“If you violate our rule, we are going to make you pay for it. You could be looking at up to 30-year prison sentences, and believe me, we will be looking to make some examples of bad actors.”
With these words, Florida’s attorney general announced the state’s June 2026 scheduling of 7-hydroxymitragynine (a short-acting psychoactive agent that shares common properties with both opioids and stimulants) and other concentrated derivatives of herbal kratom. These effects combine to make 7-hydroxymitragynine (commonly called 7-OH or just 7-O) a challenging drug to quit, as the withdrawals come on fast and mimic the effects of stopping heroin and methamphetamines all at once. Post-acute withdrawal symptoms may follow, leading to great difficulty in maintaining abstinence even after the acute withdrawal phase passes.
Florida’s announcement also presaged the nationwide scheduling of kratom extracts set for July 31, 2026. Placing substances in the DEA’s Schedule 1 category subjects users and sellers to criminal penalties under a complete ban. While removing 7-OH from gas stations and vape shops will likely curtail the casual exposure to 7-OH that has led many unsuspecting people down a path toward inadvertent addiction, this ban will harm people currently dependent on 7-OH who will wake up August 1 to find that the drug is no longer readily available on the shelf. Aside from minor mayhem at retail outlets as people grapple with the change in real time, sudden withdrawals may cause individuals to go to any source of relief, including far more dangerous but widely available opioids like fentanyl; since many 7-OH users do not have tolerance for fentanyl, they may easily overdose even on small amounts. We also may see a resurgence of tianeptine, a similarly short-acting and metabolically complex substance that carries the same risk of addiction and is sold legally as a supplement in most states.
Crucially, prohibition has never meant fewer drugs are available. If it did, the U.S. would not be in the throes of an overdose epidemic 117 years after opium was first banned in 1909. Prohibition does drive prices through the roof, which in turn draws in unsavory people willing to risk life, limb, and personal freedom to manufacture and smuggle the most concentrated versions of habit-forming drugs, then selects for the most violent impulses among those traffickers when conflict arises around territorial disputes, supply-chain control, and market dominance, a phenomenon that only worsens when a dominant cartel head is removed from the market.
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One silver lining to the upcoming regulation of 7-OH is the kratom plant itself will not be scheduled at the federal level, although this decision is not without substantial controversy. Historically, the U.S. had banned not just the strongest extracts of herbal preparations, but entire plants, with some exceptions. Marketing concentrated caffeine directly to consumers was limited in the U.S. in 2018, while the herbal sources we call coffee and tea remain widely available. Similarly, it is difficult to ban the whole ephedra shrub whose natural range covers much of the Southwest (indeed I can see two wild ephedra plants from my front window), so only the more potent concentrates were banned. More commonly, though, the U.S. bans entire plants, which means that coca leaves fall into the same schedule as crack cocaine, and “bath salts” fall into the same category as the fresh khat leaves from which they were derived, which have been used as a mild stimulant for hundreds of years in North Africa and the Middle East. Banning the stronger extracts but leaving the milder forms exerts market pressure against the more dangerous forms back toward milder choices, which is a small but welcome concession from the drug-war ethos. Unfortunately, those already taking 7-OH may be unable to find relief from their withdrawal symptoms by taking leaf kratom, which is usually too weak to offset the potency of 7-OH once dependency is established.
Meanwhile, a middle pathway exists between no regulation and total prohibition of any substance: the dispensary model. As with cannabis, a system of kratom dispensaries could sell kratom and its extracts only in licensed, regulated shops that are subject to educational requirements, potency testing, clear risk disclosure, caps on quantities sold to any one person, and age limitations on employees and clientele. This model has worked well to ease cannabis from Schedule 1 status into decriminalization and even legalization in many states. A regulated model would curtail the inevitable fellow travelers that accompany prohibition, such as mass incarceration and the diversion of public funds to interdiction activities (contrarily, dispensaries can be a substantial source of tax revenue). This alternative model also jibes with the core American values of freedom and personal choice, achieving a margin of safety while acknowledging that what willing adults put into their bodies perhaps should not fall into the province of governmental reach.
Fortunately, because kratom is primarily an opioid, standard treatment with FDA-approved agents like buprenorphine is effective. Patients may require additional support for mood, energy, and motivation drops that can occur when the stimulant effects fall off, but the primary dependence is medically manageable. We can only hope that users find their way to treatment for the severe withdrawals and cravings they may face on the day that prohibition goes into effect before turning to more potent and dangerous alternatives.
Julie Craig is an addiction medicine specialist.
