“For too long, we have kept methadone—an evidence-based, life-saving medication—locked away, far from many of the people who need it,” Markey said. “The Modernizing Opioid Treatment Access Act 2.0 of 2026 would take a carefully considered step forward in expanding access to this medication by allowing the most highly trained addiction physicians in the country to prescribe methadone for their patients to pick up at a pharmacy. We must knock down barriers to treatment for people at risk of opioid overdoses—not build them up.”

He’s right that knocking down barriers to methadone is long overdue. But would MOTAA 2.0 unlock access for everyone who needs it? The answer is no. Nothing in the updated bill addresses the fundamental problems in the 2023 version.

“We know that there aren’t enough addiction medicine physicians and psychiatrists in the country.”

As Filter reported at the time, the first iteration of the bill contained fatal flaws. Limiting non-clinic prescribing to physicians board-certified in addiction medicine would exacerbate racial disparities in access to medications for opioid use disorder (OUD). It’s also just not nearly enough. There are about 6,400 doctors with this certification. About 600,000 patients currently take methadone.

“We know that there aren’t enough addiction medicine physicians and psychiatrists in the country to expand care to everyone who needs it,” a representative from the office of Sen. Markey told Filter.

“The goal of the bill is to expand the universe of providers who can prescribe methadone,” they continued. “It starts this expansion by allowing health care providers with the greatest expertise in addiction treatment—board-certified addiction medicine physicians and addiction psychiatrists—to prescribe methadone outside of an OTP.”

When it comes to prescribing methadone for OUD specifically, however, doctors board-certified in addiction medicine have no more experience than other doctors—because none of them have been able to do it. The law has restricted this to physicians who work in opioid treatment programs (OTP). There are approximately 2,100 OTP in the US, the majority concentrated in urban centers.

“One of the main changes in MOTAA 2.0 compared to the version introduced last Congress is the addition of language to allow the HHS Secretary to designate providers able to prescribe methadone outside of an OTP setting, in addition to board-certified addiction medicine physicians and addiction psychiatrists,” Sen. Markey’s representative said. “These providers would need to be licensed and registered to prescribe controlled substances.”

But who are these other providers? The representative didn’t say. The bill itself states that they would be “otherwise determined by the Secretary, under standards established by the Secretary.” The language is troublingly vague.

We still don’t know who the “future licensed providers” would be, nor any timeline. And what’s to stop HHS using its new “flexibility” to do precisely nothing?

The American Society of Addiction Medicine (ASAM) interprets the sentence to mean, “The HHS Secretary could add other qualified prescribers, who would remain subject to applicable state scope-of-practice laws…” But who are the “other qualified prescribers”?

Kelly M. Corredor, chief advocacy officer at ASAM, confirmed via email to Filter that the organization was involved in drafting the updated bill. But when asked who the other qualified prescribers would be, she wouldn’t specify.

According to a press release from Rep. Donald Norcross (D-NJ), a sponsor of the bill in the House this provision means, “flexibility for the Department of Health and Human Services to authorize future licensed providers without Congress needing to pass a separate law.”

But we still don’t know who the “future licensed providers” would be, nor any timeline on which this might happen. And what’s to stop HHS using its new “flexibility” to do precisely nothing?

MOTAA 2.0’s inclusion of more providers, however ambiguously, is a direct response to methadone reform activists’ criticisms of the original MOTAA. But its terms offer no guarantee that the HHS secretary will ever allow more prescribers.

Unfortunately, other provisions that helped doom the original MOTAA made it into 2.0. Participating doctors would need a special registration from the Drug Enforcement Administration (DEA)—extra surveillance that will deter some as has been the case with buprenorphine. The other poison pill is that any state attorney general could stop registering new providers and revoke or deny a registration.

“We cannot allow ourselves to become embroiled in territorial turf wars over prescribing privileges under the guise of ‘modernizing.’”

ASAM is the leading advocate for MOTAA 2.0. This conservative medical society has done almost nothing to end three decades of a crisis that has seen over 1 million people die from an opioid-involved overdose. It’s notable that ASAM had zero interest in reform prior to the pandemic. Given this abysmal track record, on what basis should its members have the exclusive right to prescribe methadone outside of clinics?

“The urgency of providing access to life-saving medications for people dealing with substance use disorders, particularly opioids, cannot be overstated,” Jerry Otero, who takes methadone and is the manager of the Drug User Health Hub at St. Ann’s Corner of Harm Reduction, told Filter. “We cannot allow ourselves to become embroiled in territorial turf wars over prescribing privileges under the guise of ‘modernizing.’”

In 2023, Dr. Stephen M. Taylor, then president-elect of ASAM, (now president), testified to a US Senate committee: “MOTAA is not methadone for everyone, prescribed by anyone. It represents a responsible expansion in methadone access for OUD.”  Taylor’s statement shamefully carried no sense of urgency to save lives. The incremental, “responsible” expansion he advocated would free very few patients from the carceral clinic system.

ASAM’s description of MOTAA 2.0 as having strong federal and state oversight and safety guardrails” plays into the worst discrimination against methadone patients—the notion that they can’t be trusted and must be continuously monitored.

ASAM’s one-pager on the new bill has a section titled, “Improve Patient Safety and Address Diversion.” Diversion isn’t a major problem; lack of access is. This DEA framing panders to the idea that methadone is a uniquely dangerous medication. It’s not.

The first bullet point states that ASAM supports the terrible idea of DEA special registration of doctors. This is the DEA that has kept methadone under lock and key as people die; the DEA that has made the unregulated opioid supply exponentially more dangerous by pursuing its deadly drug war. Yet instead of campaigning to get these killer drug warriors out of addiction medicine, ASAM cosies up to them and rarely, if ever, criticizes their actions.

The second bullet point endorses the use of prescription drug monitoring programs (PDMP) for methadone dispensed through community pharmacies. According to those who’ve studied them, PDMP are tools of law enforcement and often harm patients.

“There is one thing that prescription drug monitoring programs are really good at, and that is bringing down prescribing rates,” said Dr. Elizabeth Chiarello, author of, Policing Patients: Treatment and Surveillance on the Frontlines of the Opioid Crisis. “But overdose is through the roof.”

Other ASAM bullet points welcome MOTAA 2.0’s ideas of states setting dispensing limits, which many will do to the detriment of patients, and prescriptions being written for “supervised use”—meaning pharmacists would be required to watch certain patients swallow methadone, just as clinic nurses do.  

“This bill, in action, will keep methadone out of reach for the patients who need it the most.”

The Modernizing Opioid Treatment Access Act 2.0 doesn’t modernize access to methadone. It’s designed to fail by handing a small group of doctors a monopoly on prescribing to a small group of patients, who will skew wealthier and white. And it gives states veto power over new providers—states like West Virginia, which is so hostile to methadone that it’s had a moratorium on opening new clinics for 19 years.

In line with the DEA narrative, MOTAA 2.0 emphasizes diversion control and surveillance of patients; it reinforces stigma.

“This bill, in action, will keep methadone out of reach for the patients who need it the most,” Otero said, “by overcomplicating who can prescribe.”

A bill to truly modernize access to methadone would abolish the clinic system and permit all provider prescribing.

The obfuscating language in MOTAA 2.0 that might, maybe mean more providers can prescribe sometime in the distant future—who knows!—is an insulting trick to make methadone reform advocates believe 2.0 is a different bill from its predecessor. It’s not.

Instead, believe Dr. Taylor when he says, “MOTAA is not methadone for everyone, prescribed by anyone.” 

Image by Helen Redmond

The post MOTAA 2.0 Is Not Real Methadone Reform appeared first on Filter.

The state alleged that “most” of the 641 million prescription opioid pills Albertsons dispensed during the 16-year period investigated had unresolved “red flags,” referring to activity that the Drug Enforcement Administration’s proprietary algorithms register as suspicious.  

“The AG’s office’s investigation revealed that between 2006 and 2022 Albertsons unlawfully dispensed opioid orders without adequately investigating and documenting the resolution of such red flags,” the Office of Washington State Attorney General Nick Brown stated ahead of the trial. “Albertsons also self-distributed opioids to its own pharmacy stores for a span of time and failed to report any of the more than the tens of thousands of suspicious orders from its own pharmacies to the DEA as required by law. Instead, Albertsons shipped them all.” 

During the investigation period Albertsons owned the state’s second-largest pharmacy chain. The company acquired Safeway in 2015, and owns a number of other grocery chains like the Washington-based Haggen stores. Between those brands the company currently owns about 200 pharmacies across Washington. For approximately five years Albertsons was also the distributor to its own pharmacy stores.

Similar to much of the other opioid litigation against major pharmacy chains, Washington alleged that Albertsons repeatedly pressured pharmacists to fill as many prescriptions as possible while ignoring “red flags,” required them to fill prescriptions from “pill mill” prescribers, prevented information from being exchanged between different store locations, and generally put profits over people. 

The lawsuit alleges that Albertsons violated not only Washington’s Consumer Protection Act, but state-level nuisance statutes. Washington defines a “public nuisance” as one that affects “the rights of the entire community or neighborhood,” and an “actionable nuisance” as including “whatever is injurious to health or indecent or offensive to the senses.”

In the tradition of opioid litigation nationally, the lawsuit features a number of tropes that come at the expense of chronic pain patients and anyone living outside.

In April, Albertsons announced a $774 million settlement that spanned multiple states including California, Colorado, Illinois and Oregon. 

“This settlement framework marks a significant step toward resolving opioid-related litigation, and Albertsons Cos. believes the settlement framework is in the best interest of all parties,” the company stated in April. “This settlement is not an admission of wrongdoing or liability.”

Washington, however, continued to pursue the litigation it had filed in 2022. The state has not yet announced the amount it’s seeking in damages. In addition to Albertsons, the lawsuit names Kroger, Rite-Aid and multiple subsidiaries owned by each. Kroger settled for $47.5 million in 2024. Rite-Aid declared bankruptcy in late 2025. To date, Washington’s opioid litigation payouts total approximately $1.3 billion.

In the tradition of opioid litigation nationally, the 2022 lawsuit features a number of opioid tropes that come at the expense of chronic pain patients and anyone living outside. It warns of babies being “born addicted,” and long-term use being associated with “significant mortality.” It describes “drug-seeking patients” who fake their symptoms. 

The “nuisance” conditions Albertsons has allegedly wrought include the various health care settings, abandoned homes and public spaces that “have attracted opioid drug dealers and people seeking illicit opioids.” Unlawful prescribing is further blamed for negatively impacting parks, libraries and other public spaces.

“The scope of human suffering and economic cost of opioids on Washington reverberates far beyond overdose mortality rate,” the lawsuit states. “The State spends significant additional public resources on medical services, law enforcement, corrections, workers’ compensation, diversion programs, prosecution, probation, treatment, and child welfare because of the impacts of opioids.” 

The state seems to be spending additional resources because of the impacts of the criminalization of opioids, not the opioids themselves. Its other complaints reflect distortions, exaggerations or the nation’s affordable housing crisis.

Image courtesy of Albertsons Companies

The post WA Begins Albertsons Opioid Trial, for Pharmacy’s Role in “Public Nuisance” appeared first on Filter.

“This research study is the first time the new medication MG001 is being tested in people,” states a National Institute on Drug Abuse summary. “MG001 is a formulation of mitragynine, a compound that comes from a plant called Mitragyna speciosa (sometimes known as kratom), which some people use on their own to help manage symptoms of opioid withdrawal. The purpose of this study is to understand how safe MG001 is, how well it is tolerated, and how the body processes it.”

Researchers from NIDA and the University of Florida developed a “purified formulation” of mitragynine, and anticipate enrolling about 32 volunteers. The study is part of the federal Helping to End Addiction Long-term® (HEAL) Initiative. In a June 1 announcement that the IND had taken effect, NIDA Director Nora Volkow described it as a “major step toward expanding treatment options for the millions of Americans struggling with opioid use disorder.”

Kratom has for years been informally used to manage symptoms of OUD. It’s also prompted various attempts to ban it. But more recently, bolstered by the Drug Enforcement Administration’s demonization of synthetic drugs in contrast to plant-based drugs, these attempts have honed in on 7-OH.

7-hydroxymitragynine, commonly known as 7-OH, is an active byproduct of mitragynine, and so small quantities of it are naturally present in all kratom products. But it’s also been synthetically concentrated to make more products that are much more potent than traditional kratom products, and these are what public officials are referring to when they talk about 7-OH.

The FDA’s decision appears to confirm a somewhat ambiguous statement of support from President Trump a few weeks earlier. 

In July 2025 the FDA recommended placing 7-OH under Schedule I of the Controlled Substances Act, and formally initiated the review process with the DEA. The agency explained that it was targeting 7-OH specifically, and “not focused on natural kratom leaf products.”

Since then, amid an explosion of interest from media and law enforcement, 7-OH has become the subject of multiple public health alerts including misleading claims about overdose deaths. Media began using the moniker “gas station drugs” to refer to 7-OH and other unregulated synthetic opioids and cannabinoids. Legislators proposed bills to ban all kratom products, or ban all 7-OH products, or regulate kratom while banning 7-OH, and so on. Some of these bills have advanced in the same states at the same time. Kratom products by definition include all 7-OH products, but technically 7-OH is also present in all kratom products, prompting a lot of discussions about thresholds—similar to how hemp-derived CBD products have to contain less than 0.3 percent THC, otherwise they’re legally considered marijuana.

But 10 months later, the DEA has not moved to schedule 7-OH. Meanwhile it seems increasingly likely that the administration plans to eventually approve kratom as a treatment for OUD, which would make it ineligible for Schedule I and thus complicate any attempt to place 7-OH under Schedule I (not that the DEA would be unwilling to proceed with that kind of thing). The FDA clearing NIDA to begin human trials for its mitragynine product appears to confirm a somewhat ambiguous statement of support from President Donald Trump a few weeks earlier. 

“We’re looking very seriously at natural 7-OH and getting that approved—natural 7-OH,” Trump said at an Oval Office event in May. “And we’ll take a look at that very strongly, I think [Centers for Medicare & Medicaid Services Administrator Mehmet] Oz and everybody were looking to see if we can do something there. A lot of people are asking for it.”

The phrase “natural 7-OH” has done nothing to clear up confusion about synthetic 7-OH versus plant-based kratom, but Trump probably meant the latter.

Image (cropped) via Wikimedia Commons/Creative Commons 4.0

The post FDA Greenlights First Human Trial of Kratom to Treat Opioid Use Disorder appeared first on Filter.

Orphines are a class of synthetic opioid, like fentanyls or nitazenes. (They are separate from morphine, which is a plant-based substance derived from opium poppy, as well as from buprenorphine, which is semi-synthetic.) The first orphine identified in the United States drug supply was brorphine in 2020. But cychlorphine was the first to really attract media attention, after it began showing up in overdose toxicology around mid-2025. The Center for Forensic Science Research & Education (CFSRE) attributes this directly to China’s July 2025 crackdown on nitazenes.

Like with fentanyl analogs, nitazenes and whatever novel synthetic opioid will be discovered in the drug supply next, media has claimed that orphines are many times more potent than fentanyl even though their potency is largely unknown, and can also be less than that of fentanyl. For example, CFSRE characterizes 5,6-Dichloro Desmethylchlorphine as much less potent than fentanyl—about on par with morphine, and associated with “less respiratory depression compared to other opioid agonists.”

The commonly cited claim that cychlorphine is 10 times more potent comes from petri-dish data, not real-world overdose data involving humans, though of course that doesn’t mean it’s wrong. It’s reasonable to assume that cychlorphine is more potent than fentanyl. But it’s not driving or escalating the overdose crisis so much as it’s just the latest manifestation of an increasingly harsh drug war, one that continues to move the unregulated supply beyond just fentanyl.

ONDCP DRUG THREAT NOTICE: Cychlorphine, a synthetic opioid involved in at least 55 deaths, has potential to spread across Nation. Read more pic.twitter.com/1fVxMLppYP

— ONDCP (@ONDCP) April 30, 2026

None of the headlines and law enforcement bulletins urging the public to watch out for cychlorphine actually give people any information they can use. The ones that say cychlorphine does respond to Narcan are a little better than the ones that say its high potency makes it “Narcan-resistant,” but it’s not like anyone responding to an overdose in real life knows whether cychlorphine is involved—or needs to, in that moment. The fixation with cychlorphine and with novel synthetic opioids in general has nothing to do with public health. It exists entirely because anything that can be described as “more dangerous than fentanyl” is a huge asset in headlines and reelection campaigns.

“I think my biggest concern with this is we might be seeing the early stages of what might become the next opioid epidemic,” Dr. Timlin Glaser with Arkansas Poison Center told KATV, speculating that cychlorphine may replace fentanyl the way fentanyl has replaced heroin. There is no particular reason to be concerned with this.

In April, South Carolina Attorney General Alan Wilson wrote to the Food and Drug Administration urging the agency to review cychlorphine for placement under Schedule I in order to stave off “another wave of avoidable loss.” Brorphine, which was temporarily scheduled in the Controlled Substances Act in 2021 and permanently scheduled in 2023, is so far the only orphine in the CSA. But it probably won’t be for long.

The Oklahoma Bureau of Narcotics is pushing for a state-level ban, claiming that cychlorphine is often pressed into counterfeit MDMA pills, in addition to pharmaceuticals. Cychlorphine has been suggested for expedited scheduling in Virginia. In March, Kentucky introduced legislation that would not only ban cychlorphine and establish first-degree manslaughter charges for distribution cases linked to overdose deaths, but disqualify defendants from pretrial diversion and make them ineligible for parole or other forms of early release until they’d served 85 percent of their sentence. Currently these terms only apply to fentanyl-related cases.

The Kentucky Department of Corrections projected that bill would result in county jails filling up with more overflow from the prison population, because longer sentences “ultimately decrease prison bed space.”

#AnalysisAlert: New orphine detected! DEA found 5-chloro desmethyl chlorphine in a Knoxville, TN seizure—never before seen in NFLIS. Sample was 34% pure. Watch for this emerging synthetic opioid in the illicit supply. @TheJusticeDept #DEAForensicshttps://t.co/Jq4YxdRxmo pic.twitter.com/f7J0DRjhGv

— DEA HQ (@DEAHQ) May 27, 2026

Recently the Knoxville Police Department seized a sample of white powder that the DEA has identified as an even newer orphine, 5-chloro desmethyl chlorphine (not to be confused with 5,6-Dichloro Desmethylchlorphine).

“An unknown material was submitted to the DEA Special Testing and Research Laboratory through the DEA Overdose Surveillance Exchange (DOSE) program,” the agency stated in a public alert. “It was found to contain 5-chloro desmethyl chlorphine with an estimated 34% purity. This is the first time 5-chloro desmethyl chlorphine has been identified by DEA and it has not been previously reported in the National Forensic Laboratory Information System (NFLIS).”

At publication time NFLIS hadn’t been updated since April, so 5-chloro desmethyl chlorphine has not yet been added to the reference library. Nothing is yet known about its potency, but it’ll inevitably be used in service of the same larger narrative around orphines.

The more panic there is around cychlorphine, the more medical examiners and county coroners will pursue lab testing to identify it, and the more jurisdictions will report a rising number of cychlorphine-involved deaths. The DEA and local law enforcement will comb through the cell phones of the people who died, and throw a huge amount of money into surveillance and undercover operations so that street-level sellers who don’t know any more about cychlorphine than the people they sold it to can be prosecuted for manslaughter. Legislators will introduce proposals for mandatory life sentences—maybe the death penalty—Congress will propose federal scheduling, a dozen states will place cychlorphine under Schedule I of their own CSA and the DEA will at some point issue a temporary scheduling order while the White House vows to eradicate cychlorphine-associated supply chains. After a few more international crackdowns on a few more precursor chemicals, while harm reduction groups adjust their overdose response to whatever new large animal sedative has replaced medetomidine by then, some even newer kind of synthetic opioid will show up. Definitely way more potent and scary than fentanyl.

Image (cropped) via Drug Enforcement Administration/Twitter

The post Cychlorphine Is Not the Problem appeared first on Filter.

The lawsuit was brought by a coalition of hospitals serving 15 Florida counties, alleging that between 2006 and 2018 the residents of those counties had been dispensed over 2.1 billion prescription opioid pills by CVS, Walgreens and Walmart. They argued that the pharmacy chains had violated not only the federal Controlled Substances Act, but Florida’s Racketeer Influenced and Corrupt Organization (RICO) Act by conspiring to drive up prescription opioid use—which, they claimed, drove up costs for hospitals. The lawsuit claimed the hospitals had incurred more than $500 million in unpaid bills from treating injuries related to opioid use specifically, and $1.5 billion in damages from providing other care to patients who used opioids.

“We are very disappointed with the judge’s ruling,” plaintiffs’ attorney Warren Burns told Filter. “The court previously took the exact opposite view at least three times.”

The case began in September 2025 and went to trial later that year. But in December, after two weeks of deliberations during which one of the jurors was dismissed, the jury was still unable to reach a verdict. Broward County Chief Judge Carol-Lisa Phillips ultimately declared a mistrial.

Now, rather than the case moving forward to a new trial with a new jury, Phillips has ended it with a directed verdict. This refers to when judges issue the ruling themselves, on the grounds that the case is legally unambiguous and therefore “no reasonable jury” would come to a different conclusion.

“We’re pleased to prevail in this case,” a CVS representative stated to Filter. “[T]he Court rejected this meritless claim and granted our motion for a directed verdict.”

The plaintiffs had argued that OUD patients require “very complicated” care.

This isn’t the first time RICO violations have come up during opioid litigation, but racketeering is a very difficult allegation to prove in this context. All RICO law including Florida’s has a “proximate cause” requirement, which in this case means the evidence would have to show the hospitals were injured by the pharmacy chains directly.

“[A]bsent harm to patients with opioid use disorder, Plaintiffs would have suffered no injury,” Phillips wrote in her May 26 verdict. “Plaintiffs cannot suffer harm from Defendants’ alleged predicate acts unless OUD patients are first injured—the harm to OUD patients is a necessary prerequisite to any injury suffered by Plaintiffs.”

The plaintiffs had claimed that OUD patients require “very complicated” care, which compared to other patients involves longer stays, more resources, more staff, more social workers and more medication. Their argument, as summarized by Phillips, was that “the additional resources and length of stay for these patients translated into increased costs—harms that only hospitals suffer.”

A Walmart representative stated to Filter that the verdict “confirms what we have said from the beginning; we aren’t responsible for causing any injuries to Florida hospitals.” Walgreens did not respond to Filter‘s request for comment.

Meanwhile, chronic pain patients have become increasingly disenfranchised from health care.

The lawsuit had also alleged that the pharmacy chains’ internal policies, which pushed pharmacists to fill prescriptions quickly, resulted in ignoring so-called red flags that the DEA uses to investigate potentially unlawful prescriptions.

“If it stands, this ruling will give the chain pharmacies a get out of jail free card, notwithstanding their role in creating a drug epidemic that shattered lives and robbed the hospitals of hundreds of millions of dollars,” Burns said. “That’s not justice.”

Amid the ongoing, disproportionate preoccupation with the role prescription opioids have played in the overdose crisis, major litigation has looked beyond just manufacturers like Purdue Pharma (which dissolved earlier in May when its long-awaited bankruptcy finally went into effect; it’s now a nonprofit-run public benefit corporation called Knoa Pharma). In December 2024 and January 2025 the Department of Justice sued CVS and Walgreens, respectively, for unlawful prescribing as well as fraud. Other litigation has targeted pharmacy benefit managers, including CVS Caremark.

Meanwhile, chronic pain patients have become increasingly surveilled, stigmatized and disenfranchised from health care, while opioid settlement payouts keep somehow missing syringe service programs and finding their way to law enforcement.

Image via Congresswoman Ashley Hinson

The post CVS, Walgreens and Walmart Beat Rx Opioid Racketeering Lawsuit appeared first on Filter.

That new law requires kratom products to be kept behind sales counters and not sold to anyone under 21. It does not allow for the sale of 7-hydroxymitragynine (7-OH) products, which are more potent because they contain a synthetically concentrated form of the main psychoactive compound in kratom. Both kratom and 7-OH have been the subject of increasing attention from media and lawmakers ever since 7-OH was recommended for federal Schedule I by the Food and Drug Administration in July 2025, shortly after Rhode Island passed its reform.

“Rhode Island is facing a deadly opioid crisis, and we must embrace every tool available to reduce harm and to save lives,” Senate President Pro Tempore Hanna M. Gallo (D) stated in July 2025. “Kratom is used by many to manage pain and to ease opioid withdrawal symptoms. Rhode Island remains the only New England state where this substance is prohibited. This legislation replaces prohibition with sensible regulations.”

Seven states and the District of Columbia currently have full kratom bans like the one Rhode Island overturned. (Louisiana, which enacted its full kratom ban in August 2025, is currently considering a bill that would revise that ban so it only applied to 7-OH products.) In Connecticut, where the most recent of these bans went into effect March 25, reports are already emerging that many consumers, some of whom are struggling to find withdrawal support, are driving across state lines to buy it from Massachusetts or New York.

“Some sellers lost a lot of money—threw it away or sold it at a discount,” smoke shop owner Omar Nasser told the Lakeville Journal. “It would be no surprise if others are taking it over the border into New York to sell it or are selling it under the table.”

A growing number of states have introduced consumer protection bills that would regulate kratom alongside other legislation that would ban it.

With the decision to ban 7-OH at the federal level still pending, many states moved to schedule it under their own versions of the Controlled Substance Act, which has been complicated by the fact that many of them are trying to regulate kratom at the same time—kratom naturally contains small amounts of 7-OH. While the proposed bans have tended to focus on 7-OH products rather than on the broader category of kratom products, a growing number of states have introduced consumer protection bills that would regulate kratom alongside other legislation that would ban it. 

South Carolina already enacted a consumer protection act regulating kratom in 2025, and is now considering legislation to reverse course and ban it instead. A Michigan bill to regulate kratom stalled in November 2025, while in late March a bill that would ban kratom crossed over from the House to the Senate. Iowa also recently advanced a House bill that would ban kratom under Schedule I, after narrowly rejecting an amendment proposed by  Rep. Ray Sorenson (R) that would have regulated the plant instead.

“I believe the government has a role in protecting public safety, especially when it comes to minors, but when it comes to adults making decisions about legal products, we should be cautious about expanding criminal prohibitions,” Sorenson said according to Iowa Public Radio. “We need to target the real problem: unsafe products.”

At this point in the legislative session many of the regulation bills and prohibition bills alike have already died in committee or been postponed. But multiple states, including Delaware, Idaho, Illinois, Ohio and Tennessee, are still considering both.

Image (cropped) via Tennessee Department of Health

The post State Bills to Regulate Kratom Advance, Alongside Ones to Ban It appeared first on Filter.

The score, which uses a machine learning approach called cognitive computing, is one of many innovative artificial intelligence tools that strive to reduce drug-related risks. But the first external evaluation of the model, recently published in the Journal of General Internal Medicine, found discouraging—if not dangerous—results.

Comparing Epic’s risk score to reality for over 700,000 patients, the evaluation reports that the model did accurately rule out low-risk patients. But it only caught around 8 percent of the patients who did go on to experience an overdose or receive an OUD diagnosis.

The Opioid Risk Score aims to facilitate overdose prevention and enhance primary care physicians’ efforts to detect and treat OUD as early as possible. Since it uses information already available in a patient’s electronic health record (EHR), the Opioid Risk Score could be a lightweight yet powerful addition to physicians’ toolkits.

“Basically, they’re trying to predict if a patient comes into a primary care appointment, what level of risk they are for developing opioid use disorder or having an overdose in the next year,” study co-author Dr. Stephanie Hooker, of HealthPartners Institute, told Filter. “If you know who might be at higher risk, you can appropriately direct the resources to try to prevent overdoses or to treat people who have opioid use disorder.”

Over 2,000 patients experienced an overdose or OUD diagnosis, but Epic’s system only flagged 185 of them as high-risk.

To test the model’s accuracy, the researchers pulled patient data from three health care systems—two rural sites in Pennsylvania and along the Minnesota-North Dakota border, plus an urban hospital system in Minneapolis. They compared Epic’s prediction to the actual outcome for 704,764 patients across 92 primary care clinics.

The model struggled to correctly identify high-risk patients, producing a concerning amount of false positives and false negatives.

“Most of those people [flagged as high-risk] didn’t go on to have an ‘event’—a diagnosis of opioid use disorder or overdose. That’s the false positive rate,” Hooker explained. “The false negative rate is that most of the people who do go on to have an event are classified as not being at risk.”

Hooker believes the false negative rate is particularly concerning. Over 2,000 patients experienced an overdose or OUD diagnosis, but Epic’s system only flagged 185 of them as high-risk.

The Achilles heel of Epic’s model may be its reliance on EHR data. Integrating with a patient’s medical records is a seamless design, but health data give only a partial perspective on a person’s life circumstances.

“EHR data is somewhat limited … Sometimes the things that we have easily available may not be the most salient predictors.”

Filter reached out to Epic, but representatives were not able to provide comment by publication time.

“EHR data is somewhat limited in terms of the things that we collect regularly on people. Sometimes the things that we have easily available may not be the most salient predictors,” Hooker said. “We don’t have a lot of data on social situations or other risk factors that might be more related to actually developing a substance use disorder or having an overdose.”

Design choices made by engineers removed from health care settings may also impair the model. For example, the risk score was designed with an intentionally high tolerance for false positives. Physicians should expect only one out of every 10 people flagged as high-risk to experience an adverse outcome.

“I think in clinical practice, that’s too high,” Hooker said. “A clinician wants to know, ‘If I’m going to use this tool, is it actually going to improve my decision-making to an extent that I’m not wasting my time?’”

Another salient issue is that the risk score treats overdose and OUD diagnosis as a combined outcome.

“What that does is kick everybody with existing opioid use disorder out of the model—you can’t predict overdoses in people who have OUD, because [OUD itself is] an outcome,” Hooker said. “So that’s the main issue, I think—that those people are not included in this risk model.”

To improve future performance, Epic could consider developing separate models for OUD and overdose, or reducing the system’s tolerance for false positives. But on a more fundamental level, Hooker believes that health care companies need to think critically about developing AI tools, and test them thoroughly.

”What are the reasons we would actually want to implement something like this, before we do it? And is it going to improve patient care?” she asked. “In this case, I think that the model was just put out there.”

“Any tool that could affect a patient’s treatment should face a lot more scrutiny. The bar needs to be raised.”

Dr. Nicole Fitzgerald, a postdoctoral research fellow at Columbia University’s Mailman School of Public Health who specializes in the early detection of emerging drug trends and risks, was also alarmed that Hooker’s study was the first real test of Epic’s model.

“Any tool that could affect a patient’s treatment should face a lot more scrutiny,” she told Filter.  “The bar needs to be raised in terms of the requirements for external validation before widespread deployment of these models in commercial health systems.”

Fitzgerald also pointed out weaknesses with the data and math that underlie the Opioid Risk Score. The “training data” used to calibrate the model are from 2015 to 2018—a period largely out of sync with the contemporary drug landscape. Additionally, the mathematical formula that turns these data into a score is relatively rudimentary.

“Other machine learning approaches are more adaptive, multisource and real-time,” she explained. “The way that people are using opioids—and the opioids themselves—have changed dramatically over the last couple years, and the opioid overdose crisis has evolved. That’s not captured here.”

Despite the shortcomings of individualized risk predictions, data-driven approaches to harm reduction—including, but not limited to, machine learning and artificial intelligence—still hold promise.

“Right now, the applications showing the most promise are operating at the population and drug supply level—not necessarily at the level of an individual clinical prediction,” Fitzgerald said. 

Wastewater testing is one such intervention. It provides a passive, anonymous indicator of local drug consumption that can inform where and how community organizations provide safer use supplies. Machine learning may also supercharge drug checking by speeding up mass spectrometry.

“There is value in this technology, so I’m hoping we can deploy these tools where they’re most valuable and least harmful.”

Most importantly, these population-level innovations capitalize on the enormous predictive power of machine learning without introducing as many risks to the individuals and communities who use them.

“When a wastewater alert algorithm produces a false positive, a public health team might just end up deploying some resources slightly earlier than necessary, or distributing naloxone when they might not have needed to, but that’s a net benefit to the community,” Fitzgerald explained. “But when an EHR-embedded risk score produces a false positive, a patient’s clinical care may be impacted. They could be stigmatized … or denied pain treatment. Those are real clinical harms.”

Ultimately, effective implementation of AI boils down to the same principles that already guide harm reduction efforts: weighing the potential benefits and harms, making decisions in consultation with the community, and designing solutions based on evidence rather than stigma.

“There is value in this technology, so I’m hoping we can deploy these tools where they’re most valuable and least harmful,” Fitzgerald concluded.

Photograph (cropped) by Elen Sher on Unsplash

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N-Propionitrile chlorphine, often referred to as cychlorphine, was first detected in the United States drug supply in 2024 by the Center for Forensic Science Research & Education (CFSRE).

Orphines are their own subclass of synthetic opioid, like fentanyls and nitazenes. Most coverage of cychlorphine includes the claim that it’s 10 times more potent than fentanyl. This is not wrong, but it should be noted that the estimate comes from lab studies of petri dishes, not humans.

CFSRE has described the emergence of orphines as the result of China scheduling nitazenes in mid-2025. As fentanyl crackdowns opened the door for nitazenes, the inevitable nitazene crackdowns opened the door for orphines. However, CFSRE has so far identified cychlorphine in at least 25 overdose deaths—21 in the United States and four in Canada—and in 11 of those cases cychlorphine was the only opioid detected. This is a departure from how nitazenes and other novel synthetic opioids have entered the supply.

“I do think that’s a little unusual for compounds we call opiates to be on their own,” Erin Tracy, lead chemist at the UNC Street Drug Analysis Lab, told Filter. “But other [new psychoactive substances] and other drug classes are often found on their own, like benzos or bath salts.” 

The lab is a public drug-checking service at the University of North Carolina at Chapel Hill, where harm reduction organizations around the country send residue samples by mail. Though five of the samples Tracy has identified as cychlorphine appeared on their own, the lab has only seen 11 such samples in total.

To date, there is no publicly available evidence to suggest that naloxone would be any less effective for reversing an overdose of cychlorphine than of any other opioid.

In late January, CFSRE put out a public alert describing the increase in cychlorphine-involved fatalities. In February, CFSRE added cychlorphine to its Forensically Relevant Drug Database and published a health alert, since which time the subject has been gaining more media attention.

Of the 21 US overdose cases, seven were in Tennessee. This doesn’t mean that cychlorphine is concentrated in Tennessee; what often look like “hot spots” on a map don’t necessarily reflect the regions where a new substance is most prominent, but the regions where forensics laboratories are testing for it.

“We do know it’s more powerful than fentanyl and that naloxone, or Narcan, does not completely block the effects of the drug,” Dr. Darinka Mileusnic-Polchan, chief medical officer at the Knox County Regional Forensic Center, stated in a February press release. “[M]ultiple doses may be needed to prevent an overdose.”

To date, there is no publicly available evidence to suggest that naloxone would be any less effective for reversing an overdose of cychlorphine than of any other opioid. In response to Filter’s inquiry, the Knox County Regional Forensic Center said the information had been shared internally by the Drug Enforcement Administration.

“In our discussions with toxicologists from the DEA we were informed that due to the potency of this particular drug that there is a possibility that multiple doses of Narcan would most likely be needed or possibly ineffective,” said Chris Thomas, the Center’s director and chief administrative officer.

On March 2 the Jackson Times Voice used similar language, reporting that the Kentucky Office of Homeland Security had “warned the public and officials that ‘Naloxone was not able to block the antinociceptive effects of Cychlorphine completely’ and that traditional use of the life-saving drug has proven ineffective.”

Naloxone does not work by “blocking” an opioid’s effects, because it’s administered after the effects have already taken hold. In order to block them, it would have to be administered as a pre-treatment. Which it was, in the original study supporting an October 2025 claim in Clinical Toxicology that “Naloxone was not able to completely block the antinociceptive effects of chlorphine.”

N-Propionitrile chlorphine and cychlorphine are the same thing. Chlorphine is actually a different substance. 

A pervasive misconception about naloxone is that it affects the opioid molecules themselves. It doesn’t.

The Kentucky Office of Homeland Security and the DEA did not respond to Filter’s requests for comment, but it seems reasonably likely that the DEA has been feeding that claim to KOHS and the regional forensic centers and health departments. “Chlorphine” could have become “cychlorphine” intentionally or without any of the government agencies responsible ever noticing, and neither would be surprising.

A pervasive misconception about naloxone is that it affects the opioid molecules themselves. It doesn’t. It affects the receptors they bind to in the human brain and body, which are the same receptors regardless of the opioid’s potency. It is unequivocally false to say that naloxone doesn’t work well on higher-potency opioids. Using too much can in some cases be as dangerous as not using enough.

“Treatment should be supportive,” CFSRE stated in its February cychlorphine alert. “Treat the airway and breathing first, followed by reversal with cautious administration of an opioid antagonist (e.g. naloxone), being careful not to precipitate acute withdrawal.”

Though chlorphine is not the substance being increasingly detected in overdose deaths, it’s still an opioid, so it would be concerning if naloxone really had proven ineffective, or less effective. Fortunately, the original study showing that naloxone “was not able to completely block the antinociceptive effects of chlorphine” had nothing to do with overdose, and was instead referring to naloxone as a pretreatment for chlorphine-dosed mice, to see if they were still sensitive to pain when their tails were pinched. It actually goes on to say that naloxone pretreatment “fully” blocked the decrease in respiratory rate brought on by chlorphine. But again, we’re talking about the wrong drug, responding naloxone being dosed prophylactically, in mice.

Image via Kentucky Office of Homeland Security/Facebook

The post No, Synthetic Opioid Cychlorphine Has Not Proved Narcan “Ineffective” appeared first on Filter.

The large majority of people who are prescribed opioids don’t develop opioid use disorder (OUD)—an important reality, amid an ongoing crackdown on pain patients. But her son did. For seven years, he successfully hid it, finding good work and showing no signs of trouble. Until one day, he was caught burglarizing houses.

“I was blown away. It made no sense, I couldn’t believe it. And that’s how I found out,” Pleus told Filter. He’d land in jail twice. He managed to stay in recovery for 20 months. “And then I lost him.” Jeff was 28.

Her middle son also struggled with opioid use. And she hates the advice she was given in standard recovery programs: to administer “tough love,” or to wait for her son to “hit rock bottom.”

“How do you wait for a child to hit rock bottom?” Pleus asked. With the help of Suboxone, and support not predicated on “tough love,” her other son is now thriving.

Much of the money, she said, is going to entities including large hospitals. “That one really gets my ass!”

Like many parents who have lost children to overdose, Pleus became active in harm reduction advocacy, founding Truth Pharm in 2015. The group does community outreach, and gives presentations in schools, to medical professionals and local business leaders. They aim to lift stigma and promote harm reduction interventions like naloxone, syringe access and medications for OUD. They also run a syringe service program and see up to 60 people a day in their offices, providing them with personal care items “to survive,” and links to medical services.

But like so many grassroots groups, their work is hampered by a lack of funding. That’s where money from New York State’s Opioid Settlement Fund (OSF) could come in. After lawsuits targeting pharmaceutical companies, the fund reached $3 billion. That money has been administered over the course of three years. It’s meant to go to programs that help reduce overdose deaths. But Pleus said small organizations like hers, despite being deeply rooted in their communities, are being sidelined. 

Much of the money, she said, is going to entities including large hospitals. “That one really gets my ass! Hospital CEO salaries are more than what they get [from OSF funding], and they don’t do anything about treating addiction.”

A new report by the Drug Policy Alliance audited the first three years of New York’s OSF spending. It found that in Financial Year 23-24, more than 80 percent went to large organizations that pursue statewide initiatives and/or are affiliated with major institutions. Only 19 percent has gone to small local groups, which most often serve a single community with a budget below $5 million.

“It is critical that opioid settlement funds are protected from filling budget gaps … and used effectively as supplemental resources to address the overdose crisis.”

Though overdose deaths are decreasing overall, vulnerable populations remain at great risk: Between 2019 and 2023 Black and Native New Yorkers had the highest rates of overdose fatalities, with deaths increasing substantially, even as they remained stable for other demographics.

As the Trump administration plans to slash Medicaid and other programs—and favors old-fashioned, ineffective models of treatment—funding for small harm reduction community groups is dire.

“In the face of these challenges, it is critical that opioid settlement funds are protected from filling budget gaps created by federal funding cuts and used effectively as supplemental resources to address the overdose crisis,” the report states.

Testimonies from people with experience of OUD included in the report back Pleus’s claim that many larger organizations, including hospitals receiving OSF funding, are failing people.

“I was failed by two different treatment centers and the state system before I got sober,” one person wrote. “And in 2018, I overdosed … I was actually declared legally dead. I was completely alone during my overdose. The nurses and doctors in the hospital were … shaking their heads full of disgust and pity. The only person who talked to me that night was a police officer who wanted to know where the drugs came from.”

“There are so many mom-and-pop organizations that have popped up. We’re doing the work to fill those gaps that left our kids behind.”

“Patients with substance use disorders at [public hospital] do not have equal access to treatment compared to other health conditions and are being discriminated against … “ wrote another person with lived experience. “It is unreasonable to expect the poorest and most vulnerable patients within our health system to overcome the unnecessary barriers being placed before them … We are appalled that despite so much public health expertise governing our system … we continue to face such tremendous neglect and disregard for the wellbeing of people.”

Small local groups, often started by bereaved parents, can help mitigate these failings with personalized, nonjudgmental assistance—if they have the resources.

“There are so many mom-and-pop organizations that have popped up, after a parent loses their child,” Pleus said. “We’re doing the work to fill those gaps that left our kids behind. That’s not what the big systems are doing.”

A representative from the New York State Office of Addiction Services and Supports (OASAS), which administers the funds, even toured their location and said he was very impressed, according to Pleus. 

But then, she said, the agency stopped taking her phone calls. “We haven’t gotten a dollar.”

Image via the Drug Policy Alliance report “New York’s Opioid Settlement Funds: Lessons Learned and Recommendations After the First 3 Years.” It shows the distribution of awards reported by OASAS in FY23-24, in terms of organizations defined as small-scale and large-scale.

The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance. Filter‘s Editorial Independence Policy applies.

The post Grassroots Harm Reduction Sidelined in NY Opioid Fund Spending appeared first on Filter.

The crackdown was largely implemented in the southern provinces of Helmand and Kandahar. Local authorities enforced the ban, and major suppliers and larger farms were able to offset lost income by drawing down opium stocks they’d built up during boom times in the previous five years.

Did the poppy ban in Afghanistan succeed? Not really. Afghan farmers crossed the border into Pakistan and planted poppy in the remote province of Baluchistan. Pakistan is now the “world’s new capital of opium production.”

“Necessity has driven cultivation shifts to less conspicuous areas.”

“The Taliban’s opium ban was initially lauded as successful but as critics anticipated, without addressing issues of rural and land poverty, and unemployment, the ban was unlikely to hold,” Julia Buxton, professor of justice at Liverpool John Moores University, told Filter. “Necessity has driven cultivation shifts to less conspicuous areas from the south to the northeast of Afghanistan and displacement into Pakistan.”

It’s called the “balloon effect.” Push down production of a profitable commodity in one area and it pops up in another.

Satellite imagery shows an exponential growth of large poppy farms in Balochistan, a large but thinly populated province in Pakistan that borders Afghanistan. Poppy farmers there have benefited from its isolation from the center of government and its mountainous terrain. Balochistan is bringing a bumper crop to the illicit market with “unrestrained cultivation that has not ever been seen in Afghanistan, even in its peak years of opium production,” David Mansfield, an expert on the opium trade, told the Telegraph.

Proponents of poppy prohibition have been proven wrong once again.

Powerful structural and economic factors ensure that opium production in the region isn’t going to end. Poppy is more lucrative than any other crop. It’s suited to growing in dry conditions and opium paste can easily be stored. Thousands of workers are employed all along the chain of production, from planting to harvesting to transporting the raw opium to market.

“The Taliban is under intense domestic pressure to lift the ban. Powerful classes in Afghanistan maintain lucrative interests in opium farming.”

Though Afghanistan has ceded its position of top opium producer to Pakistan for now, this might only be temporary.

“The Taliban is under intense domestic pressure to lift the ban,” Buxton said. “Following Iran’s expulsion of 600,000 Afghan migrants in July, and in a situation of severe hardship, powerful, wealthy landed classes in Afghanistan maintain lucrative interests in opium farming.”

In the contradictory and dangerous world of drug prohibition, it’s good news that farmers  continue to grow massive amounts of poppy that is then turned into heroin to be sold in Asia and Europe. The continuation of this trade makes it less likely that more-potent synthetic opioids will displace heroin, as happened in North America.

There, the arrival of fentanyl, in particular, and its consumption by many people who initially didn’t know what they were being sold, was a major factor in an unprecedented overdose crisis that has tragically claimed hundreds of thousands of lives.

There are solutions to help both farmers who are dependent on growing poppies for a living and people dependent on opioids, and they involve ending—or failing that, at least loosening—prohibition. 

The Afghan government should build a domestic industry that produces opioid medications like morphine and employ farmers to grow poppies legally. That’s what India, Turkey and Australia have been doing for decades. Heroin has a public health role too: Heroin-assisted treatment (HAT) is at least partially available in countries like the United Kingdom and Switzerland, and is proven to be effective. HAT needs to be available worldwide.

Such interventions are life-sustaining. They can help to alleviate endemic poverty in Afghanistan and keep people who use opioids alive. Playing drug-war whack-a-mole does neither.   

Photograph by Karl Egger via Pixabay

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