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Issue

#13

August 2026

Louisiana Just Banned the Kratom Plant Itself. The State-by-State Patchwork Is Now a Clinical Problem.

Louisiana's kratom law took effect August 1, making it one of the most aggressive state-level actions to date. Unlike the federal 7-OH threshold rule (which targets concentrated high-potency products above a specific 0.05% threshold), Louisiana classified the kratom plant itself as a state Schedule I controlled substance. Botanical kratom at any concentration is now illegal in Louisiana. The CDC has reported a 1,200% rise in kratom-related poison-center cases since 2015, providing the epidemiological basis for increasingly assertive state and federal action.

The current legal landscape requires jurisdiction-level awareness. Louisiana joins Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin in broadly restricting kratom. Other states, including Virginia, have no current scheduling action pending, though the 2027 General Assembly session is the appropriate venue to watch for any Virginia-specific legislation. The federal 7-OH order (discussed in the Regulatory section below) layers an additional set of restrictions at the national level, targeting concentrated products but not leaf kratom.

The clinical issue is abrupt access loss. Patients using kratom products for self-managed opioid withdrawal, opioid substitution, or pain management across multiple states face the same pattern: supply is legal in one state, unavailable in the next. The withdrawal profile following abrupt kratom discontinuation includes opioid-like symptoms (anxiety, insomnia, diaphoresis, GI distress) plus potential muscle aches and cravings, with duration and severity correlated to product potency and use frequency. A patient presenting in withdrawal with a negative standard opiate immunoassay may be in kratom discontinuation.

◷  In Effect

DEA Scheduling: Now in Effect

The 7-OH Schedule I Order Is Federal Law as of August 5. Here Is What Is and Is Not Prohibited.

The DEA temporary Schedule I order placing 7-hydroxymitragynine (7-OH) above specified thresholds went into effect August 5. The companion order covers mitragynine pseudoindoxyl, MGM-15, and MGM-16. The threshold rule is central to what the order does and does not prohibit: kratom plant material with naturally occurring 7-OH concentrations below 0.05% is not targeted. Concentrated extracts, tinctures, edibles, and pressed tablets that exceed 0.05% 7-OH (or 1 mg per serving in finished products) are now Schedule I controlled substances.

The practical impact on retail supply has been immediate. Products marketed as "enhanced kratom," "liquid kratom shots," high-milligram extract capsules, and branded "7-OH" tinctures that have been sold as legal buprenorphine alternatives are now off the market. Botanical leaf powder sold for tea preparation at concentrations below the threshold is currently unaffected. The order is temporary (two-year duration) pending a permanent scheduling decision.

For OTPs and CTCs: patients who have been using concentrated 7-OH products as opioid substitutes or for withdrawal management now face abrupt loss of that supply. Anticipate treatment-seeking from this population. For lab programs: LC-MS/MS confirmation panels with mitragynine and 7-OH targets will see increased ordering as clinicians try to document use and guide clinical decision-making. Sources: Federal Register.

ADDICTION  ·  2026  ·  COHORT STUDY / 32,348 PATIENTS

The Six-Month Threshold for MOUD Is a Floor, Not a Data-Derived Taper Target. Here Is the Evidence.

Hayes CJ et al. followed 32,348 US Veterans receiving MOUD (19,666 buprenorphine, 8,675 methadone, 4,007 extended-release naltrexone) and found that survival probability continued to increase with time on treatment out to approximately four years across all three agent classes (Addiction, 2026. doi:10.1111/add.70211). The benefit did not plateau at six months or at twelve months. This is the largest real-world US outcomes dataset on MOUD duration published to date, and the directional finding is the same for every agent tested.

The clinical implication is direct: feeling well on MOUD is evidence that treatment is working, not evidence that treatment is no longer needed. The six-month mark that appears in many program standards as a minimum was established to prevent premature discontinuation. It was not derived from data showing that protective benefit stops accumulating at that point. Those are two different claims, and it matters that clinicians, patients, and families understand the distinction when taper conversations come up.

Hayes CJ, et al. Evaluating the optimal duration of medication treatment for opioid use disorder. Addiction. 2026. doi:10.1111/add.70211. [Primary Data — Cohort Study, 32,348 US Veterans]

Also From ToxiPharm This Week

Tox Pearl #13: Your Patient Wants to Taper at Six Months. The Data Say Wait. Free one-page clinical reference with the Hayes et al. data framed for the taper conversation.