Walk into a convenience store. You will see sleek bottles, gummies, shots, and powders in bright wrappers. Companies market them as calm, focus, energy, sleep, pain relief. People treat them like upgraded vitamins. They swipe a card and head home. Nobody runs a checklist on dose, interactions, tolerance, withdrawal, or contamination.

This culture runs on a simple story. Natural means safe and plant means gentle. Legal means regulated while a label means truth. None of those statements hold up. A national poll found only 19 percent of Americans even recognized one widely sold botanical product with opioid-like effects. The same poll found less than 8 percent of adults felt very familiar with other unregulated substances marketed for mental health. That gap explains the chaos I see in clinic. People use products with real pharmacology. People also use them with almost no usable knowledge.

The conflict of belief

Americans hold two competing beliefs at once. They fear addiction. They also romanticize the next shiny “alternative.” They distrust institutions. They also trust a stranger behind a counter who speaks with confidence. They doubt prescriptions. They also accept mystery blends in a bottle with zero clinical trials.

Marketing teams exploit that tension. They sell identity. They sell rebellion. They sell relief. They never sell the hard part: tolerance, escalation, withdrawal, and the slow narrowing of life around a dose.

I meet patients who arrive scared and confused. They tell me a product helped at first. They tell me the dose climbed. They tell me sleep broke. They tell me anxiety spiked. They tell me their heart raced. They tell me they tried to stop and felt sick, restless, and trapped. They tell me they asked a clinician and got a shrug. They heard “It’s fine.” They kept going. Then the bottom fell out.

This is not a character flaw. This is a systems failure.

Clinicians face the same information fog. Training rarely covers these products. A busy primary care visit leaves no time to interrogate a label from a vape shop. Many clinicians never ask. Many patients never disclose. The White House itself highlighted a similar pattern with another plant-based drug. A patient survey showed only 56 percent of older Americans who used marijuana discussed that use with a health care provider. Silence drives risk.

Regulatory mixed signals

Public perception also bends under policy whiplash. Federal agencies send mixed signals. The White House described an ongoing push to move marijuana from Schedule I toward Schedule III, with tens of thousands of public comments and an administrative law hearing ahead. Americans read that as normalization. Many people translate rescheduling into safety. They also translate delay into permission. They also translate public debate into proof that harm sits “somewhere in the middle.”

Meanwhile, regulators target concentrated derivatives hiding in plain sight. In July 2025, the FDA warned about products labeled around “7-OH,” a concentrated opioid-like ingredient that binds to opioid receptors and shows abuse potential. The FDA described sales in gas stations, corner stores, and vape shops. The FDA also warned about misleading labels and products marketed to look harmless. Americans see the same shelves and draw the opposite conclusion. If a store sells it, a regulator approved it. If a package looks clean, the contents look clean. If a product tastes like fruit, danger feels far away.

Complexity and categorization

Public perception also loves simple categories. People accept nicotine as “a habit.” People accept alcohol as “normal.” People accept cannabis as “medical.” People accept pills as “pharma.” People accept supplements as “wellness.”

Those categories fail when a product hits opioid receptors, carries stimulant-like effects at one dose, and sedative-like effects at another dose. A Harvard Health review described exactly that split and highlighted opioid receptor activity from key alkaloids. Complexity breaks the average consumer’s mental model. Marketing fills the gap with certainty.

We also built a culture that treats pain as an emergency and distress as an intolerable defect. People want fast relief. They want privacy. They want control. Unregulated addictive products offer all three. They also demand payment later.

So what should shift?

First, clinicians need an updated operating model. Treat unregulated psychoactive products like medications. Ask about them every visit. Document them. Screen for escalation, cravings, withdrawal, and functional decline. Treat adverse effects early. Do not outsource safety counseling to a store clerk.

Second, patients need plain language education that respects their motives. Most people chase relief, not ruin. Tell the truth about risk without shaming. Name the pattern: early benefit, dose creep, tolerance, withdrawal, then impairment. Connect the dots between “natural” branding and real neurobiology.

Third, policymakers need coherent governance. Wild swings in scheduling talk create noise, not clarity. Regulators should focus on quality control, truthful labeling, contaminant testing, and dose transparency. The FDA already signaled that direction for concentrated opioid-like derivatives and warned about mislabeled products. Put guardrails on the supply chain. Do not leave families and clinicians to clean up the aftermath alone.

Fourth, medicine needs intellectual honesty. Some people use these products as self-directed harm reduction. Some people spiral into dependence and medical harm. Both stories exist at the same time. Public health must handle both. Denial helps nobody. Hype helps nobody.

I want a different future. I want a culture where Americans understand addictive products as engineered experiences, not harmless lifestyle choices. I want clinicians who lead with curiosity and precision. I want patients who bring every bottle to the visit without fear. I want regulators who move faster than the marketing cycle.

Addiction does not announce itself with a headline. It walks in through a “wellness” door.

Muhamad Aly Rifai is a nationally recognized psychiatrist, internist, and addiction medicine specialist based in the Greater Lehigh Valley, Pennsylvania. He is the founder, CEO, and chief medical officer of Blue Mountain Psychiatry, a leading multidisciplinary practice known for innovative approaches to mental health, addiction treatment, and integrated care. Dr. Rifai currently holds the prestigious Lehigh Valley Endowed Chair of Addiction Medicine, reflecting his leadership in advancing evidence-based treatments for substance use disorders.

Board-certified in psychiatry, internal medicine, addiction medicine, and consultation-liaison (psychosomatic) psychiatry, Dr. Rifai is a fellow of the American College of Physicians (FACP), the American Psychiatric Association (FAPA), and the Academy of Consultation-Liaison Psychiatry (FACLP). He is also a former president of the Lehigh Valley Psychiatric Society, where he championed access to community-based psychiatric care and physician advocacy.

A thought leader in telepsychiatry, ketamine treatment, and the intersection of medicine and mental health, Dr. Rifai frequently writes and speaks on physician justice, federal health care policy, and the ethical use of digital psychiatry.

You can learn more about Dr. Rifai through his Wikipedia page, connect with him on LinkedIn, X (formerly Twitter), Facebook, or subscribe to his YouTube channel. His podcast, The Virtual Psychiatrist, offers deeper insights into topics at the intersection of mental health and medicine. Explore all of Dr. Rifai’s platforms and resources via his Linktree.