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. 

Missouri Finds Managing Pain Without Opioids Isn’t Easy

By Lauren Weber, Kaiser Health News

Missouri began offering chiropractic care, acupuncture, physical therapy and cognitive-behavioral therapy for Medicaid patients in April, the latest state to try an alternative to opioids for those battling chronic pain.

Yet only about 500 of the state’s roughly 330,000 adult Medicaid users accessed the program through December, at a cost of $190,000, according to Josh Moore, the Missouri Medicaid pharmacy director. While the numbers may reflect an undercount because of lags in submitting claims, the jointly funded federal-state program known in the state as MO HealthNet is hitting just a fraction of possible patients so far.

Meanwhile, according to the state, opioids were still being doled out: 109,610 Missouri Medicaid patients of all age groups received opioid prescriptions last year.

The going has been slow, health experts said, because of a slew of barriers. Such treatments are more time-consuming and involved than simply getting a prescription.

A limited number of providers offer alternative treatment options, especially to Medicaid patients. And perhaps the biggest problem? These therapies don’t seem to work for everyone.

The slow rollout highlights the overall challenges in implementing programs aimed at righting the ship on opioid abuse in Missouri — and nationwide. To be sure, from 2012 to 2019, the number of Missouri Medicaid patients prescribed opioid drugs fell by more than a third — and the quantity of opioids dispensed by Medicaid dropped by more than half.

Still, overdoses linked to legal and illicit opioids killed an estimated 1,132 Missourians in 2018 and 46,802 Americans nationally, according to the latest data available. Progress to change that can be frustratingly slow.

“The opioids crisis we got into wasn’t born in a year,” Moore said. “To expect we’d get perfect results after a year would be incredibly optimistic.”

Despite limited data on the efficacy of alternative pain management plans, such efforts have become more accepted, especially following a summer report of pain management best practices from the U.S. Department of Health and Human Services. States such as Ohio and Oregon see them as one part of a menu of options aimed at curbing the opioid crisis.

St. Louis chiropractor Ross Mattox, an assistant professor at chiropractic school Logan University, sees both uninsured patients and those on Medicaid at the CareSTL clinic. He cheered Missouri’s decision to expand access, despite how long it took to get here.

“One of the most common things I heard from providers,” he said, “is ‘I want to send my patient to a chiropractor, but they don’t have the insurance. I don’t want to prescribe an opioid — I’d rather go a more conservative route — but that’s the only option I have.’”

And that can lead to the same tragic story: Someone gets addicted to opioids, runs out of a prescription and turns to the street before becoming another sad statistic.

“It all starts quite simply with back pain,” Mattox said.

Practical Barriers

While Missouri health care providers now have another tool besides prescribing opioids to patients with Medicaid, the multistep approaches required by alternative treatments create many more hoops than a pharmacy visit.

The physicians who recommend such treatments must support the option, and patients must agree. Then the patient must be able to find a provider who accepts Medicaid, get to the provider’s office even if far away and then undergo multiple, time-consuming therapies.

The effort and cost that go into coordinating a care plan with multiple alternative pain therapies is another barrier.

“Covering a course of cheap opioid pills is different than trying to create a multidisciplinary individualized plan that may or may not work,” said Leo Beletsky, a professor of law and health sciences at Northeastern University in Boston, noting that the scientific evidence of the efficacy of such treatments is mixed.

And then there’s the reimbursement issue for the providers. Corry Meyers, an acupuncturist in suburban St. Louis, does not accept insurance in his practice. But he said other acupuncturists in Missouri debate whether to take advantage of the new Medicaid program, concerned the payment rates to providers will be too low to be worthwhile.

“It runs the gamut, as everyone agrees that these patients need it,” Meyers stressed. But he said many acupuncturists wonder: “Am I going to be able to stay open if I take Medicaid?”

Structural Issues 

While helpful, plans like Missouri’s don’t address the structural problems at the root of the opioid crisis, Beletsky said.

“Opioid overutilization or overprescribing is not just a crisis in and of itself; it’s a symptom of broader structural problems in the U.S. health care system,” he said. “Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments for which we’re not doing enough in terms of prevention and treatment.”

Fixing some of the core problems leading to opioid dependence — rural health care “deserts” and the impact of manual labor and obesity on chronic pain — requires much more than a treatment alternative, Beletsky said.

And no matter how many alternatives are offered, he said, opioids will remain a crucial medicine for some patients.

Furthermore, while alternative pain management therapies may lessen opioid prescriptions, they do not address exploding methamphetamine addiction or other addiction crises leading to overdoses nationwide — even as a flood of funds pours in from the national and state level to fight these crises.

“Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments.”

— Dr. Leo Beletsky, Northeastern University

The Show-Me State’s refusal to expand Medicaid coverage to more people under the Affordable Care Act also hampers overall progress, said Dr. Fred Rottnek, a family and addiction doctor who sits on the St. Louis Regional Health Commission as chair of the Provider Services Advisory Board.

“The problem is we relatively cover so few people in Missouri with Medicaid,” he said. “The denominator is so small that it doesn’t affect the numbers a whole lot.”

But providers like Mattox are happy that such alternative treatments are now an option, even if they’re available only for a limited audience.

He just wishes it had been done sooner.

“A lot of it has to do with politics and the slow gears of government,” he said. “Unfortunately, it’s taken people dying — it’s taken enough of a crisis for people to open their eyes and say, ‘Maybe there’s a better way to do this.’”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Rx Drug Monitoring Not Reducing Opioid Abuse

By Pat Anson, Editor

Prescription drug monitoring programs (PDMPs) have long been promoted as a critical tool in the fight against opioid abuse and overdoses. PDMP’s in 49 states and the District of Columbia allow physicians and pharmacists to consult a prescription drug database to see if patients might be “doctor shopping” or selling their opioid medication.

But a new study has found little evidence that PDMPs are working and that they may in fact be driving some patients to the black market for cheaper drugs such as heroin.

Researchers at Columbia University's Mailman School of Public Health and University of California, Davis, analyzed 17 studies that looked at the effectiveness of PDMPs. Their findings are published online in the Annals of Internal Medicine.

“Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences,” wrote lead author David Fink, MPH, a doctoral candidate in epidemiology at the Mailman School of Public Health.

What were those unintended consequences? Three studies that looked at heroin related overdoses found a “statistically significant” increase in heroin deaths after PDMPs were implemented.

"This suggested to us that heroin substitution may have increased after PDMP-inspired restrictions on opioid prescribing," says Silvia Martins, MD, a professor of epidemiology at Mailman and co-senior author. "We therefore caution that programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids."

Researchers believe that efforts to reduce doctor shopping and the diversion of prescription opioids may have backfired.

“A reduction in black market prescription opioids, although generally viewed as positive, also may generate unanticipated outcomes. For example, an ethnographic study of high-risk users in Philadelphia and San Francisco found that key drivers of the progression from prescription opioid to heroin use are the rising cost of the ‘pill habit’ and heroin’s easy availability and comparatively lower cost,” Fink said.

Heroin overdoses also rose after Purdue Pharma introduced a new and more expensive abuse deterrent formulation of OxyContin in 2010. According to one study, each death that was prevented by OxyContin's reformulation “was replaced with a heroin death.”

Fink and his colleagues say more studies are needed to examine the true effectiveness of PDMPs, which can vary widely from state to state.

Doctor Shopping Rare

Missouri is the lone state that has not adopted a statewide PDMP and one family physician would like to keep it that way.

In an unpublished study, John Lilly, DO, claims that PDMPs are not working because doctor shopping is rare to begin with. In 2016, doctor shopping was responsible for only 1.7% of all misused opioid prescriptions. The rest are stolen, borrowed or bought on the black market, or misused by the patients they were prescribed to.

“The prescription drug monitoring programs will never catch the remaining 98.3 percent of the problem. That is why the death rate has not decreased despite 49 states having an operational PDMP,” Lilly wrote.  “There is now an alternative to prescription drugs that is easier to obtain and more powerful. Illicit fentanyl is now the preferred opioid and the PDMPs have absolutely no effect on its rapid rise. I would not be surprised if prescription opioid deaths start to fall, not due to the effectiveness of the PDMPs, but due to market competition from illicit fentanyl.”

If PDMP's were effective, Lilly says states that have them would see a decline in opioid overdoses. But in 2016, West Virginia had the highest opioid death rate in country -- over three times higher than Missouri's -- which ranked 25th.

Missouri’s Governor ordered the creation of a statewide PDMP last year, but the state legislature has so far resisted efforts to fund it. Critics say it doesn’t give doctors the necessary tools to prevent overprescribing, but allows law enforcement to track and prosecute physicians and pharmacists.  A spokesman for the Missouri State Medical Association called the program a “witch hunt against physicians.”