On October 14, the Drug Enforcement Administration (DEA) proposed placing four substances linked to the plant kratom on Schedule I of the Controlled Substances Act. This is the schedule reserved for substances which have a high potential for abuse and have no medical use. Kratom leaf is explicitly not included, and in fact this is to protect whatever the not listed. Rather, the substances targeted must all exceed a certain threshold before falling into the banned schedule. These are 7‐hydroxymitragynine (7‐OH) and mitragynine pseudoindoxyl (MGPI), MGM‐15, and MGM‐16. They all have opioid‐like qualities. 7‐OH is found in trace amounts in kratom. The other three substances are synthetically derived from the plant. The DEA Federal Register notice also warned of deceptive branding in which these products were called “kratom” and marketed as medical treatments, energy supplements, and so on. The federal Department of Health and Human Services (HHS) also participates in such rulemaking when it comes to the abuse potential of drugs. On October 9, HHS made it clear that the DEA recommendation was designed to distinguish the four substances from “natural botanical kratom products,” which may contain trace amounts of the banned substances – hence the threshold criterion. “We are drawing a clear line between natural kratom and dangerous, enhanced opioid products,” said HHS Secretary Robert F. Kennedy, Jr. “We listened to the public, followed the science, and developed a clear recommended threshold for temporary scheduling that targets concentrated 7‐OH and MGPI without sweeping natural botanical kratom into Schedule I. The Trump Administration will continue taking decisive action against dangerous products that fuel addiction while making sure our policies are grounded in rigorous science.” The National Institute on Drug Abuse is researching an active component of kratom, which explains the reticence to place kratom on Schedule I. For the DEA Federal Register notice, go to https://www.federalregister.gov/documents/2026/10/14/2026‐20943/schedules‐of‐controlled‐substances‐temporary‐placement‐of‐7‐‐hydroxymitragynine‐and‐mitragynine
Since the days of the COVID pandemic, the Drug Enforcement Administration (DEA) has allowed buprenorphine to be prescribed by telephone when used to treat opioid use disorder. During the pandemic, it allowed folks to continue to receive this lifesaving medicine and made it possible for many more to become engaged in care! It has worked, and all the federal administrations since March 2020 have allowed telephonic initiation to continue. That will end after more than six years, on December 31, 2026.
In 2018, there was one state with legalized online sports betting. Now there are 31. That increase is associated with an increase in treatment for mental illness, researchers have found. Gambling disorder (GD) is in the category of substance use disorder (SUD), but this study suggested that GD itself increases mental health problems.
Last week's issue of the Journal of the American Medical Association (JAMA) took a close look at the observed declines in opioid‐related deaths with two studies published in the same issue: one on declines in opioid prescribing since 2010 and the other on an increase in access to naloxone.
A general session at the InUnity Alliance meeting this month featured two top consultants answering questions from the attendees. The consultants, Robert Kent, Esq., president of Kent Strategic Advisors, and Josh Rubin, vice president of Client Solutions at Health Management Associates, shared their advice on the business pressures facing the substance use disorder (SUD) treatment field today.
