I was able to find some semblance of stability with a cocktail of opioid and OTC pain medications. I know how lucky I am to be among those who can still get an opioid prescription. But while the opioids have kept the suicidal-level pain at bay, they have never allowed me to actually live.

7-OH does that.

It’s not an exaggeration to say that it has given me my life back. It’s been even more effective than hydrocodone or morphine for me. It instantly treats my pain while also combating fatigue. 

Losing access to 7-OH will be devastating for me. 

I am worried I will no longer be able to work full-time, and that I will then lose the health insurance I only just got. Without work and insurance, I will be back to living below the poverty line, and relying on food pantries. 

But none of that has anything to do with why I think 7-OH should remain legal.

7-OH should remain legal because – as an adult – I should have the legal right to put whatever I want into my own body, and it is no one else’s business how I do that.

That’s it. That’s the only reason needed. Anything else is irrelevant.

This is a bodily autonomy issue. I should be the only one who controls my own body, especially my own medical decisions. 

Not to mention the fact that nicotine and alcohol are legal despite the fact that they are both very addictive and sometimes deadly. Why single 7-OH out? Especially considering how safe it is in comparison to those drugs. 

AKA Betrayal

What’s worse is the outright glee from some leaf kratom advocates, who think banning 7-OH will somehow let them be seen as the golden child.

I feel so betrayed by them. The American Kratom Association in particular pushed for this and they have made a deal with the devil. When 7-OH is banned nationwide, it’s likely that leaf kratom is next. It’s already happened in several states.

I will never again use a single kratom product from any of the companies that support the AKA.

For now, I plan to taper down and hopefully get off 7-OH without going into withdrawal. And I am going to look into different substances that may give me a similar effect. 

I’m also hopeful that the 7-OH manufacturers are working on new formulations of kratom alkaloids that will still be available after the ban. 

And I am clinging to the 1% chance that the DEA backtracks on this, as they did in 2016, after initially announcing plans to make mitragynine and 7-hydroxymitragynine illegal Schedule One drugs. 

I know we cannot count on that though.

Honestly, writing this column feels futile. I know it won’t do anything to stop the ban on 7-OH from coming. But I do feel it’s important to at least create a record of my objections. 

I want it plainly stated that a ban on 7-OH will be detrimental to my life, and to the lives of thousands of others who have found relief from this drug.

But how do I convince people to care about my life? Why do I even have to do so? Shouldn’t caring about other people’s well-being be something that comes naturally?

It’s degrading that I have to beg the world for pain relief. That I have to plead for a medication that allows me to live my life, work a job, care for my cats, love my fiancé, and aid my elderly relatives.

It disgusts and depresses me that we live in a country that would deny me those things.

DEA Will Classify 7-OH as Illegal Drug

By Pat Anson  

The Drug Enforcement Administration is moving to ban all concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) by classifying it as an illegal Schedule One controlled substance, the same classification as heroin and LSD. 

In a notice pre-published in the Federal Register, the DEA said it would enact a temporary scheduling of 7-OH, which will begin 30 days after the notice is formally published on July 6. That would effectively ban the manufacture, sale and possession of 7-OH products nationwide, potentially in early August.

A separate notice applies the same Schedule One classification to the kratom derivatives mitragynine pseudoindoxyl (MP), dihydro-7-hydroxymitragynine (MGM-15), and the 9-fluoro derivative of 7-hydroxymitragynine (MGM-16).

Kratom comes from the leaves of a tropical tree in Southeast Asia, where it has long been used as a natural stimulant and pain reliever. 7-OH occurs naturally in kratom in trace amounts, but when concentrated it becomes more potent and has “opioid-like” effects.

The DEA’s order limits the amount of 7-OH to no more than 0.05% of a product by weight or volume. Virtually all 7-OH products currently on the market are well above that threshold.

Although many pain patients have found 7-OH to be an effective analgesic, concern has risen that repeated use may lead to addiction and overdose. Several states and dozens of cities and counties have banned 7-OH products, which are currently sold as unregulated dietary supplements.  

“7-Hydroxymitragynine has opioidergic activity, sharing a similar pharmacological profile to schedule II opioids like morphine. Preclinical data indicates that 7-hydroxymitragynine carries a high abuse potential with safety risks, including tolerance, dependence, and respiratory depression, which are comparable to those of classic opioid analgesics,” the DEA said.

“While sellers promote these products for their euphoric and opioidergic effects, evidence demonstrates they may also contain other opioid alkaloids, such as mitragynine pseudoindoxyl. These combinations, coupled with a lack of regulatory oversight, pose significant safety risk to unsuspecting consumers by exposing them to high doses of opioids.”

Under the Controlled Substances Act (CSA), the DEA can “temporarily” place a new substance in Schedule One for two years without a public hearing, as long as the Department of Health and Human Services (HHS) has no objection.  

“I commend the DEA for taking decisive action to address these addictive and harmful substances,” HHS Secretary Robert F. Kennedy, Jr. said in a statement.  “7-OH, MP, MGM-15, and MGM-16 are dangerous opioids that fuel addiction and put American lives at risk. HHS reviewed the science and recommended this action.” 

‘More Than We Were Hoping For’

The DEA action was applauded by the American Kratom Association (AKA), an organization of kratom vendors that promotes the use of unadulterated natural leaf kratom. The AKA has been lobbying local governments to ban 7-OH, but keep kratom legal.

“State officials should be very clear about what happened here,” said Mac Haddow, an AKA lobbyist and spokesman. “The 7-OH industry created this crisis. They manufactured or distributed high-potency opioid products, dressed them up as kratom, and then tried to force natural kratom consumers to pay the price for their recklessness.”

Haddow says the DEA’s action will lend weight to arguments that natural leaf kratom is safer than 7-OH.  

“It's more than we were hoping for, in the sense that we got another clear affirmation from HHS about the distinguishing characteristics, because that's important to state legislatures and to state AGs and to boards of pharmacy,” Haddow told PNN. 

“This was all a great set of announcements that clarifies for every state legislator, every attorney general, and every local county elected body to see exactly that they should be in alignment with the federal policy on these issues.”

7-OH advocacy groups are likely to mount a legal challenge to the DEA’s scheduling of 7-OH.

“We understand that this announcement is causing a lot of confusion, fear, and uncertainty throughout the consumer community. First and most importantly, we want to be clear: 7-OH has not been immediately banned or scheduled,” the 7-HOPE Alliance said in a statement.

“While this development is serious, there is still a process ahead, and there is still an opportunity for science, evidence, and consumer voices to be heard. The 7-HOPE Alliance is actively reviewing the announcement and coordinating with legal, scientific, policy, and advocacy partners to determine the strongest path forward.”

Legal options appear to be limited. Under the CSA, DEA and HHS are given wide discretion to classify a new drug as a Schedule One controlled substance if its poses an “imminent hazard to public safety.” In addition to the two-year temporary scheduling of 7-OH, the U.S. Attorney General has the authority to add an additional third year.

In another notice being published in the Federal Register, HHS is opening a 30-day public comment period on the proposed threshold for 7-OH and the other kratom derivatives.

You can leave a comment by clicking here. Comments must be posted by July 31.

It’s important to note HHS is not asking whether 7-OH should be classified as Schedule One, only if the 0.05% threshold set by DEA is appropriate. It is “not soliciting comment on any permanent scheduling decision, the general safety or utility of kratom-derived products.”

AMA Calls for Complete Ban on Sales of 7-OH

By Pat Anson

The American Medical Association (AMA) is calling for a complete ban on the sale, distribution and marketing of products containing 7-hydroxymitragynine (7-OH), a kratom alkaloid that is of growing concern for its potential to cause dependence and addiction.

7-OH occurs naturally in kratom in trace amounts, but when concentrated acts as a potent pain reliever and stimulant with “opioid-like” effects.

The policy adopted by the AMA at its annual meeting urges the FDA to classify “7-OH kratom products” as adulterated or misbranded. It is particularly concerned about sales to minors and the packaging of 7-OH in colorful, child-friendly forms that could be mistaken for candy.

“We cannot ignore the growing availability of unregulated products marketed in ways that appeal to children and adolescents. Concentrated 7-OH products are being sold in forms that can resemble candy and other treats, creating unnecessary risks for young people,” Dr. Melissa Garretson, a member of the AMA Board of Trustees, said in a statement.

As for kratom itself, the AMA’s House of Delegates passed Resolution 201, which recommends that kratom be evaluated for regulation as a drug under the Controlled Substances Act:

“Our AMA recommends kratom, and its derivatives, should be regulated by the FDA, and its safety and efficacy should be determined through clinical trials before it can be marketed or prescribed as treatment for any condition.”

As dietary supplements, kratom and 7-OH are currently regulated as food — not as drugs — by the FDA, as long as unverified claims are not made about their medical uses. The FDA has repeatedly warned kratom distributors not to make such claims.

Several states and dozens of cities and counties have already banned kratom and 7-OH or put age restrictions on sales. The AMA’s new policy position will likely add weight to further efforts to ban kratom products.

The American Kratom Association (AKA), an association of natural leaf kratom vendors, supports efforts to ban 7-OH products. but is concerned the AMA was not specific enough about its concerns.

“The AMA correctly identifies the danger posed by concentrated 7-OH products, but it stops short of making the most important distinction,” Mac Haddow, an AKA lobbyist, said in a statement. “These chemically manipulated 7-OH opioids are not traditional kratom products. They are highly concentrated opioids manufactured through chemical conversion processes that fundamentally alter the natural composition of kratom.” 

The AKA’s position is at odds with the 7-HOPE Alliance and the Holistic Alternative Recovery Trust (HART), which represent 7-OH consumers and manufacturers. Those groups support age restrictions and regulation of 7-OH, but not outright bans.  

“As discussions surrounding kratom continue, HART urges policymakers, medical organizations, and regulators to engage with the available scientific evidence and work toward regulatory solutions that protect children and consumers while preserving access for responsible adults,” Jeff Smith, HART’s National Policy Director, said in a statement to PNN.

“The fixation and misinformation on 7-OH is a deliberate distraction from far more concerning products that remain widely available to consumers. Instead of pursuing misguided bans on naturally occurring compounds, policymakers and regulators should focus on protecting consumers through consistent, science-based standards that apply equally across all kratom products.”

(Editor’s note: An earlier version of this story incorrectly reported that the AMA only wanted a ban on sales of 7-OH products to minors. PNN regrets the error.)

Kratom and 7-OH Often Confused

The lines between kratom and 7-OH often get blurred. A case in point is a recent news release from the Laguna Treatment Center, an addiction recovery clinic in Southern California, which warned of the “growing threat of kratom and its byproducts.”

In the first 5 months of 2026, the center said it was treating 25 patients “who sought help for kratom dependence.” That represents a 525% increase from the 4 kratom consumers who sought treatment at the center in all of 2025. The center makes no distinction between the different forms of kratom. 

“An alarming number of patients are coming in dependent on and addicted to kratom and its byproducts, such as 7-OH, who were previously unaware of the risks. This is relatively new territory for many providers, and we encourage insurance providers to expand and prioritize coverage for those seeking treatment for kratom misuse,” said Trace Swartzfager, Executive Director of the Laguna Treatment Center. 

Federal policies about kratom and 7-OH are also confusing, if not incoherent. Last month, President Trump said his administration would support the approval of “natural 7-OH,” without clarifying whether he was talking about natural leaf kratom or concentrated 7-OH versions.  

Nearly a year ago, FDA commissioner Marty Makary, MD, called on the DEA to classify 7-OH as an illegal Schedule I controlled substance, but not “natural kratom leaf products.” The DEA has yet to act on the FDA’s request and Makary has since been fired. The Trump administration has yet to replace him.

Claims are often made that 7-OH and kratom are opioids that cause addiction and overdoses. Technically, they are alkaloids and are not derived from poppy plants. Kratom and 7-OH stimulate endorphin nerve receptors in the brain – often called “opioid receptors” – but the same could be said about chocolate and coffee, which stimulate the production of endorphins and other natural “feel good” hormones.

Most of the overdose deaths attributed to kratom and 7-OH involve other substances, so it is not clear if they were the actual causes – much as opioid pain medications were mistakenly blamed for many overdose deaths. The FDA admits there is “ambiguity about the contributory role of 7-OH” in many overdoses.

Further muddying the waters about kratom, the National Institutes of Health (NIH) recently said it would study one of its purported health benefits. The NIH is launching a preliminary study to see if the kratom alkaloid  mitragynine could be used as a treatment for opioid addiction. Many kratom consumers already use the herbal supplement to help reduce their cravings for opioids and alcohol. 

A previous NIH study concluded that kratom is an effective treatment for pain, helps users reduce their use of opioids, and is “relatively safe” to use.

How I Finally Got Health Insurance Again

By Crystal Lindell

In 2022, I was unceremoniously laid off from my job of 12 years. During the exit meeting, I was told that it would all be okay because I could sign up for COBRA!

That way, despite losing my job, I’d at least have health insurance until I could find something else.

Then, I saw the price of COBRA. It was about $500 a month. 

That’s a lot of money when you have a job, but it’s an obscene amount of money when you’ve just been laid off. 

People with a lot more wealth than me were flabbergasted that I turned it down. Extended relatives and former co-workers could not grasp why I decided to instead try the alternative health insurance plan, known as “Hope for the best.”

But looking back, “Hope for the best” has served me relatively well for almost four years now. 

I paid out-of-pocket for my routine doctor appointments, and cash for all of my monthly prescriptions. But I had to skip all my recommended preventative care, like getting mammograms. 

I also prayed every night that I wouldn’t have a medical emergency.

About 27 million Americans do that too, because they can’t afford private health insurance or the higher premiums of Affordable Car Act plans. They’ll soon be joined by over 5 million adults and children due to tougher Medicaid work rules

Yes, I still have medical debt to worry about. But I finally have real-life health insurance again! 

Oddly, it’s all thanks to the war with Iran. Let me explain.

For the last year, I had been earning a few hundred dollars a week delivering meals for DoorDash. But after we went to war, gas prices went from $2.79/gallon to $4.29/gallon in northern Illinois almost overnight. 

Suddenly, the math for most deliveries just didn’t make sense anymore. There were some orders where I was literally paying to bring someone McDonald’s.

When I factored in the wear and tear on my car, it became obvious that even a part-time minimum wage job would make more sense financially.

So, I applied at a Michael’s Craft Store because I thought it sounded fun, and then I applied at a gas station 12 minutes from my house because I thought it sounded convenient. The next day, the gas station called me back.

While I was initially hired as part-time, as of June 1, I am officially full-time.

And full-time employees get health insurance!

I signed up online right away and immediately scrolled to the most expensive plan, which was $68/week. But then I was given a $15/week discount for not being a tobacco user. (Thanks D.A.R.E.!) I also added on a $3.83/week dental plan, bringing my total health insurance cost to about $227/month.

That’s less than half the cost of the COBRA I was offered, plus now I have a weekly income to help cover it.

After years of paying out-of-pocket for all my medical care, my new plan includes some exciting features – like $10 co-pay for two medications I need every month; free preventative care like those mammograms I missed; and $20-co-pays for my doctor, who is thankfully in-network.

I’m going to call and make multiple appointments that I have been putting off, and then when they ask me how I’ll be paying for the visit, I will proudly tell them that I will be using my very own Blue Cross Blue Shield health insurance!

You might be wondering how I’m able to physically do a gas station cashier job with my chronic pain, and the answer to that question is 7-OH, a potent form of kratom. I started taking it a few months ago, and it has greatly improved my daily quality of life.

Yes, 7-OH is expensive, and yes, it does cause withdrawal symptoms if you stop abruptly, so it’s not perfect. But for me, it’s been life-changing in all the best ways. It relieves pain while also giving me energy, making me more functional than I have been in years. 

I am not exaggerating when I say that 7-OH is the reason that I am now able to work a job full-time. And by extension it’s the reason that I am able to have health insurance now.

So tonight, when I go to sleep, I’ll be praying to a God I don’t really believe in that 7-OH remains legal. For now, anyway.

But hey, at least I no longer have to worry about what happens if I break a bone or have a heart attack. Because I finally, after four long years, really do have health insurance again!

Trump’s Endorsement of ‘Natural 7-OH’ Stirs Debate in Kratom Industry

By Pat Anson

The Trump administration has given another sign that it plans to keep some “natural” forms of kratom legal under federal law. Left unclear, however, is what the administration means by “natural.” 

In wide-ranging remarks on healthcare Monday in the Oval Office, President Trump said his administration would seek to have “natural 7-OH” approved. That is a reference to 7-hydroxymitragynine (7-OH), an alkaloid in kratom that has pain relieving and mood enhancing qualities.   

“We’re looking very seriously at natural 7-OH and getting that approved, natural 7-OH. And we’ll take a look at that very strongly. I think Oz and everybody, we’re looking to see if we can do something there. A lot of people are asking for it. And thank you very much for the work on that,” Trump said, while gesturing towards Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services.

Trump’s remark about “natural 7-OH” soon became a Rorschach test for rival advocacy groups in the kratom industry. Supporters of natural leaf kratom said the president was referring to the trace amount of 7-OH – usually no more than 2% – found in unadulterated kratom.

MNG Brands, a kratom vendor, said it was “encouraged by the support shown for natural leaf kratom Trump was clearly endorsing” – not the concentrated and more potent forms of 7-OH that have entered the market in recent years.

Several states and dozens of cities and counties have banned those "synthetic" forms of 7-OH, saying they are potentially harmful and addictive. 

"MNG Brands has long supported regulatory frameworks that protect consumers, prevent youth access, and create accountability within the industry," Dafna Revah, Chief Strategy Officer of MNG Brands, said in a statement.

"We believe there is a meaningful difference between traditional natural leaf kratom products and highly concentrated or synthetic derivatives being introduced into the market without consistent standards or oversight."    

But the Holistic Alternative Recovery Trust (HART), which represents 7-OH manufacturers like American Shaman, has a different take on what Trump said. A HART news release said the president was endorsing all forms of 7-OH, even the concentrated products that contain as much as 96% 7-OH. 

7-OH vendors maintain that their products are “natural” since they contain an alkaloid that occurs naturally in kratom and is produced by the human body itself. That happens when the liver processes and converts mitragynine, another kratom alkaloid, into even more 7-OH.

“President Trump said his administration is trying to keep 'natural 7-OH' available. That distinction matters, and it is the same distinction lawmakers and regulators should be moving forward. Policymakers should focus on stopping bad actors, mislabeled products, unsafe marketing practices, and inconsistent manufacturing standards, not criminalizing naturally derived products that millions of Americans already use,” said Jeff Smith, HART Executive Director. 

“A blanket ban on natural 7-OH is now directly at odds with the President’s stated goal. The FDA should support the direction set by the President and work toward a regulatory framework that protects consumers without eliminating lawful access to natural products.”

Mac Haddow, Senior Fellow on Public Policy for the American Kratom Association, a group of natural leaf kratom vendors, said that was a misleading take on what the president said.

“As I understand it, from people who are familiar with the President's view on this, that he was speaking about natural kratom, as opposed to synthetic or chemically manipulated 7-OH,” Haddow told PNN.

“These people are deliberately misleading legislators and public health officials in order to try to make their products sound like, ‘Oh, they're okay, they're just like natural kratom.’ They are not, and it's a big con job.”

Like other dietary supplements, kratom and 7-OH currently are lightly regulated under federal law. As long as manufacturers and vendors don’t make medical claims about them, kratom and 7-OH can be sold legally as far as the federal government is concerned. They are not controlled substances — at least not yet.

But that hasn’t stopped states and local governments from banning 7-OH or natural leaf kratom for their opioid-like qualities, as many have in recent months.

It’s been nearly a year since the FDA asked the DEA to have 7-OH – but not whole leaf kratom – classified as an illegal Schedule One controlled substance. The DEA has yet to act on the FDA’s request, leaving 7-OH in a legal limbo.

President Trump’s remark this week doesn’t change 7-OH’s status, but it does signal that the administration is willing to have some forms of 7-OH remain on the market. Whether that’s the “natural” 2% or concentrated 96% versions remains unclear.

The Downside to Powering Through Pain

By Crystal Lindell

I spent the last few days being incredibly active physically, and using 7-OH to help me power through my pain.

And I’m going to be honest with you: It was FANTASTIC… in the moment.

I got so much stuff done! I felt amazing. And other than the fact that I had to take a bite of a 7-OH tablet every few hours, I got to pretend I was completely healthy!

If you’re unfamiliar with it, 7-OH is an alkaloid that occurs naturally in kratom. When concentrated, it has opioid-like effects that relieve pain and boost energy levels. 

I was swimming in wins after I took it.

But, today? Today does not feel fantastic. Today feels like hell.

When I woke up, I realized that all that activity was done with a predatory loan, and now the bill is due.

Every joint hurts, my eyes are extremely dried out, and the bottom of my right foot is swollen because I have been ignoring my bone spur for the last week. I struggled to even stand up out of the bed and walk to the bathroom.

I am also completely exhausted.

Over the years, anti-opioid advocates have started to spread the idea that pain medication is bad because it covers up pain that your body is trying to communicate. For example, if you don’t feel like you can walk on a sprained ankle, it probably means you should not be walking on your sprained ankle.

This has always annoyed me because my most prominent pain – intercostal neuralgia in my ribs – is both unexplained and incurable. It’s not trying to communicate anything at all. It just IS. And the only thing I can do is treat it with pain relievers.

But that makes it easy for me to forget about all the other ways that having Ehlers-Danlos Syndrome impacts my body. My joints are not as strong as other people’s, I seem to get injured more frequently, and just existing causes exhaustion.

The good news is that I can take pain medication to power through all that if I need to. And I have recently found 7-OH to be especially great at helping me do that. 

The bad news is that powering through pain and fatigue will eventually catch up with me – an effect that I’m clearly dealing with today.

I definitely do not want anyone to think that I am siding with the anti-opioid crowd about how pain medication is bad because it covers up symptoms. Pain medication is a godsend. And many chronic pain patients – myself included – desperately need to power through because we have no other choice. 

When the pain lasts for years, or even decades, you can’t just stay in bed all day “listening to your pain.” The world doesn’t work that way. 

But perhaps it is best to admit that there is a limit to just how much we should be using pain relievers to power through. And maybe it is wise to make sure that we don’t go too far past that limit – if only because the bill will eventually come due. 

As for me, I will be spending the rest of the day paying for my excesses over the last week with lots of naps and recovery time. Hopefully, I’ll be relatively functional again soon.

I will definitely be using 7-OH again. But next time, I’ll also be taking breaks and listening to my body. 

Bitter Rivals: Kratom’s Three-Ring Circus

By Pat Anson

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

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

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

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

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

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

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

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

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

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

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

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

Kratom vs 7-OH

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

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

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

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

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

AKA IMAGE

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

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

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

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

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

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

‘Kratom Is an Opioid’

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

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

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

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

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

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

“For now, the evidence shows that kratom is an opioid with real risks – not a harmless supplement,” wrote Kolodny, while shamelessly ignoring his own role in restrictions on the use of opioid medication, which ironically led to greater use of kratom.

“Kratom’s rising use over the past decade coincided with the opioid crisis, as people searched for alternatives to prescription opioids,” he wrote. “Some in the kratom industry argue that only newer products with boosted levels of 7OH are dangerous. But the evidence does not support that claim. Deaths linked to kratom were already rising before the newer 7OH products appeared on the market in late 2023.”  

The three kratom advocacy groups – who all favor limited regulation – would be wise to consider that demonizing each other’s products only blurs the lines between kratom and 7-OH, which contributes to state after state and city after city enacting bans on both.

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

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

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

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

Doctors Increasingly Mention Kratom in Patient Notes

By Crystal Lindell

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

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

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

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

Mentions of “Kratom” in Patient Notes

JAMA NETWORK OPEN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

California Expands Crackdown on Kratom and 7-OH

By Pat Anson

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

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

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

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

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

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

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

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

Federal Efforts Foiled

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

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

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

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

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

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

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

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

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

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

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

7-OH Is a Breakthrough for Pain Relief and Should Remain Legal

By Crystal Lindell 

This week, Missouri took a step towards banning most 7-OH products, joining a long list of governmental bodies considering similar things. 

If you’re unfamiliar, 7-OH is an alkaloid that occurs naturally in kratom, the full name of which is 7-hydroxymitragynine. When concentrated, it has opioid-like effects that can relieve pain and boost energy levels. 

The interesting part is that 7-OH doesn’t cause respiratory depression the way opioids do, which means it is not deadly the way opioids can be. 

Unfortunately, multiple governmental bodies are attempting to ban it. While the FDA would like to ban it nationwide, states like Florida, Ohio and Kentucky have already banned it, while health officials in California are taking it off store shelves.

The Missouri Senate is considering a bill that would also effectively ban 7-OH. The proposed law would prohibit the sale of all kratom products to people under the age of 21 and specifically limit the 7-OH content in products to 2%.

Since many contain about 50% 7-OH or even more, that would essentially prohibit the sale of all 7-OH products. Violators could face felony charges if the bill becomes law.

The Missouri Independent reported that during a committee hearing on the bill, State Sen. Maggie Nurrenbern (D) of Kansas City said several families submitted statements calling 7-OH products “highly addictive, unregulated drugs” that have impacted their loved ones and children.

“I don’t know if there’s any more pressing issue before us than making sure that kids don’t have access to these drugs,” Nurrenbern told the committee. “As well as making sure that we’re not doing further damage to our community right now that’s already grappling with so much in terms of addiction and mental health.” 

A Painkiller That Actually Works

It’s disheartening to see 7-OH framed this way, when I know just how much value it has for the lives of the millions of people suffering from chronic pain. 

For years, we’ve been told that the reason opioid prescriptions had to be greatly restricted was because of overdose deaths. But now that we finally have something that actually treats pain without directly causing OD deaths, officials are still trying to claim it is doing “damage” to the community. 

What about the damage caused by chronic pain?

My life is littered with hellish stories about people I know who couldn’t get pain meds when they needed them. In fact, comment sections on PNN’s social media are often overflowing with the same type of stories.

Readers tell us many doctors dismiss their pain, refuse to prescribe opioid medication, and leave patients to suffer. Some pharmacists also refuse to fill opioid prescriptions and get irate when pushed. 

I have even seen numerous patients lamenting that they have lost the will to live because their severe pain is untreated. I have been there myself. Before I found my current doctor — who prescribes me enough pain medication to function — I still remember talking to my mom about how, if I do kill myself, I want her to understand that death would be a mercy for me.

But now there is an over the counter substance that actually treats pain, and I just have to call it what it feels like to me as a patient: a miracle.

In fact, I would argue that  7-OH is likely the closest we will come in my lifetime to seeing something like hydrocodone being sold OTC – something I have long advocated for.

In a humane society, everyone should have access to effective pain treatment, especially in a country without universal healthcare or insurance coverage.  

I was talking to my fiancé about a surgery he had a few years ago, where the operating surgeon initially refused to give him opioid medication for post-operative pain. The doctor claimed that his other patients had only needed ibuprofen — after he took a scalpel and sliced open their arms to repair a nerve. 

While my partner was still coming out of anesthesia, I had to argue with his surgeon to make sure he was sent home with at least a handful of Norco. 

I had made the mistake in the past of not doing this after my partner’s nose surgery, and then I was left to watch him suffer on the couch for three days while he lamented that every time he tried to breathe, it felt like death.

If either situation happened today, we could save ourselves from so much stress and agony because he could just take 7-OH post-op. Yes, 7-OH is that good of a painkiller.

If doctors were smart they would be jumping all over 7-OH. Finally, something that actually relieves pain and doesn’t kill their patients.  It’s what we have all been looking for! 

But no, doctors are not recommending 7-OH. In fact, most have never heard of it, while state and local governments either ban it or threaten to do so. 

Yes, there are some downsides. The main one is how expensive it is. One 7-OH chewable tablet, which has 4 servings, will run you around $10. 

It can also be difficult to figure out which brand works best for you, in large part because there’s so little regulation of kratom or 7-OH, making it difficult to know what each brand puts into their tablets and how much is in there.

My circle of people really like using the brand 7Stax, but you can also browse through the r/7_hydroxymitragynine subreddit for additional recommendations and user experiences. 

You should know that 7-OH can cause dependence and withdrawal symptoms if you abruptly stop taking it. As someone who has used opioids for over a decade to manage pain, I am an expert on tapering down medications to avoid withdrawal. Newcomers may have some trial and error time before they figure out what’s best for their own bodies.

There’s also not much research on how 7-OH interacts with other drugs or health conditions, not to mention the lack of information about long-term side effects.

That is largely why I am still hesitant to recommend it to elderly relatives, as their health tends to be more fragile. Although, paradoxically, they also tend to be much more likely to have chronic pain.  

With everything going on in the news, it does seem like the fight to make 7-OH illegal has taken a backseat to other issues.  

What I would say is that if you have been hesitant to try 7-OH because you don’t want to waste money on another supplement that probably won’t work, then I can vouch for the fact that it does work on my pain. 

I’m not a doctor, just a patient who also has a lot of loved ones with chronic pain. And I can tell you that everyone I know who tries 7-OH finds it to be effective.  

If you are among those who have already found 7-OH to be effective, I encourage you to be proactive by reaching out to your local government officials to tell them how important it is for you. I would also encourage you to make yourself available to local reporters when possible, so that they can offer more balanced coverage of what 7-OH is and what it does. 

While 7-OH is a breakthrough, it will only stay that way if it remains legal. We all have to fight to keep it that way. 

Federal and State Warnings May Be Increasing 7-OH Sales

By Pat Anson

Federal and state efforts to ban the sale of 7-hydroxymitragynine (7-OH) products may be having the unintended effect of increasing sales of the kratom extract, which is a potent pain reliever.

The owner of Kansas City-based American Shaman, the largest U.S. producer and seller of 7-OH products, says sales have increased since the FDA sent a warning letter to his company in July alleging its 7-OH tablets were being sold illegally as adulterated dietary supplements.

“We’re busier than ever,” says Vince Sanders, who estimates that millions of Americans are using 7-OH for pain relief and as a mood enhancer. “More people are familiar with it now than there were a year ago. All this press just makes more and more people educated about it, and more people go out and try it.”

7-hydroxymitragynine is a naturally occurring alkaloid found in kratom, an herbal supplement used in southeast Asia for centuries as a stimulant and pain reliever. Kratom contains only trace amounts of 7-OH, but Sanders has developed a process that makes it more concentrated and potent. 

Although technically not an opioid, 7-OH has opioid-like effects. Last summer, the FDA asked the DEA to classify 7-OH as an illegal Schedule One controlled substance, claiming it was a dangerous and addictive substance “more potent than morphine.” While the DEA has yet to act on that request, Florida, Ohio, California, and several other states and municipalities have recently moved to ban 7-OH sales.  

‘This Isn’t Some Party Drug’

While there are anecdotal reports that 7-OH is addictive, there is little solid evidence that people are overdosing or being harmed by it. And American Shaman continues to sell it, even though thousands of its tablets have been seized by the FDA.

Sanders believes 7-OH may be at least partially responsible for the recent decline in drug overdoses, because it keeps pain sufferers from turning to more dangerous substances like illicit fentanyl and other street drugs. Some use it as an alternative to Suboxone to treat opioid withdrawal symptoms. 

“There's probably roughly 75,000 people walking the earth today that wouldn't be here, and hundreds of thousands of others that have used 7-OH to completely stop taking a street drug,” Sanders told PNN..

“This isn't some party drug. It's not like, ‘Oh my gosh, I feel so high. This is incredible.’ That's not what 7-OH does. 7-OH is tremendous for pain and it definitely is a mood enhancer. It puts you in a better mood, but it doesn't make you high, like alcohol, marijuana or a traditional opioid. It doesn’t have that effect.”

7-OH is so effective that Sanders advises pain sufferers to use it sparingly in small amounts, and to take a break from it at least once a week to avoid building a tolerance that requires higher doses.  

“If you take it appropriately, you won't build a tolerance. You're not going to build an addiction to it. My 82 year old mother has been using it for nearly two years now. She needed a dual hip replacement, but refused to get it. She was almost to the point of not being mobile, she was in so much pain. But now she gets along like normal. It's amazing. Just takes her pain away.”

Are pain patients using 7-OH? We posed that question to PNN readers on our Facebook page and got some mixed responses.

“It absolutely works! Gets me through an eight hour shift every single day,” said one poster.   

“Best pain relief I ever had,” said another.

“Very effective, but it is addictive. It’s helped a lot of people, but it’s hurt some people as well,” warned one poster.

“Can’t stop taking them. It’s been over a year (and) trying to get down to below 100 mg a day is tough. I cannot have a normal digestion process anymore. Sucks and costs a lot of money,” warned another 7-OH user.

Some drug testing companies have started looking for 7-OH in blood and urine samples. Clinical Reference Laboratory in Kansas tested for it in a random batch of 1,000 samples from across the country. Surprisingly, 7-OH was detected more often than fentanyl and prescription opioids like oxycodone and morphine.

“We found a 1.09% positive rate, which is, depending on the population, higher than all the other opiates we test for combined,” CEO Robert Thompson told the Kansas City Star. “That was pretty concerning to me.”

As perplexing as 7-OH may be to health officials and drug regulators, there’s another kratom extract called pseudoindoxyl that’s even more potent and gaining in popularity. Derived from the alkaloid mitragynine, pseudoindoxyl also has opioid-like effects, but without the respiratory depression and risk of overdose that comes with traditional opioids.  

“For pain relief, it's better than 7-OH. The science would indicate that it's probably five times more potent for pain than 7-OH,” says Sanders, who sells pseudoindoxyl chewable tablets on American Shaman’s website.

He has yet to get any warning letters telling him to stop.

3 New Year’s Resolutions on Behalf of Pain Patients

By Crystal Lindell

It’s now 2026, which means I’ve spent too many decades making mostly failed New Year’s resolutions for myself. So this year, I’m not going to bother.

Instead, I have some New Year’s resolutions for other people. Specifically, they’re for people with power, like doctors and healthcare policy makers.

After all, it really seems like they need to make some policy changes, given the current state of things for people in pain. Perhaps they are just waiting for someone to tell them what those changes should be. 

Below is a look at three of my 2026 New Year’s resolutions on behalf of pain patients..

Resolution # 1: Fully Legalize 7-OH and Develop New Edibles

There’s so many conflicting local regulations when it comes to kratom and 7-OH, despite the fact that neither one is as harmful as health officials and lawmakers often claim.

For those unfamiliar, 7-OH is short for 7-hydroxymitragynine, an alkaloid that occurs naturally in kratom in trace amounts. Some kratom vendors now sell concentrated versions of 7-OH to boost its potency as a pain reliever and mood enhancer.

A lot of pain patients find both 7-OH and kratom to be effective at treating chronic pain. And while I am glad that both are still legal in most places in the United States, I would really like to see them fully legalized across the country, as municipalities and states realize just how beneficial these products can be.

I also would really like to see 7-OH vendors come out with some new edible formats, like chocolates, gummies and even seltzer.

I think 7-OH in particular has the potential to help a lot of people who have been denied adequate pain treatment. However, many of them may not be comfortable figuring out where to buy and correctly dose a 7-OH chewable tablet, especially if they are among one of the largest demographic of pain patients: the elderly.  

I think of my grandma trying to get 7-OH tablets at a local smoke shop, or having to figure out how to order them online. Both options are bad. 

Ideally, regular grocery stores and local pharmacies would have a display of low-dose 7-OH chocolates available over-the-counter for pain patients like her.

Resolution # 2: Stop Prescribing Gabapentin and Tramadol for Pain

This would be such a relatively easy change for doctors to make, and there’s so much science to back it up.

In October of 2025, PNN covered a study showing that tramadol is often not effective for chronic pain. And PNN has long been covering how ineffective gabapentin is for most pain conditions.  

However, despite the evidence, doctors still regularly prescribe gabapentin and tramadol for chronic pain. 

It doesn’t have to be that way. Doctors have alternatives that actually work, most notably low-dose hydrocodone. Yes, there are more regulations around that medication, making it more difficult to prescribe. But actually giving pain patients real options shouldn’t be so difficult.  

So, I would like doctors and other healthcare professionals to make it their goal to stop prescribing ineffective medications. Instead, offer pain treatments that actually work. Your patients will thank you.

Resolution # 3: Implement Medicare for All

Yes, I know this one is kind of unrealistic. But that’s what New Year’s magic is all about —  putting whimsical ideas out into the universe with the hope of seeing them come to fruition. 

After all, it can’t happen if we never ask for it.

Unfortunately, as the year starts off, we are actually heading in the opposite direction, with many Americans seeing their health insurance premiums soar or even deciding not to buy coverage. 

But I’m hoping that may be the catalyst we need for the public to start demanding real change. Right now, millions of people are losing their health insurance because the Trump administration ended federal subsidies for coverage under the Affordable Care Act. 

It’s an awful and unnecessary situation that our policy leaders have the power to fix, if only they worked together on the issue.

Every human should have the right to healthcare, and Medicare for All would go a long way to making that happen.

I know a lot of these resolutions probably won’t come to fruition in 2026, but I do think they could realistically happen before we start the next decade. And all of them have the potential to vastly improve the lives of millions of people living with chronic pain.

Happy New Year everyone. May your 2026 be filled with low-pain days, too much joy, and lots of love.