Why is 7-OH Called ‘Gas Station Heroin’ but Caffeine and Alcohol Are Not?

By Crystal Lindell

I think it’s because I work as a manager at a truck stop that the phrase “gas station heroin” particularly pisses me off.

If you haven’t seen the coverage, “gas station heroin” is the favorite phrase used by the media and anti-7-OH groups to describe kratom and the alkaloid 7-OH (7-hydroxymitragynine).

But it’s not based on anything real, because kratom and 7-OH are not even close to being heroin.

So as the DEA nears a potential nationwide ban on 7-OH, and state and local governments ban kratom, it’s a good time to really look at the ways media and advocacy groups try to justify these bans. Notice how their labeling never extends to other substances like caffeine, nicotine, or alcohol. 

Indeed, calling 7-OH and kratom “gas station heroin” is about as accurate as calling coffee and energy drinks “gas station meth.” Or calling beer “gas station LSD.”

Lots of mind-altering and addictive things are sold at gas stations. But something being a little addictive and a little bit mind-altering does not mean it should be lumped in with more dangerous and more mind-altering substances like heroin.

Take this New York Post article trying to scare readers about 7-OH. Large portions of it focus on the idea that 7-OH is sold at gas stations, as though that’s a reason to ban it in and of itself. 

"People can buy 7-OH at vape shops and truck stops with little guidance on how much they’re actually supposed to take," the Post warned.

Okay, so does that apply to the nicotine products sold at vape shops? Or the alcohol sold at truck stops? I mean, there’s little to no guidance for those substances too. 

The Post also includes a quote from Dr. Oliver Grundmann, a kratom specialist at the University of Florida.

“Even if 7-OH can help people wean themselves off stronger opioids, it has no business being peddled at bodegas,” Grundmann said. “It should be appropriately labeled and also only available in the hands of someone who can provide professional guidance, like a licensed pharmacist. Not a clerk at a gas station.”

Here again, we can easily flip this around to apply to the beer and cigarettes that are readily available at gas stations and “bodegas” – a fancy way of describing a neighborhood convenience store. 

Imagine saying: ““Even if alcohol can help people relax, it has no business being peddled at bodegas.” 

Or this: "Nicotine should be appropriately labeled and also only available in the hands of someone who can provide professional guidance, like a licensed pharmacist. Not a clerk at a gas station.”

In fact, when it comes to things like alcohol and nicotine, we as a society have decided that even if something causes thousands of deaths a year, it can still be sold at gas stations.

The thing is, kratom and 7-OH do not cause thousands of deaths a year. If they did, the DEA would no doubt have thousands of deaths they could point to to justify a ban. Instead, they had to really stretch to find any deaths to share.   

In fact, the DEA could identify only one man in Norway who supposedly died from using 7-OH. The only problem was the death occurred in 2014, long before concentrated 7-OH actually became available in the U.S. in 2022.

By that logic, caffeine should also be turned into a Schedule One drug. After all, a U.S. teen died from cardiac arrhythmia after chugging three caffeinated drinks in 2017. And a young woman died in 2022 after going into cardiac arrest hours after drinking caffeinated lemonade.

Oh, and in regards to the Norway death, that man also had a sedative, antidepressant, and anti-seizure medication in his blood and urine. So it was clearly a case of polysubstance use.

Someone having 7-OH or kratom in their system at the time of death should not be enough reason to classify those substances in the most restrictive DEA drug category.

Imagine if we tracked how many people had caffeine in their blood when they died. Or nicotine. We don’t even bother because when it comes to those drugs, we all understand that simply having a substance in your blood when you die does not mean that it caused your death.

I’m not saying kratom and 7-OH should be sold without any regulations or age restrictions. Rather, just the opposite. I believe the industry should be heavily regulated and nobody under 21 should be able to buy any kratom products.

The good news is that we already have a model for how to implement that: We just need to look to the other drugs already sold at gas stations, like nicotine, alcohol and caffeine. 

Potentiation: How to Make Opioid Medication More Effective

By Forest Tennant, PNN Columnist

The oldest measure to either minimize the dosage or make an opioid more effective has been to add a chemical agent that makes the opioid act longer and stronger. This concept is known as “potentiation” and there are many examples of it throughout history.

Various herbs such as Boswellia (frankincense) were used with opium in ancient times to make it more potent. The Greek physicians Dioscorides and Galien recorded the use of opium combined with cannabis for many therapeutic purposes.

Physicians during the American Revolution titrated alcohol with opium for tuberculosis. The legendary gambler and gunslinger John Henry “Doc” Holiday survived many years with this regimen for his tuberculosis or sarcoid.

British physicians combined aspirin with morphine around the turn of the 19th Century. Later they determined that a stimulant-type drug, such as cocaine, made morphine more effective for the person with severe pain. This was called the Brompton Cocktail, named after the Royal Brompton Hospital in London, where it was used to treat cancer patients in the 1920’s.

Beginning around World War II, American pharmacological companies began combining the opioids codeine, hydrocodone and oxycodone with substances such as aspirin, caffeine, acetaminophen, ibuprofen and phenacetin. Today, the most popular potentiating combinations are acetaminophen with codeine, hydrocodone or oxycodone.

An opioid should almost never be taken alone by a person with Intractable Pain Syndrome. Why? First, you don’t get the full effect of the opioid. Second, without a potentiator, you will need to take a higher opioid dose when a lower one would suffice and have fewer risks.

Every IPS patient needs to identify at least two potentiators that won’t bother their stomach or cause headache, drowsiness or dizziness.

Available Potentiators

• Caffeine Tablet

• Mucuna

• Boswellia

• Gabapentin

• Taurine

• CBD Products

• Adderall

• Methylphenidate

• Dextroamphetamine

• Benadryl

• GABA

Consider switching to an opioid with acetaminophen, such as Vicodin or Percocet, or take a potentiator with your opioids. Don’t take alcohol, marijuana or a benzodiazepine (Xanax, Ativan, Valium, Klonopin) at the same time you take an opioid. Separate the two by at least an hour to avoid over-sedation. 

Forest Tennant is retired from clinical practice but continues his research on intractable pain and arachnoiditis. This column is adapted from newsletters recently issued by the IPS Research and Education Project of the Tennant Foundation. Readers interested in subscribing to the newsletter can sign up by clicking here.

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

Does Coffee Reduce Your Pain?

By Steve Weakley

Saturday, September 29th is National Coffee Day, so drink up! A new study shows that caffeine can be an effective pain reliever.

Researchers at the University of Alabama at Birmingham (UAB) reported in the journal Psychopharmacology that regularly consuming caffeine can make a noticeable difference in your ability to withstand pain.  The study involved 62 healthy men and women, who shared with researchers their caffeine consumption from coffee, tea, soda, energy drinks and chocolate over seven days.

The group averaged 170 milligrams of caffeine a day, about the same as two cups of coffee.  Fifteen percent of the group consumed more than 400 milligrams a day and one participant drank the equivalent of 6.5 cups of coffee daily.

After a week, the volunteers were subjected to painful heat and pressure tests in a laboratory. Researchers discovered that people who regularly consumed caffeine significantly reduced their sensitivity to pain. The more caffeine they consumed, the lower their sensitivity.

“Diet can actually be a useful intervention for decreasing pain sensitivity,” said lead author, Burel Goodin, PhD, an associate professor of psychology at UAB. “It’s not just caffeine. A study has shown, for example, that a plant-based diet can actually help increase pain tolerance.”

Researchers say caffeine reduces pain by blocking receptors in the brain called adenosines, which enhances the effect of dopamine chemicals associated with pain relief.  

Caffeine has been added to over-the-counter pain relievers like Excedrin for years, and has been shown to increase their effectiveness by as much as 40 percent.  South Korean researchers have also added caffeine to the opioid medication of patients with advanced cancer and found that it decreased their pain and improved alertness.

Other research has corroborated the effectiveness of caffeine alone as a pain reliever.  A University of Georgia study revealed that two cups of coffee can reduce post workout pain by nearly half.  And a study at the University of Pittsburgh found that a single 200mg tablet of caffeine was effective in treating muscle pain.

Excessive caffeine consumption can have serious side effects, but the Mayo Clinic says 400mg per day is a safe dosage (about 4 cups of coffee). A few cups could be a useful addition to your pain treatment regimen.

Does Coffee Work Better Than Painkillers?

By Pat Anson, Editor

Insomnia and chronic sleep loss are well known to increase pain sensitivity. But an unusual animal study suggests that stimulants that keep you awake – like a cup of coffee -- may give sleep deprived patients more pain relief than morphine or ibuprofen.

That unexpected finding was reached by researchers at Boston Children's Hospital and Beth Israel Deaconess Medical Center, who studied pain sensitivity in sleep deprived laboratory mice.

Unlike other sleep studies that force rodents to stay awake walking treadmills or falling off platforms, the researchers deprived the mice of sleep in a way that mimics what happens with people: They entertained them.

"We developed a protocol to chronically sleep-deprive mice in a non-stressful manner, by providing them with toys and activities at the time they were supposed to go to sleep, thereby extending the wake period," says sleep physiologist Chloe Alexandre, PhD.

“This is similar to what most of us do when we stay awake a little bit too much watching late-night TV each weekday."

The mice wore “tiny headsets” to monitor their sleep cycles and sensitivity. Whenever they showed signs of sleepiness, the mice were given toys to keep them alert.

"Mice love nesting, so when they started to get sleepy, we would give them nesting materials like a wipe or cotton ball," says pain physiologist Alban Latremoliere, PhD. "Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball."

The mice were kept awake for as long as 12 hours in one session, or six hours for five consecutive days. Pain sensitivity was measured by exposing the mice to controlled amounts of heat, cold, pressure or capsaicin -- the chemical agent in chili peppers -- and then seeing how long it took the animal to move from or lick away the discomfort.

"We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice," says Alexandre.

Surprisingly, when the mice were given ibuprofen or morphine, the analgesics didn’t seem to reduce their pain sensitivity. But when the rodents were given caffeine or modafinil, a drug used to promote wakefulness, it blocked the pain caused by sleep loss. Researchers think the caffeine and modafinil gave the mice a jolt of dopamine – a “feel good” hormone – that helped alleviate their pain.

"This represents a new kind of analgesic that hadn't been considered before, one that depends on the biological state of the animal," Clifford Woolf, a professor of neurology and co-senior author of the study. "Such drugs could help disrupt the chronic pain cycle, in which pain disrupts sleep, which then promotes pain, which further disrupts sleep."

The study only involved rodents, but researchers were quick to suggest there are lessons to be learned for people. Rather than just taking painkillers, they say pain patients would benefit from better sleep habits or by taking sleep-promoting medications at night.

"Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities," notes Kiran Maski, MD, a specialist in sleep disorders at Boston Children's. "This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care.”