CDC Study Warns Against Consuming Kava-Kratom Drinks

By Pat Anson

For the second time in a week, the CDC has released a study warning of “serious medical outcomes” for people who consume kratom, a controversial supplement used by millions of Americans as a stimulant and pain reliever.

This time, the study focuses on the co-use of kratom with kava, a plant in the pepper family used to make a coffee-like drink that promotes relaxation and improves mood. 

Consumption of kava declined after the FDA warned in 2002 that it could cause severe liver injury. But consumption began rising about a decade ago, as drinks containing both kava and kratom rose in popularity among young people.

“These commercial products are commonly marketed as healthy alternatives to alcohol, sold near college campuses, and increasingly being combined with kratom, a psychoactive botanical with opioid-like effects, raising safety concerns,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.

Holstege and his colleagues reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR) that kava-related calls to U.S. poison control centers rose 383% from 2011 to 2025 (from 57 cases to 203). About a third of the kava calls in 2025 also involved kratom. 

“These data indicate a resurgence of overall kava exposure reports to poison centers, as well as an increase in kratom-related kava reports, which has coincided with higher rates of serious clinical outcomes. The findings in this report suggest the need for enhanced surveillance for, clinical awareness of, and public education regarding commercial products containing kava,” Holstege said.

Nearly half (43%) of the kava-related calls involve other substances, including ethanol (alcohol) and benziodiazepines. While most adverse effects were minor, such as nausea and dizziness, about a third resulted in hospitalizations or serious outcomes. Eight kava-related deaths were reported during the study period.

Last week the same group of researchers warned in another MMWR report that kratom-related calls to U.S. poison control centers rose by 1,200% over the past decade. While that appears to be a startling increase, it’s a misleading number that represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.

A MMWR report in 2016 was used by the DEA to justify its efforts to have the kratom alkaloids 7-hydroxymitragynine (7-OH) and mitragynine listed as Schedule One controlled substances, a move that would have effectively banned kratom. That report was also based on calls to poison control centers.

The DEA dropped its proposal after a public outcry. A top federal health official in the first Trump administration later admitted the scheduling request was based on “embarrassingly poor evidence & data” from the FDA and could result in “substantial risk to public health” if kratom were made illegal.

The growing controversy over potent forms of 7-OH recently revived efforts by the FDA to have the DEA list 7-OH as a controlled substance, but not natural leaf kratom. The DEA has yet to act on that request. 

A controversial drink that contains kava and natural leaf kratom is Feel Free Classic, made by Oklahoma-based Botanic Gardens. Media stories claimed the drink is addictive, has “opioid-like effects” and is “hooking young people.”  

A class action lawsuit was filed against Botanic Gardens that alleged it used misleading advertisements to promote Feel Free as a healthy alternative to alcohol. The company settled the case for $8.75 million, and agreed to put stronger safety warnings on Feel Free bottles and limit sales to people 21 and older. 

In 2023, the FDA seized nearly 250,000 bottles of Feel Free, alleging the drink was an adulterated substance with inadequate safety information. Over a year later, the FDA quietly dropped the case.

A small short-term clinical study funded by Botanic Gardens found that Feel Free was “generally safe, with only mild to moderate AEs (adverse events) reported, which were all transient in nature.”

Calls About Kratom to U.S. Poison Control Centers Surge

By Pat Anson

In what could be part of a new federal effort to ban kratom nationwide, the CDC has released a new study pointing to an exponential increase in kratom-related calls to U.S. poison control centers over the past decade.

There was a 1,200% increase in kratom-related reports to the National Poison Data System, from 258 in 2015 to 3,434 in 2025, including a “marked surge” last year. 

There was a similar 1,200% increase in kratom-related reports that resulted in adverse events and hospitalizations, from 43 cases in 2015 to 538 in 2025.

Over that 11-year period, there were a total of 233 kratom-related deaths. Most of the deaths and hospitalizations involved other drugs, such as alcohol, opioids, cannabis, stimulants and benzodiazepines. 

About half of the exposure reports were considered “intentional misuse” or suspected suicide attempts, researchers reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

“Kratom-related adverse effects are increasing in number and complexity in the United States. Increasing use, the availability of high-potency kratom, and frequent multiple-substance exposure reports contribute to hospitalizations from physical as well as psychiatric causes,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.

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

7-OH occurs naturally in kratom in trace amounts, but some kratom vendors are selling concentrated versions of 7-OH that boost its potency as a pain reliever and mood enhancer. The surge in poison control cases in 2025 is mainly attributed to the growing use of 7-OH products. 

“As FDA moves to regulate 7-hydroxymitragynine but not whole-leaf kratom products, surveillance should distinguish product types to assess risks. Building this evidence base is essential to promoting safe kratom use, identifying high-risk combinations of substances, and guiding public health action to prevent future health effects in this rapidly evolving drug landscape,” said Holstege. 

Misleading Numbers

It’s important to note that the surge in kratom-related calls to poison control centers has more to do with kratom’s growing popularity in the United States. 

Kratom comes from the leaves of a tree in Southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Kratom’s use began growing in the U.S during the 2010’s, as restrictions were placed on opioid analgesics and pain patients sought other ways to get relief. 

According to the MMWR, about 5 million Americans have used kratom, although some estimates are as high as 20 million..

Even using the conservative estimate, the 14,449 kratom-related calls to poison centers over the 11-year period represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.

Critics say calls to poison control centers are “notoriously unreliable” and an imperfect way to measure the risks associated with a substance, since most calls involve minor symptoms such as upset stomachs or dizziness.

The number of calls can also be misleading. For example, a study of poison control data from 2000 to 2017 found there were more calls about exposure to nutmeg than there were about kratom.  

Nevertheless, the poison control data is often used by federal health officials and law enforcement agencies to seek changes in the legal status of a substance.  In 2016, the DEA and FDA cited another MMRW study to justify their efforts to have 7-OH and the alkaloid mitragynine listed as Schedule One controlled substances, in the same category as heroin. Such a move would have effectively banned kratom.

“Evidence from poison control centers in the United States also shows that there is an increase in the number of individuals abusing kratom, which contains the main active alkaloids mitragynine and 7-hydroxymitragynine. As such, there has been a steady increase in the reporting of kratom exposures by poison control centers,” the DEA said in 2016, citing the earlier MMRW study.

The DEA dropped its proposal to schedule mitragynine and 7-hydroxymitragynine after a public outcry, saying a ban on kratom would have “significant risk of immediate adverse public health consequences.” 

A top federal health official later admitted the FDA and the DEA based their scheduling request on “embarrassingly poor evidence & data.”

The growing controversy over 7-OH has revived efforts to restrict or ban sales of kratom and 7-OH at the state and local level. It may only be a matter of time before the DEA joins that movement, by renewing its effort to schedule 7-OH, mitragynine, and perhaps kratom itself.

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.”

Illicit Use of Rx Opioids Down Significantly

By Pat Anson

The illicit use of prescription opioids by patients undergoing addiction treatment has fallen dramatically over the past decade, according to a new analysis by Millennium Health. 

The drug testing company analyzed nearly 1.7 million urine samples collected from patients diagnosed with substance use disorder (SUD). The findings show that opioid pain medication now plays only a minor role in the nation’s drug crisis, while the use of stimulants is growing.  

In 2016, up to 80% of the patients who tested positive for illicit fentanyl also tested positive for a prescription opioid that was not prescribed to them. 

By 2025, only 4.9% of patients tested positive for both fentanyl and an illicit prescription opioid. There was a lot of regional variability in the numbers, with 9.1% of SUD patients in the South testing positive for both fentanyl and Rx opioids, compared to only 4.1% in the West.

Positive Drug Tests for Fentanyl and Prescription Opioids

SOURCE: MILLENNIUM HEALTH

“Within the population using fentanyl, we've seen a continued drop in the detection of prescription opioids in those using fentanyl. In 2025 the positivity rate for prescription opioids, I’m talking about hydrocodone, hydromorphone, oxycodone, oxymorphone, tramadol as a group, are at all-time lows in our database,” said Eric Dawson, PharmD, Vice President of Clinical Affairs at Millennium Health.

The findings suggest that fewer prescription opioids are being diverted into the illicit drug supply. That makes sense, as opioid prescribing has fallen sharply over the past decade and the medications are difficult for many pain patients to get. According to the DEA, the estimated diversion rates for hydrocodone (0.53%) and oxycodone (0.69%) in 2026 are both well under one percent.

In their place, illicit drug users have increasingly turned to stimulants, such as methamphetamine and cocaine. Millennium’s data shows that while fentanyl and opioid use have declined in recent years, stimulant use has risen steadily.

Positive Drug Tests for Fentanyl, Opioids and Stimulants

SOURCE: MILLENNIUM HEALTH

“It makes us wonder if we're now moving to something more prominent, larger. I don't know the right word there, but a stimulant era,” Dawson told PNN.

“I continue to hear it everywhere I travel. Stimulants, methamphetamine and cocaine, are just incredibly plentiful in so many communities, and extremely inexpensive. And so, if you present a drug in front of a population that tends to use drugs and it's cheap or free and potent, they tend to gravitate toward that.” 

Another trend that appears in Millenium Health’s drug testing data is the growing detection of kratom and its alkaloids, mitragynine and 7-hydroxymitragynine (7-OH).

In 2016, less than 1.5% of patients nationwide being treated for SUD tested positive for a kratom alkaloid. By 2025, that had grown to about 3 percent, with even higher levels in the South.

Positive Drug Tests for Kratom

SOURCE: MILLENNIUM HEALTH

Part of that growth can be attributed to the wider availability of kratom and increased awareness that the herbal supplement can be used to treat pain, anxiety and other health conditions. 

The federal government estimates that 1.7 million Americans used kratom in 2021. The American Kratom Association, a kratom advocacy group, puts the number much higher, at 10 to16 million Americans.

The growing awareness about kratom has spread to addiction treatment providers. In 2016, only about a third of Millennium Health’s urine drug tests included a request from a provider to test for kratom. By 2025, over 77% of urine drug tests included an analysis for kratom.

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.

Feds Target Large 7-OH Vendor

By Pat Anson

Federal agents have seized about 73-thousand tablets, gummies, shots and other products containing 7-hydroxymitragynine (7-OH) from a Missouri company that sells 7-OH products nationwide. The seized items have an estimated value of about $1 million.

The seizure is part of a growing effort by federal and state regulators to crackdown on sales of 7-OH, an alkaloid that occurs naturally in kratom. When concentrated, 7-OH has opioid-like effects that can relieve pain and boost energy levels. Health officials say 7-OH can be abused and is addictive, although they have offered little evidence to support those claims.

“This enforcement action is a strong step to protect Americans from the dangers of concentrated 7-OH products, which are potent opioids,” FDA Commissioner Marty Makary, MD, said in a press release.  “We must be proactive and vigilant to address emerging threats to our communities and our kids.”

To be clear, 7-OH and kratom are not opioids. But they act on nerve receptors in the brain that control pain and mood, as do many other non-opioid substances, such as coffee and chocolate. Kratom and its alkaloids also don’t cause respiratory depression, the leading cause of an overdose.

The FDA worked with the Missouri Department of Health in targeting Kansas City-based CBD American Shaman, a company that was the subject of a recent investigative series by the Kansas City Star. American Shaman sells its kratom, CBD and hemp-based Delta-8 products online and in hundreds of smoke shops, gas stations and retail stores around the country.

Missouri’s Health Department released a health advisory in October claiming 7-OH was 13 times more potent than morphine, and could cause poisoning and overdose. The advisory noted the Missouri Poison Center was aware of three cases involving 7-OH, including one person who was “evaluated in a health care facility.”

The FDA’s Adverse Events Reporting System lists 52 “serious cases” associated with 7-OH so far this year, including 6 deaths. Most of the adverse effects were for dependence or withdrawal symptoms.

Warning Letters 

The FDA sent a warning letter to Shaman Botanicals, a subsidiary of American Shaman, last summer accusing it of illegally selling 7-OH in adulterated dietary supplements. Warning letters were also sent to six other companies selling 7-OH products. In response, some removed the 7-OH products from their websites, while others kept right on selling them.   

American Shaman currently still offers 7-OH tablets on its website, saying the tablets provide “relief, relaxation, and focus.” Asked if the tablets are safe, a chat bot gave us this answer:

“Great question! Our Advanced Alkoloids tablets feature precise, lab-tested 7-hydroxymitragynine (7-OH) or mitragynine pseudoindoxyl, depending on the variety. Many customers appreciate their reliable effects and controlled dosing compared to traditional kratom products.

As with any supplement, it’s a good idea to consult with your doctor before starting – especially if you have health concerns or take other medications.”

A disclaimer on the website also warns consumers not to use the tablets if they are taking pain relievers, opioids or other medications, and not to take them daily or for prolonged periods.

CBD AMERICAN SHAMAN

The FDA has recommended to the DEA that it classify 7-OH as a Schedule I controlled substance, which would make it illegal to sell or possess. The FDA says it is not focused on banning natural kratom leaf products, although some state and local governments have already banned kratom sales. 

The DEA has yet to act on the FDA’s request, a process that could take several months once a proposed scheduling is posted in the Federal Register. Kratom and 7-OH are not even mentioned in the DEA’s 2025 National Drug Threat Assessment, an annual report on the production and distribution of illicit drugs in the United States.

A Holiday Reading Guide for People Living with Chronic Pain

By Pat Anson

Is kratom really as dangerous as public health officials say it is? What foods can help reduce pain and inflammation? Why do some people get Long Haul Covid and others don’t? How can I manage pain flares from Ehlers-Danlos syndrome? What is percutaneous hydrotomy and why is it growing in popularity with injured athletes?

The answers to these and other questions can be found in PNN’s annual holiday reading guide. If you live with chronic pain and illness or have a friend or family member who does, here are 12 books that would make great gifts over the holidays. Or you can “gift” one to yourself. Click on the book cover or title to see price and ordering information.

The Essentials of Ehlers-Danlos Syndrome

This book is intended to help people understand and manage Ehlers-Danlos syndrome (EDS), a genetic and painful disorder that presents as a confusing set of symptoms that are often misdiagnosed. Topics covered include the 7 sub-types of EDS, what specialists to see, and how to create a personalized care plan to manage pain flares and fatigue.

Kratom: Facts, Myths, and Cultural Insights

This is one in a series of books by Adrian Colewood that seeks to present a balanced and neutral view on kratom, a controversial supplement used by millions to relieve pain, anxiety, depression and withdrawal. With kratom facing new regulations and outright bans due to its opioid-like effects, the book explores the myths and misinformation about a medicinal plant that’s been used for centuries in southeast Asia.

Handbook for Newly Diagnosed Cases of Adhesive Arachnoiditis

This second edition of Dr. Forest Tennant’s book for new cases of Adhesive Arachnoiditis (AA) explores the treatments that can reduce the symptoms of this debilitating spinal nerve disease. Left untreated, AA can result in intractable pain, a bed-bound state, and premature death. This handbook summarizes Dr. Tennant’s 3-step protocol to suppress inflammation and autoimmunity, regenerate damaged tissue, and control pain caused by AA.

Eat to Heal: Unlock the Healing Power of Food

After years of suffering from chronic migraine, fatigue and cancer pain, Dr. Joseph Jacobs turned to nutrition, developing the Advanced Soft Tissue Release (ASTR) diet to reduce inflammation, relieve pain and restore energy. In this book, he shares how eating the right foods helped him beat chronic pain from the inside out, while debunking the myths of so-called “healthy diets” that have left millions of people chronically sick and fatigued.

The Comprehensive Guide to Ibuprofen

Aldrin Gomes, PhD, and his team of researchers at UC Davis look at the benefits and risks of ibuprofen, one of the world’s most widely used pain relievers. Like many NSAIDs, ibuprofen increases the risk of heart attack, stroke and stomach ulcers — even at regular doses — and may interact with hundreds of medications. Studies suggest ibuprofen may also have some surprising health benefits, such as lowering the risk of dementia.

It Doesn’t Have to Hurt: Your Smart Guide to a Pain-Free Life

CNN medical correspondent Dr. Sanjay Gupta is a neurosurgeon by trade who believes all pain starts in the brain, and chronic pain “comes with baggage attached.” Gupta is not a fan of opioid medication, and thinks the body’s own pain relief system can be primed through meditation, sleep, nutrition, acupuncture and physical therapy such as foam rolling. He calls pain “the most mysterious of all human sensations.”

Hip Pain Relief For Seniors

This book is designed for older adults who want to overcome hip pain and limited mobility without surgery or medication. Simple and gentle exercises can be done at home to regain flexibility, strength and movement. These “senior-friendly routines” will help you stay active and independent, including older adults recovering from hip replacement or arthritis.

Secrets to Long Haul Viral Recovery

Author Michael Alcock is a “long-hauler” from Covid-19 and the Epstein-Barr virus, who spent a decade researching why some people are more prone to long-haul viral infections, while others recover easily. This book explains how to recover holistically from viral infections like long Covid by strengthening the immune system through better nutrition, vitamins and supplements.

The Complex PTSD Workbook for Self-Healing

Has chronic pain or a chronic illness left you exhausted — physically and emotionally? Do you live in dread of another pain flare or sleepless night? Alex Carter wrote this self-help handbook to guide you on a 6-week action plan to overcome Post Traumatic Stress Disorder (PTSD) with practical ways to help quiet your mind and nervous system.

The Headache: The Science of a Most Confounding Affliction

Over 3 billion people worldwide suffer from a headache disorder, including author Tom Zeller Jr., who suffers from cluster headaches. Zeller wrote this book to better understand what causes migraines and headaches, and why there are few effective treatments for such a common condition. Zeller looks at the inner workings of the human nervous system and provides a vivid account of the disabling pain that headache sufferers endure.  

Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a debilitating chronic nerve disease that is usually caused by trauma and can strike any part of the body. This book, edited by Drs. Lynn Webster and Jijun Xu, is part of the "What Do I Do Now? Pain Medicine" series. It looks at 11 clinical cases of CRPS and how they were treated with conventional analgesics and novel therapies, including neuromodulation and ketamine infusions.

Stopping Pain: A Simple, Revolutionary Way to Stop Chronic Pain

Chances are you’ve never heard of percutaneous hydrotomy, a minimally invasive regenerative treatment in which a sterile saline solution is injected into the body to relieve musculoskeletal pain and “flush out” inflammatory substances. Percutaneous hydrotomy has been used in Europe for 30 years and is gaining popularity with amateur and professional athletes who want to stop pain, heal nagging injuries, and boost performance.

These and other books about living with chronic pain and illness can be found in PNN’s Suggested Reading page.  PNN receives a small amount of the proceeds -- at no additional cost to you -- for orders placed through Amazon.

A Beginner’s Guide to Using Kratom for Pain Relief

By Crystal Lindell

Whenever I meet someone who’s having trouble managing their chronic pain, I always suggest that they look into kratom. However, many soon realize that there’s not much trustworthy information out there about what kratom is and how to use it. 

I’ve been taking kratom for my own chronic pain since 2018, and I have found that it’s the only thing sold over the counter that actually helps me. 

Below is a look at my experiences with it, and some tips to help if you’re new to the idea of taking kratom for chronic pain. 

Also, I want to make clear that this column is not sponsored, and you’ll notice that there are no links to any specific kratom products or companies. There is a lot of spammy content in articles about kratom, but this isn’t one of them.

What Is Kratom?

The formal name for kratom is “Mitragyna speciosa.” It’s a tropical tree that’s native to southeast Asia, and belongs to the same botanical family as coffee. 

Kratom has been used for centuries in Asia as a natural stimulant and pain reliever, but only in the past decade has it become widely available in the United States

To create the powder that’s usually sold in smoke shops, gas stations and online, kratom leaves are dried and ground up into a fine powder. 

There are three basic strains of kratom, and each one has different effects. 

There is a white strain, which I have found acts as a stimulant or energy booster. The red strain seems more like a mood booster that helps with pain. And then there’s a green strain, which is seen as more of the middle point between the two. 

You’ll also find products labeled as “gold” and “black” and those claim to be stronger versions of kratom, although I haven’t always found that to be the case. 

I personally use a mix of the strains, which is commonly referred to as a "trainwreck" mix. 

Is Kratom Legal?

Laws vary by state, county, and even cities in the United States. So it’s best to check your local laws before purchasing kratom. 

In June, the FDA sent warning letters to 7 kratom vendors about illegally marketing their products as dietary supplements. The letters were specifically in regards to an alkaloid in kratom called 7-hydroxymitragynine -- known as 7-OH -- which relieves pain and increases energy.

The FDA said it would try to get 7-OH classified as an illegal controlled substance, falsely claiming it was an opioid. While 7-OH occurs naturally in kratom, it is present only trace amounts.

To boost its potency, some vendors are selling gummies, tablets and extracts with concentrated levels of 7-OH, which the FDA says “may be dangerous.” For more information about 7-OH, check out this recent column I wrote about that product.

Although some states and cities have already banned 7-OH, the natural leaf powder is widely available (and still legal) in most U.S. states, as long as no medical claims are made about it. 

Is Kratom Dangerous?

It’s rare for someone to have an adverse reaction to natural kratom leaf, which is the form I take. However, people who consumed the concentrated extracts have been hospitalized or experienced overdoses. In most cases, they also consumed alcohol and other substances.

Recently, former CDC Commissioner Robert Redfield, MD, talked about a 2024 FDA-funded study, the final results of which have never been published. He said they found that kratom has low abuse potential.

“In 2024, the FDA completed a single ascending-dose clinical trial examining ground kratom leaf in experienced users. The results were illuminating: participants experienced no serious adverse events at doses up to 12 grams, with side effects limited to mild nausea and pupil constriction. Crucially, subjective ‘drug liking’ scores never reached statistical significance compared to placebo, indicating low abuse potential for natural leaf.”

According to the American Kratom Association, FDA researchers were "profoundly disappointed” at the lack of adverse events associated with kratom, as its contradicts the agency’s long-standing opposition to it. That’s supposedly why the study’s findings have not been formally released.

Does Kratom Relieve Pain?

I think kratom really works, at least it does for my chronic pain. I can tell there’s a difference in my pain level shortly after I take a dose. My partner also swears by kratom as an effective treatment for chronic pain.

A 2016 PNN survey of over 6,000 kratom users found that 97% thought it was very or somewhat effective in treating their pain, depression, anxiety and other medical conditions. Over 98% said that kratom wasn’t harmful or dangerous.  

I always say that the best way to know that kratom actually works is when people try to regulate or ban it.

How Do You Take Kratom?

I mostly use the powder form of kratom. It comes in a bag, and it’s usually sold by weight.

I take half a spoonful of the powder, put it under my tongue, and then wash it down with a non-carbonated flavored beverage like juice or Gatorade. The powder is gritty and tastes bad, so you’ll probably need something to wash it down quickly with. To improve the taste, the powder can be mixed into a beverage directly.

You can also buy the powder in capsules, which are easier to consume. I personally find that capsules give me heartburn, so I tend to avoid them. 

There are also edible versions of kratom on the market, such as gummies, chocolates and even seltzers. I find those take longer to kick in, but they tend to offer a more even effect. However, they are more expensive than the raw powder, so I don’t buy them very often. 

If you do try kratom, I recommend using an extremely small dose to start with and, if possible, purchasing it from a smoke shop where employees can help you navigate your options. 

Overall, kratom has the potential to help a lot of people. But everyone is different, so your experience with the substance may vary. My hope is that people who could benefit from using kratom will feel more confident about trying it after learning more about it. 

Does 7-OH Actually Work for Pain?

By Crystal Lindell

I have some bad news for pain patients: 7-OH is the new pain reliever we’ve been searching for.

It’s about as effective at treating pain as a mild opioid pain reliever, with almost no risk of an overdose if used wisely. And best of all, you can buy it the same way you buy alcohol and tobacco: Over-the-counter. No doctor or prescription required.

So why is this bad news? Well, multiple government agencies are working on making 7-OH illegal, including the FDA. Some states, like Florida, have already banned it, while in California, they’re taking it off store shelves.

While those efforts would be benign if 7-OH was just another snake oil treatment, they quickly turn dire when we’re talking about a substance that actually helps pain patients, many of whom have lost access to prescription opioids.

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.

One of my relatives credits 7-OH with giving him back the ability to play with his daughter. 7-OH has done for him what Advil never could: it helped his back pain so much that it allowed him to be a better father.

Another one of my friends credits 7-OH with allowing him to stay off street fentanyl. Seriously. It’s that effective at treating his pain and alleviating long-term opioid withdrawal symptoms.  

Another friend of mine who has been living in constant fear of losing access to her prescription hydrocodone says 7-OH has eased those fears. Because she now knows that if the unthinkable happens, she will still have access to pain relief. 7-OH works really well at treating her pain and lifting her mood. 

While opioid pain relievers can cause drowsiness, many people report that 7-OH actually gives them a small burst of energy – just as kratom does. 

My friends have told me that a small dose of 7-OH works about as good as 5 mg of hydrocodone, while larger doses rival the effectiveness of oxycodone.

When taken alone, 7-OH also doesn’t cause the same respiratory depression that large doses of opioids can, which means it doesn’t carry the same risk of overdose. Most deaths attributed to 7-OH actually involve other substances, such as alcohol or street drugs. 

There are definitely downsides to 7-OH though. 

One is that it does cause physical dependence pretty rapidly, especially if you take 7-OH on a regular basis. So, if you try to stop taking it abruptly, you may feel more irritable, have trouble sleeping, and you may have other symptoms like a restless leg. The best way to deal with that is to slowly taper off it if you want to stop using it. 

Second, a lack of regulations around 7-OH also means that you may have to trial and error your way into finding a reliable brand you can trust. For example, some brands put additives in the tablets that cause bad headaches, and some brands don’t put as much 7-OH into their tablets as they claim, making them ineffective.

The third major downside to 7-OH is that it’s expensive. Smoke shops and online retailers sell a 5-pack of chewable 7-OH tablets for at least $50, while one tablet sells for about $10. Insurance won’t pay for it.

Each chewable tablet is made to be broken into sections, and the packaging usually says that either a fourth or half a tablet can be considered one dose. 

However, how much you take depends greatly on your personal tolerance levels. Some people I know take a half tablet as a dose. But others I know take far less – about 1/16th of a tablet – because that’s more than enough to relieve their pain.

Unfortunately, one dose only lasts about four to six hours, which means you may need multiple tablets if you need to use it all day. You can see how fast that can add up financially when each tablet is $10. 

Part of me wishes that pharmaceutical companies would work on developing pain relievers that use 7-OH, and their advancements would help address safety issues by making doses more uniform. But my fear is that they would also make the 7-OH medication available only by prescription, thereby killing one of its best features: accessibility.  

If you are a chronic pain patient who’s looking for something over-the-counter to treat your pain, it might be worth giving 7-OH a try. 

And if you’re a government official trying to ban it, well, all I can say is, please don’t. Pain patients get relief from 7-OH – and one day, you may need it too.

California Leads Crackdown on Kratom and 7-OH

By Pat Anson

California isn’t waiting for the federal government to classify a potent synthetic form of kratom as an illegal drug. In fact, it’s going a step further.

The California Department of Public Health (CDPH) is warning consumers that products containing kratom or the alkaloid 7-hydroxymitragynine – known as 7-OH -- are illegal to sell or manufacture in the state. In recent months, six fatal overdoses linked to 7-OH have been reported in Los Angeles County, although alcohol, medication and illicit substances were also involved in those deaths.

7-OH occurs naturally in kratom in trace amounts, but some retailers are selling concentrated synthetic versions of 7-OH that boost its potency as a pain reliever and mood enhancer.

In July, the FDA said it would ask the DEA to classify 7-OH as an illegal Schedule One controlled substance, but specifically noted that the move was “not focused on natural kratom leaf products.” 

California health officials are focused on both, claiming natural kratom and 7-OH cannot legally be marketed or sold in the state as drugs, dietary supplements or food additives. In recent weeks they’ve been removing kratom and 7-OH products from retail outlets and manufacturing locations across California.  ​

“We are still finding kratom and 7-OH products for sale in gas stations, smoke shops, online and other retailers. While these products are sometimes marketed as natural remedies, they are dangerous and can result in fatal overdoses,” Dr. Erica Pan, CDPH Director and State Public Health Officer, said in a statement. “The best way to protect yourself is to avoid using 7-OH and kratom-related products.”  

7-HOPE Alliance, a nonprofit that advocates for continued sales of 7-OH, calls the crackdown “unlawful” because there is no California or federal law that bans kratom or 7-OH.

“This is government overreach at its worst,” Jackie Subeck, founder of 7-HOPE Alliance, said in a statement. “When the FDA is already under fire from both Democrats and Republicans for politicizing science, from vaccines to dietary supplements, it’s reckless for California to take cues from them without peer-reviewed evidence and taking action that will put lives at risk.”

Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin have already classified natural kratom as a controlled substance. Dozens of cities, counties and local jurisdictions have also banned its sale. In August, Florida classified synthetic 7-OH as an illegal controlled substance.

Ohio’s governor recently sought to have all forms of kratom and 7-OH banned in his state, but postponed action after reportedly getting a call from HHS Secretary Robert F. Kennedy Jr.

In 2016, the DEA and FDA tried unsuccessfully to classify 7-OH and the kratom alkaloid mitragynine as illegal drugs, 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” about the harms posed by kratom.

“Policymakers across the spectrum have questioned whether the current FDA can be trusted to put science over politics,” said Subeck. “Californians deserve the medical freedoms that they were promised. Not fear campaigns and knee-jerk bans.”

Kratom and 7-OH are not even mentioned in the DEA’s 2025 National Drug Threat Assessment, an annual report that highlights threats to public health posed by illicit drugs.

Kratom products are usually sold as powders, tablets, shots, capsules and gummies. Consumers typically take them to relieve pain, anxiety, depression or withdrawal symptoms from other substances.

Critics call kratom “gas station heroin” and often claim it’s an opioid. But kratom actually comes from a tropical tree native to southeast Asia that belongs in the same botanical family as coffee. Natural opioids are derived from poppy plants, not kratom.

Like coffee, cheese, chocolate and many other food items, kratom acts on nerve receptors in the brain that trigger the release of endorphins and other “feel good” hormones that relieve pain naturally and have other opioid-like effects. Kratom’s effects are usually mild, depending on the amount consumed.

Balancing the Risks and Benefits of Kratom

By David Kroll

David Bregger had never heard of kratom before his son, Daniel, 33, died in Denver in 2021 from using what he thought was a natural and safe remedy for anxiety.

By his father’s account, Daniel didn’t know that the herbal product could kill him. The product listed no ingredients or safe-dosing information on the label. And it had no warning that it should not be combined with other sedating drugs, such as the over-the-counter antihistamine diphenhydramine, which is the active ingredient in Benadryl and other sleep aids.

As the fourth anniversary of Daniel’s death approaches, a recently enacted Colorado law aims to prevent other families from experiencing the heartbreak shared by the Bregger family. Colorado Senate Bill 25-072, known as the Daniel Bregger Act, addresses what the state legislature calls the deceptive trade practices around the sale of concentrated kratom products artificially enriched with a chemical called 7-OH.

7-OH, known as 7-hydroxymitragynine, has also garnered national attention. On July 29, 2025, the U.S. Food and Drug Administration issued a warning that products containing 7-OH are potent opioids that can pose significant health risks and even death.

As kratom and its constituents are studied in greater detail, the Centers for Disease Control and Prevention and university researchers have documented hundreds of deaths where kratom-derived chemicals were present in postmortem blood tests. But rarely is kratom deadly by itself. In a study of 551 kratom-related deaths in Florida, 93.5% involved other substances such as opioids like fentanyl.

I study pharmaceutical sciences, have taught for over 30 years about herbal supplements like kratom, and I’ve written about kratom’s effects and controversy.

One Name, Many Products

Kratom is a broad term used to describe products made from the leaves of a Southeast Asian tree known scientifically as Mitragyna speciosa. The Latin name derives from the shape of its leaves, which resemble a bishop’s miter, the ceremonial, pointed headdress worn by bishops and other church leaders.

Kratom is made from dried and powdered leaves that can be chewed or made into a tea. Used by rice field workers and farmers in Thailand to increase stamina and productivity, kratom initially alleviates fatigue with an effect like that of caffeine. In larger amounts, it imparts a sense of well-being similar to opioids.

In fact, mitragynine, which is found in small amounts in kratom, partially stimulates opioid receptors in the central nervous system. These are the same type of opioid receptors that trigger the effects of drugs such as morphine and oxycodone. They are also the same receptors that can slow or stop breathing when overstimulated.

In the body, the small amount of mitragynine in kratom powder is converted to 7-OH by liver enzymes, hence the opioid-like effects in the body. 7-OH can also be made in a lab and is used to increase the potency of certain kratom products, including the ones found in gas stations or liquor stores.

And therein lies the controversy over the risks and benefits of kratom.

‘No Currently Accepted Medical Use’

Because kratom is a plant-derived product, it has fallen into a murky enforcement area. It is sold as an herbal supplement, normally by the kilogram from online retailers overseas.

In 2016, I wrote a series of articles for Forbes as the Drug Enforcement Administration proposed to list kratom constituents on the most restrictive Schedule 1 of the Controlled Substances Act. This classification is reserved for drugs the DEA determines to possess “no currently accepted medical use and a high potential for abuse,” such as heroin and LSD.

But readers countered the DEA’s stance and sent me more than 200 messages that primarily documented their use of kratom as an alternative to opioids for pain.

Others described how kratom assisted them in recovery from addiction to alcohol or opioids themselves. Similar stories also flooded the official comments requested by the DEA, and the public pressure presumably led the agency to drop its plan to regulate kratom as a controlled substance.

But not all of the stories pointed to kratom’s benefits. Instead, some people pointed out a major risk: becoming addicted to kratom itself. I learned it is a double-edged sword – remedy to some, recreational risk to others. A national survey of kratom users was consistent with my nonscientific sampling, showing more than half were using the supplement to relieve pain, stress, anxiety or a combination of these.

Natural Leaf Powder vs Concentrated Extracts

After the DEA dropped its 2016 plan to ban the leaf powder, marketers in the U.S. began isolating mitragynine and concentrating it into small bottles that could be taken like those energy shots of caffeine often sold in gas stations and convenience stores.

This formula made it easier to ingest more kratom. Slowly, sellers learned they could make the more potent 7-OH from mitragynine and give their products an extra punch. And an extra dose of risk.

People who use kratom in the powder form describe taking 3 to 5 grams, the size of a generous tablespoon. They put the powder in capsules or made it into a tea several times a day to ward off pain, the craving for alcohol or the withdrawal symptoms from long-term prescription opioid use.

Since this form of kratom does not contain very much mitragynine – it is only about 1% of the powdered leaf – overdosing on the powder alone does not typically happen.

That, along with pushback from consumers, is why the Food and Drug Administration is proposing to restrict only the availability of 7-OH and not mitragynine or kratom powder. The new Colorado law limits the concentration of kratom ingredients in products and restricts their sales and marketing to consumers over 21.

Even David Bregger supports this distinction. “I’m not anti-kratom, I’m pro-regulation. What I’m after is getting nothing but leaf product,” he told WPRI in Rhode Island last year while demonstrating at a conference of the education and advocacy trade group the American Kratom Association.

Such lobbying with the trade group last year led the American Kratom Association to concur that 7-OH should be regulated as a Schedule 1 controlled substance. The association acknowledges that such regulation is reasonable and based in science.

Potential Use as Medicine

Despite the local and national debate over 7-OH, scientists are continuing to explore kratom compounds for their legitimate medical use.

A $3.5 million NIH grant is one of several that is increasing understanding of kratom as a source for new drugs.

Researchers have identified numerous other chemicals called alkaloids from kratom leaf specimens and commercial products. These researchers show that some types of kratom trees make unique chemicals, possibly opening the door to other painkillers.

Researchers have also found that compounds from kratom, such as 7-OH, bind to opioid receptors in unique ways. The compounds seem to have an effect more toward pain management and away from potentially deadly suppression of breathing. Of course, this is when the compounds are used alone and not together with other sedating drugs.

Rather than contributing to the opioid crisis, researchers suspect that isolated and safely purified drugs made from kratom could be potential treatments for opioid addiction. In fact, some kratom chemicals such as mitragynine have multiple actions and could potentially replace both medication-assisted therapy, like buprenorphine, in treating opioid addiction and drugs like clonidine for opioid withdrawal symptoms.

Rigorous scientific study has led to this more reasonable juncture in the understanding of kratom and its sensible regulation. Sadly, we cannot bring back Daniel Bregger. But researchers can advance the potential for new and beneficial drugs while legislators help prevent such tragedies from befalling other families.

David Kroll, PhD, is a Professor of Natural Products Pharmacology & Toxicology in the Department of Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus.

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

Ohio Governor Seeks Ban on All Kratom Products

By Pat Anson

Ohio Governor Mike DeWine wants his state to immediately ban the sale and use of all natural and synthetic kratom products by designating them as illegal Schedule One controlled substances, on the same level as heroin and LSD. DeWine is also seeking bans on “all existing and future synthetic kratom compounds.” 

If approved by the Ohio Board of Pharmacy, stores and other businesses in the state would be required to remove all kratom edibles, powders and drinks from their shelves and stop selling them online.

Kratom comes from the leaves of a tree that grows in southeast Asia and has been used for centuries as a natural stimulant and pain reliever. In recent years, millions of Americans have discovered that kratom can be used to treat pain, anxiety, depression and addiction.

The FDA, however, has not approved kratom for any medical condition. The agency recently warned that synthetic kratom products boosted with concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) could cause addiction and overdoses, and should be classified federally as Schedule One drugs by the DEA.

“These modified kratom products, sold online and in stores, are essentially legal, over-the-counter opiates that anyone – including kids – can buy with just a few bucks,” Gov. DeWine said in a press release.

“There is no accepted medical use for kratom in Ohio, and it is an imminent public health risk. The Ohio Board of Pharmacy should act with urgency to schedule all kratom compounds and future alterations of them as Schedule I illegal drugs.” 

This isn’t the first time the Ohio Board of Pharmacy will consider banning kratom. In 2018, the board voted to classify kratom as a Schedule One drug after receiving a report from the Ohio Substance Abuse Monitoring Network blaming kratom for several deaths and falsely claiming that people were injecting kratom like it was heroin. The board later rescinded its decision after a public outcry.

Another public outcry is likely, judging by the early reaction to DeWine’s proposal on X/Twitter.

“This is not good! Do you want to help patients with uncontrolled pain get their pain medicine doctors back? Because they quit prescribing,” said one poster. “Some have now found relief with Kratom and you want to take this away?”

“Prohibition of both plain-leaf kratom and 7-OH extracts is a bad thing. In both cases, they will lead to people turning to more dangerous opioids,” said another. “Kratom, particularly the pure leaf powder, is incredibly safe, pretty much impossible to have a lethal overdose. Mike DeWine is putting hundreds of thousands of people in his state at risk.”

“Our system has already turned their back on people suffering from chronic pain, disregarding their quality of life. Now the government wants to have us suffer more. This is total bull,” wrote another poster.

Under existing Ohio state law, kratom can only be sold in its natural, dried leaf or powdered form. Selling synthetic or adulterated kratom is also illegal.

Despite those safeguards, the Ohio Department of Health says kratom was found to be a cause of death in more than 200 overdose deaths in the state from 2019 to 2024.

Earlier this month, Florida Attorney General James Uthmeier filed an emergency rule classifying concentrated forms of 7-OH as a Schedule One controlled substance in Florida. Gov. DeWine’s proposal would go much further than that, by classifying all kratom products – including natural leaf kratom – as Schedule One drugs.

Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin have already classified kratom as a controlled substance. Dozens of cities, counties and local jurisdictions have also banned its sale.

While hundreds of deaths in the US have been linked to kratom use, most cases involve other drugs and illicit substances, making it difficult to determine the exact cause of death or any liability.

In a playbook reminiscent of the campaign against opioid pain medication, several law firms are seeking plaintiffs allegedly harmed by kratom to participate in class action lawsuits against kratom vendors and wholesalers.    

A former CDC director recently said that natural leaf kratom caused “no serious adverse events“ to patients involved in an FDA study, but agreed that synthetic kratom should be scheduled as an illegal drug.

“Natural kratom leaf, when used as it has been for centuries, presents a markedly different risk profile than the synthetic products flooding American markets,” said Robert Redfield, MD. “Full spectrum kratom, used responsibly, appears to have acceptable safety margins based on FDA’s own clinical data.”  

(Update 8/27/25: The Ohio Board of Pharmacy cancelled a special meeting scheduled for Wednesday to make an emergency move to ban kratom. No explanation was made as to why the meeting was cancelled.)