An American Medical Association (AMA) policy from June 9, 2026, calls for prohibiting the sale, distribution, and marketing of concentrated 7-hydroxymitragynine (7-OH) products while supporting surveillance, additional research, and other public health measures for kratom, according to the AMA press release and the AMA House of Delegates report. This policy raises an uncomfortable question: Was the AMA duped on 7-OH?

The question is particularly relevant in light of the New York Times investigation, “How an Addictive Gas Station Drug Found Allies in the Trump Cabinet,” published June 16, 2026, which detailed the considerable political influence exerted by segments of the kratom industry.

For physicians unfamiliar with these products, kratom is a botanical substance derived from Mitragyna speciosa, a tree native to Southeast Asia. One of its naturally occurring alkaloids is 7-hydroxymitragynine (7-OH), a compound that is also sold in concentrated formulations, primarily semi-synthetic, independent of traditional kratom products.

The issue is not whether kratom or 7-OH pose health risks. Both do. The issue is why the AMA concluded that 7-OH warrants prohibition while kratom warrants regulation.

Both substances can produce psychoactive effects. Both have the potential for misuse. Both are sold in a marketplace largely devoid of regulatory oversight. Yet the AMA has provided little explanation for why 7-OH should be prohibited while kratom should be regulated. That distinction matters.

Prohibition is not regulation. In fact, prohibition drastically reduces our ability to regulate. A substance that cannot legally be sold cannot be meaningfully regulated. Product testing cannot be required. Manufacturing standards cannot be enforced. Labeling requirements cannot be monitored. Surveillance becomes more difficult. Public health oversight diminishes. Consumers who continue seeking the product are pushed toward illegal markets where none of these protections exist. This dynamic is directly counter to the public health consumer protection that the AMA asserts it is supporting.

Public health professionals should recognize this dynamic. We have seen it repeatedly. Removing a psychoactive substance from legal commerce does not eliminate demand. Instead, it transfers the market to less transparent and less accountable channels.

The AMA’s position is particularly puzzling because concerns raised regarding 7-OH are not unique to 7-OH. Critics point to questions regarding toxicity, dependence, marketing practices, product potency, and youth access. These are legitimate concerns. They are also concerns that apply, to varying degrees, across the broader kratom marketplace.

If the AMA believes the risks associated with 7-OH justify prohibition, it should clearly articulate the evidence supporting that conclusion. What evidence demonstrates that 7-OH presents a qualitatively different threat than kratom products that naturally contain or metabolize into 7-OH? What threshold of risk justifies prohibition rather than regulation? Why has that threshold been met for 7-OH but not for kratom? The AMA’s policy statement provides few answers.

To be clear, the current evidence regarding 7-OH remains limited. Available data do not establish that 7-OH is safe. Neither, however, do they clearly establish that it belongs in the same category as substances traditionally subject to prohibition. Reports linking kratom alkaloids to fatalities frequently involve polysubstance exposure, making causal interpretation difficult. Detection of 7-OH in toxicology testing does not necessarily indicate consumption of a concentrated 7-OH product, as 7-OH is a naturally occurring metabolite of kratom. More broadly, epidemiologic evidence regarding population-level harms remains incomplete.

The AMA’s policy statement repeatedly asserts that concentrated 7-OH products pose unique risks. Yet it provides little evidence demonstrating that these risks justify prohibition rather than regulation. Physicians routinely make distinctions among medications, substances, and interventions based on comparative risk. If organized medicine intends to advocate prohibition of one kratom-derived product while leaving others legally available, it should clearly articulate the evidence supporting that distinction.

Uncertainty should encourage better regulation, better surveillance, and better research. Instead, the AMA has endorsed prohibition.

Recent revelations concerning the political and commercial forces operating within the kratom marketplace raise troubling questions. If industry influence is a concern, the logical response is stronger regulation. Public health agencies routinely regulate industries, such as alcohol, tobacco, and gambling, whose financial interests are not aligned with public health. The existence of commercial influence is not an argument against regulation; it is one of the primary reasons that regulations exist.

The AMA appears to have embraced a false choice: either unrestricted availability or prohibition. There is a third option.

Policymakers can responsibly regulate. They can establish age restrictions, product testing standards, manufacturing requirements, accurate labeling, retailer licensing, marketing restrictions, and adverse-event surveillance systems. These tools are available whether one favors broader access to kratom products or not. They are the tools of public health.

Ironically, the AMA’s policy undermines its own stated objective. If lawmakers follow its recommendation and prohibit 7-OH products, the ability to regulate those products will largely disappear. What remains will be an illegal market beyond the reach of many of the safeguards the AMA claims to support.

The question is not whether 7-OH should be subject to oversight. It should. The question is why the AMA rejected a regulatory approach in favor of prohibition while failing to provide convincing evidence that 7-OH warrants treatment fundamentally different from kratom itself.

Whether the AMA was persuaded by an incomplete narrative, influenced by political pressures, or simply failed to apply the same evidentiary standards it routinely demands elsewhere, its policy leaves an unanswered question: What evidence justifies prohibiting 7-OH while recommending regulation, not prohibition, for kratom?

Bryon Adinoff is an addiction psychiatrist, neuroscientist, academician, and advocate. He was appointed clinical professor at the University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, following his retirement as distinguished professor of alcohol and drug abuse research at the University of Texas Southwestern Medical Center.

He has published more than 200 papers and book chapters on the neurobiology and treatment of addiction, and serves as editor-in-chief of The American Journal of Drug and Alcohol Abuse. A representative sample of his work is available through his PubMed author page.

As president of Doctors for Drug Policy Reform (D4DPR), he advocates that drug prohibition be replaced by a science-based, compassionate, and just system that protects both the individual and society. He shares more about his work on his addiction psychiatry website and on LinkedIn.