Greg Kiesow Had 20 Years Sober From Alcohol. A Smoke Shop Tablet Took Ten Months of It.

Greg Kiesow had been sober from alcohol for almost 20 years when he took 7-OH from a smoke shop. STAT reports that he became addicted to it, and that it took about ten months and a taper to get off. Then he did something that tells you how big the hole was: he started a support group for it. Kratom Anonymous now holds 15 virtual meetings a week.

Twenty years of sobriety did not protect him, because nobody had told him what he was holding. It was sold over the counter, next to the gum.

A ban that arrives before the beds do is not a safety policy. It is a withdrawal schedule.

That is where the federal argument over 7-OH, the concentrated cousin of kratom, has to be read from. Not from the question of whether the product is dangerous. It is. The question is what happens, in the weeks after a rule lands, to the person who woke up this morning needing it.

The product in the smoke shop is not the plant

Start with the plain version, because most people have never had it. Kratom is a leaf from a tree native to Southeast Asia. The main chemical in it, mitragynine, presses on the same receptors in the brain that heroin and fentanyl press on, but only part of the way. Think of a key that fits the lock and turns it a third of the turn. At low doses people describe a mild lift, like strong coffee. At higher doses it has been used for pain and to ease opioid withdrawal. STAT’s explainer notes there are no evidence-based dose recommendations for any of it.

7-OH is different. It occurs in fresh leaf only in trace amounts, according to Yale epidemiologist Katherine Hill, quoted by STAT. What is on the shelf now is semi-synthetic: chemists concentrate it, then press it into tablets, gummies and drink shots. Early tablets ran 12 to 14 milligrams. STAT reports 25, 50 and 100 milligram tablets now, sold under names like Dozo Perks and Roxy. The names do some of the work the label won’t. A survey from the Annenberg Public Policy Center found that two-thirds of nearly 2,000 people had never heard of kratom, and most could not tell the leaf from the lab product.

The national numbers moved before the public noticed. CDC’s weekly report found that poison center calls involving kratom rose from 258 in 2015 to 3,434 in 2025, hospitalizations where kratom was the only substance climbed from 43 to 538, and 233 deaths were linked to it over the period. Most of those deaths involved other drugs, and CDC is careful to say poison center data cannot separate leaf from 7-OH. That caveat matters in both directions: it means nobody can honestly say how much of the surge is the new product, and nobody can honestly say none of it is.

The clinics have a clearer view, because they see who walks in. STAT’s September reporting found that kratom users were 3% of new patients at the telehealth company Boulder Care in September 2025, 8% by July 2026 and 14% in August. Nearly a third of new buprenorphine patients there reported current kratom or 7-OH use. At two Recovery Centers of America inpatient sites in Massachusetts, clinicians used to see at most one kratom-related admission a week. Now it is 10 to 20.

Clinicians told STAT the same story in different words. Steve Klein, a physician at Caron Treatment Centers in Pennsylvania, described a “potency rabbit hole”: the product seems harmless because it is legal and on a shelf, tolerance builds fast, and people climb to stronger tablets. Some arrive in treatment not knowing what they were taking. Some are people with years in recovery from opioids who relapsed after trying it. Klein told STAT that patients in remission from opioid use disorder have returned to use after kratom.

Klein told STAT that patients in remission from opioid use disorder have returned to use after kratom.

If you have been through it, none of that reads as news. It reads as someone finally writing down what the floor of a smoke shop looks like to a person who is trying to feel better by Friday.

What withdrawal actually is, and why the old reassurance is out of date

For years the standard line was that kratom withdrawal is mild. In studies of the natural leaf, it generally is: anxiety, fatigue, stomach trouble, restlessness. Danelle Kawasaki, a Montana resident and member of the Fort Peck tribe, told STAT she took natural kratom tea from a dry bar, a bar that serves no alcohol, and ended up drinking it daily. When she stopped abruptly she had anxiety, vomiting and several days of withdrawal. She now argues for a tribal ban. Her experience is the leaf. It was still bad enough to change her mind about the whole category.

7-OH appears to be a heavier thing. Clinicians told STAT the withdrawal looks like opioid withdrawal: agitation, sweating, diarrhea, anxiety, no sleep, no appetite. At Recovery Centers of America, the medical director Myles Jen Kin said comfort medications were once enough, and that his team now treats these admissions like fentanyl, oxycodone or heroin withdrawal. The evidence behind that is case reports and case series, plus what clinicians see in their own units. Katherine Hill, who is studying tolerance and withdrawal in 7-OH users, made the limit explicit: treatment-center patients are not everyone, because people who quietly get off on their own never show up in a clinic’s numbers. Nobody has a trial. Everybody has a waiting room.

Here is what the psychology of it looks like from the inside, in plain terms. When something sits on the opioid receptors for weeks, the brain turns down its own comfort chemistry to compensate. Stop the product and you are left with the quiet, which feels like a body and mind with the dimmer switch jammed. The craving is not weakness. It is the brain asking for the thing that it has been told, by the product, is what keeps the lights on. Early case reports suggest that the same medicines used for opioid dependence, buprenorphine and methadone, can help, which is consistent with the mechanism. It is also consistent with the story Greg Kiesow tells: a drug that a man with two decades of sobriety did not recognize as a drug at all.

One more fact belongs here, because it cuts against everyone’s slogan. Boulder Care’s head of medical affairs, Ayesha Appa, told STAT that losing access under state restrictions may be driving some of the withdrawal cases clinics are now seeing. The tablets get harder to buy. The dependence does not go away on the date of the ban.

The fight over scheduling is a fight over who gets the last pill

Now the policy, with the gate named first. Nothing here is final. In July the DEA filed notices of intent to temporarily place 7-OH above a concentration threshold into Schedule I, the strictest category, reserved for drugs it says have no accepted medical use. A companion request for information went out from HHS; the Federal Register notice from August 26 extended its comment deadline to September 10. STAT reports nearly 36,000 comments came in. If finalized, temporary scheduling could last up to two years, with a possible one-year extension. A separate action already placed three less common kratom-related compounds into Schedule I, effective August 26.

The state picture is a patchwork. Several states and localities have issued emergency bans on 7-OH, and some have banned all kratom. Massachusetts imposed a temporary statewide ban in late August. Whether a ban touches you depends on your zip code, which tells you a person can lose a supply in one state and find it a county line away.

Several states and localities have issued emergency bans on 7-OH, and some have banned all kratom.

The experts are split along a line that has less to do with ideology than with who they picture standing at the counter. Andrew Herring, chief of addiction medicine at Alameda Health System, wants a blanket ban: “Make it illegal.” Leah Kaufman of Shatterproof says that, for the market as it is, “we need to press pause.” Nabarun Dasgupta, a pharmacoepidemiologist at UNC and a harm reduction advocate, likes the threshold approach because it targets the quantity rather than the molecule. Hill argues the evidence is too thin to schedule. And Regina LaBelle, who ran addiction policy in two White Houses, put the underlying problem in one line: “Often, the only tool we have in our tool belt is scheduling.”

We have watched this film. In 2016 the DEA moved to put the main kratom compounds in Schedule I and then backed off after the public pushed back, as STAT notes. The government decided a thing sold as natural was dangerous, met resistance, and retreated. Ten years later the product that came back is stronger, sold in 100 milligram tablets, and the people using it were never given the other thing a policy should come with: a place to go. The pattern repeats whenever a drug is banned faster than treatment is built. The ban is announced on a Monday and the withdrawal starts on a Wednesday.

The lobbying is real too. STAT reports that the October revision of the DEA approach was reportedly shaped by a lobbyist for the American Kratom Association, which shifted the target from a flat ban to a ratio. The industry’s own spokesman, Mac Haddow, told STAT that people defending every concentrated 7-OH product “are not defending the natural kratom plant.” That sentence is useful. It means even the leaf’s loudest defenders concede the tablet is a different thing.

What to do this week, and what is still yours

If you are a provider, three moves cost nothing. Add kratom and 7-OH to your intake questions by name, because patients often don’t know what they took or don’t think of it as a drug. Ask every new buprenorphine patient about it, given that nearly a third of new starts at one large telehealth practice reported it. And plan for withdrawal in someone who tells you they “only take a supplement” as if it were opioid withdrawal, not as comfort-med territory, because the clinicians who are seeing it say that is where severity is heading. Put one question on your next team meeting agenda: if a state ban lands next month, who on our census is about to lose their supply, and what is our plan for them.

If you are the person holding the tablet, or you love them, here is what is still real tonight. Buprenorphine and methadone are available treatments for opioid dependence, and early reports say they help with this too. Peer help exists: Kratom Anonymous runs 15 virtual meetings a week, per STAT. You can call SAMHSA’s National Helpline at 1-800-662-4357, free and open all hours, or start at Rize’s find-help tool. Stopping abruptly and alone is the hard way. You are allowed to want the easy way. Treatment is allowed to be the easy way.

Greg Kiesow went from twenty years sober to ten months of something nobody warned him about, and came out of it running meetings. That is the part of the story the rule does not cover. A bill can take a product off a shelf. It takes a person to be there when the one who needed it comes looking for the next thing, and the only honest policy is the one that makes sure someone is.

That is the part of the story the rule does not cover.