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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Unregulated botanical products: the hidden risks of convenience store supplements.” Muhamad explores the dangerous misconception that “natural” equals safe, revealing how consumers unknowingly ingest substances with opioid-like effects sold as wellness products. He highlights the conflict between Americans’ fear of addiction and their trust in sleek, unregulated marketing that promises relief without consequences. The conversation examines the regulatory mixed signals and the critical need for clinicians to screen for these products during visits. Muhamad advocates for intellectual honesty in medicine and clearer governance to protect families from the spiral of dependence. Discover why addiction often walks through a “wellness” door and how to spot the risks before it is too late.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Muhamad Aly Rifai, psychiatrist, internist, and addiction medicine specialist. Today’s KevinMD article is “Unregulated botanical products: the hidden risks of convenience store supplements.” Muhamad, welcome back to the show.

Muhamad Aly Rifai: Thank you very much for having me to talk about this timely topic. The unregulated botanical products are a concern. As a psychiatrist, an internist, and somebody who deals with addiction medicine, I deal with these products on a daily basis. I feel it is very important to talk to the public about these products and the hidden dangers. We must discuss how we can alert the public and alert our patients about the dangers of some of these products.

Kevin Pho: All right, so tell us more. What products are we exactly talking about?

Muhamad Aly Rifai: We have seen an explosion of botanical products that are available in convenience stores, gas stations, and vape shops. These come in a variety of formulations. You see these sleek bottles that are energy bottles. You see gummies, shots, pills, and powders. These are all products that are marketed to adolescents and adults as something that would give them more energy. Basically, you see a convenience store clerk acting as an advisor for unknown botanical and natural products. Sometimes we see patients trusting that convenience store or vape shop clerk more than their physicians about these products that they use on a regular basis, sometimes with catastrophic consequences.

Kevin Pho: It is funny you say that. Sometimes when I try suggesting a prescription medication to patients, they would rather not take the prescription medicine. They will take something over the counter or something they find at a grocery store. Just because it says it is natural doesn’t mean it is safe, right?

Muhamad Aly Rifai: Yes. As a psychiatrist, I know Americans have two competing beliefs at once. They fear addiction. They don’t want to be addicted to something. But they also romanticize the next shiny alternative things. They distrust institutions. They distrust us as physicians, but they also will trust a stranger who is behind a counter and who speaks with a cocky confidence. People will listen to that. They will doubt our prescriptions, but they will believe a shiny bottle that they drink for five-hour energy, concentration, or to help pain. These are things that have zero clinical trials, but people do trust them.

The American Psychiatric Association actually conducted a national poll that showed that only 19 percent of Americans even recognize a widely sold botanical product called kratom. So only one out of five even recognize what that product is. Less than 8 percent of adults really felt any familiarity with other substances that are being sold in vape shops or convenience stores. Basically, there is no knowledge whatsoever. I think that it is very important for us physicians to educate our patients not to engage with these products because they carry significant adverse effects.

Kevin Pho: So in these energy shots that you find in convenience stores, I have always thought that it was just caffeine. But if you look at the ingredients, there is more than just caffeine in them. So what exactly is in the shots that you find in convenience stores?

Muhamad Aly Rifai: There is a variety of products. Some of them they call kava. We are finding out that a lot of these products have either kratom, mitragynine, or 7-hydroxymitragynine, known as 7-OH. I find it hard to believe, but there is some data showing that even my colleagues who are physicians engaged in the treatment of individuals with pain conditions permit their patients to utilize kratom products with opiates.

I have seen several patients who are on opiate products, and because of a lack of knowledge or a lack of understanding, their pain management doctors allowed them to transition or supplement with kratom or 7-OH. This created a significantly dangerous situation because we now have two medications that are affecting the opiate receptors. Basically, what ends up happening is these people develop dependence on opiate products. It is very hard for us to get them off these opiate products. They require maintenance with buprenorphine, for example, for a long period of time for us to be able to get them off the kratom and the 7-OH.

Kevin Pho: So you are saying that sometimes with these energy shots that you could get in a drugstore or a convenience store, they have kratom and kratom-based derivatives that are habit-forming. So conceivably, these patients can take a daily energy shot and find it difficult to stop that habit.

Muhamad Aly Rifai: Absolutely. It is not just drinks. It comes in powders, pills, and leaves. Sometimes people just utilize them as teas and as pills and products where they don’t understand what it is doing to them. We are seeing a significant increase in the number of people who are calling poison control and who are struggling with these medications. I see that as someone who treats individuals with addiction. Basically, we have to treat them in an addiction unit to be able to wean them off these medications.

Kevin Pho: What kind of regulations are there surrounding these types of supplements? How do we know what is inside these energy shots is safe?

Muhamad Aly Rifai: We do not know what is inside these products. That is the problem. We have a lot of companies that are marketing these products and making a significant amount of money from these products, and we don’t know what is in them. Some of them will say kratom. Some of them will say 7-OH. We know that there are many states, up until now it is around ten states, that have banned 7-OH.

That is a difficult situation because people view kratom and 7-OH similar to a product like cannabis, which also has a hybrid place. It is approved in many states for adult use, recreational use, and medicinal use, but continues to be on a Schedule I basis for the federal government, the Drug Enforcement Agency, and the FDA. Now, the White House, to its credit, has talked about a path to move marijuana from Schedule I toward Schedule III, but that has not happened.

The general public is really confused. They see these products in gas stations. They are unregulated, they utilize them, they are labeled safe, and they are labeled as giving energy, and then they become hooked on them. Not everybody becomes dependent on them. I think that there may be some genetic predisposition that makes people actually susceptible to becoming dependent on them. While not everybody becomes dependent, I think that we need to be careful and talk to our colleagues about counseling patients on these unregulated botanical products that they use on a regular basis.

Kevin Pho: Are any of them safe? I think that in the exam room, when I am talking to patients about smoking and the use of illicit drugs, is there any over-the-counter botanical product that you feel comfortable recommending or feel comfortable with if a patient tells you they are taking it? Or are they under one blanket where we just don’t know?

Muhamad Aly Rifai: I put them under one blanket. I mean, I don’t know what is in them. That is the problem when you just take that shiny bottle or shiny pill box or shiny leaves and you don’t know what is in them. Companies will tell you: “Well, we have third-party testers and we know this is going to be safe for you.” But we don’t know, and they are unregulated. The FDA has chosen not to regulate them.

So I think that we need to alert our patients not to utilize anything. But our patients seek help and they want to use things that can help them with energy, concentration, and sleep, and that is why they end up with these products.

Kevin Pho: And to be clear, other than a cup of coffee, there really isn’t anything over the counter or supplement-based that could help with things like fatigue and concentration. There is no unicorn supplement that is out there.

Muhamad Aly Rifai: There is no unicorn supplement. This is a wake-up call to us physicians and to our colleagues that we really need an updated operating model. We want to start asking our patients whether they are taking any over-the-counter unregulated products. We need to document them and screen for their use. You would be surprised. The thought is around 30 to 40 percent of our patients are using some over-the-counter unregulated product on a regular basis, whether it is vitamins or some of these other products. If we are not asking about them, we are missing them. I can tell you so many times we see that a lot of our patients are taking things that are not listed on their medication lists and that have significant drug-drug interactions.

Kevin Pho: We are talking to Muhamad Aly Rifai, psychiatrist, internist, and addiction medicine specialist. Today’s KevinMD article is “Unregulated botanical products: the hidden risks of convenience store supplements.” Muhamad, as always, let’s end with take-home messages that you want to leave with the KevinMD audience.

Muhamad Aly Rifai: I wrote this piece because I want a different future. I want a culture where our patients understand that there are over-the-counter addictive products that are engineered experiences. They are not harmless lifestyle changes; they are harmful. I also want my fellow clinicians to lead with curiosity and ask their patients about their utilization of over-the-counter botanical products. Every patient who brings a bottle to a visit should do that without fear and talk to their physician about it. Show it to your physician and have a discussion because I think these are dangerous products and we need to alert our patients because they will cause significant addiction issues for the future.

Kevin Pho: Muhamad, thank you so much again for sharing your perspective and insight. Thanks again for coming back on the show.

Muhamad Aly Rifai: My pleasure. Thank you.