Something else in the "bad ideas over the counter" category. We recently addressed the issue of nicotine pouches and the various claims for wellness enhancement. The problem is that nicotine is highly addictive, and potential longer-term side effects are not well known. These pouches and similar products are now widely sold "over the counter" to potentially unsuspecting individuals. Now I read, in an article in the Washington Post by Andrew Kolodney (medical director of the Opioid Policy Research Collaborative at Brandeis University; "It's an opioid: My patients are becoming addicted to this supplement"; July 24, 2026), that an opiate called kratom is also being sold as a "supplement" over the counter in gas stations and convenience stores. There are also a plethora of online sources as well.
The author notes that twenty years ago, the patients he treated for opioid use disorder had become addicted to prescription opiates. Now many are hooked on kratom. Kratom consists of the dried leaves of a tree from Asia. The FDA is about to ban a product called "7-OH" that boosts the potency of the leaves, but still allows powders, capsules, and extracts of the dried leaves.
Kratom is being marketed as "natural, nonaddictive wellness product that relieves pain and boosts pain." But this is far from the truth. The active ingredient in kratom is an opiate, and it activates the same opiate receptors in the brain and body as does heroin and other opiates. But many people don't realize this until they find themselves experiencing withdrawal. They believed it was harmless, since they bought it over the counter without a prescription. But the author states that some people have become addicted enough to need treatment with medication for other kinds of opiate addiction.
Concerns go beyond the risk of addiction. Opiate receptors are distributed throughout the body, and opiate drugs can have effects on many bodily tissues. Case histories link kratom to sudden cardiac death.
Opiates in general are particularly bad for the gut (Rueda-Rufaza 2020). In addition to inducing constipation, opiates can influence the gut microbe populations, facilitating gut dysbiosis, and are also linked to gut barrier disruption.
Apparently, the FDA previously had plans to ban kratom and kratom products, but somehow the kratom industry was able to successfully lobby to keep it legal. I find it concerning that this drug is marketed as a "supplement" in spite of its known risks. The Virginia Department of Health has a page listing all the problems with kratom (https://www.vdh.virginia.gov/environmental-health/public-health-toxicology/kratom/), but it notes that in Virginia, kratom-containing (but not 7-OH) products are legal for people over the age of 21. In November, kratom products will be required to have a warning label. Well.