Health Wanted: The New Opioid Crisis

The Episode

Walking into a gas station in the past handful of years, you might have noticed a new product on the shelves: pills, powders, gummies, or energy shots containing “pure kratom alkaloids.” But what is kratom? And what is the new substance (7-hydroxymitragynine) that the FDA is concerned about?

In this episode of Health Wanted, host Laurel Bristow dives into the rise of 7-OH, the substance being dubbed the “next opioid crisis,” including:

• The history of kratom’s use and the controversy surrounding it
• A scientific breakdown of kratom’s composition
• How kratom has morphed into the more potent substance 7-OH, and why that substance is impacting our ability to understand potential risks.

Then, she is joined by guest Oliver Grundmann, PhD, to explore whether these products are a harm-reduction tool or a danger to public health. 

Listen to the episode now

The Listener Questions

What’s the latest news on COVID vaccines?

The Food and Drug Administration (FDA) severely restricted the groups vaccines are approved for, and Pfizer lost its approval for the pediatric vaccine for those under 5 years old. Currently:

• Novavax is approved for people aged 12 to 64 with an eligible, underlying health condition and anyone over 65.
• Pfizer is available for people aged 5 to 64 with an eligible health condition and everyone over 65.
• Moderna is available to people 6 months to 64 years with an eligible health condition and anyone over 65.

The updated shots are not yet available, but the Advisory Committee on Immunization Practices is set to meet September 18 to 19 to make those recommendations. It is possible that their recommendations for who should get vaccinated could be even more narrow than the FDA’s approval.

In theory, anyone under 65 could get the vaccine “in consultation with a provider,” but there are questions about if insurance will cover it. This includes people who want to get their infant vaccinated before their first exposure to the virus. And if insurance doesn’t end up covering it, it could be $150-$200 per shot.

If you were thinking about trying to get one of last year’s formulations before the new recommendations come out…good luck.

Walgreens and CVS currently have a patchwork of availability for COVID shots depending on what state you’re in. Some are requiring a prescription, and some are not even offering shots at all right now. There is currently no exception for people who live with someone who is medically fragile, and it will be up to health care systems to offer shots to their staff.

If you’re wondering if pregnancy is an eligible condition, so is everyone else. Originally in the letter that FDA officials wrote in May outlining their plan for COVID vaccine approvals, they listed pregnancy. Then, RFK Jr. said, “No COVID vaccines for pregnant people,” and then maybe briefly the CDC quietly said, “Yes COVID vaccines for pregnant people.” But as of right now the CDC has no specific guidance for the pregnant. 

Is there any truth to the claim that Tylenol causes autism? 

Over the years there has been some research showing a positive association between taking acetaminophen in pregnancy and increased risk of developmental disorders like ADHD and ASD. 

But a lot of those studies have some pretty big confounders like being retrospective and relying on people to recall if and how much acetaminophen they took, or not controlling for genetic conditions that could cause someone to reach for a bottle of Tylenol. 

In 2024, there was a huge study that was published from Sweden that enrolled pregnant people at the start of their pregnancy and then asked about acetaminophen use at every visit, so people didn’t have to try to recall how much they used after the fact. They sampled nearly 2.5 million children born between 1995 and 2019, and when they looked at siblings whose mom used Tylenol in one pregnancy but not another, they found no association between Tylenol use and ASD or ADHD.

Acetaminophen is one of the few options that pregnant people have when it comes to pain relief or fever reduction. We know that high fevers in pregnancy have a huge risk of complications for the baby, so it’s way better to treat what we know is a risk, rather than avoid acetaminophen based on really weak evidence.

Do folate deficiencies cause autism? 

We know that folate is an important part of fetal development. It’s why we enrich our foods with folic acid, a synthetic form of folate, to reduce the risk of neural tube defects in babies, and it works incredibly well. But there are other forms of folate available, like methylfolate and folinic acid, which the body processes differently.

What the upcoming report linking folate deficiencies to autism is alleged to be talking about is not a folate deficiency in the sense that someone isn’t getting enough folate in their diet. It’s the idea that some people develop autoantibodies to the folate receptors that help carry folate across the blood-brain barrier, and that causes a deficiency of folate in the cerebral spinal fluid, which (theoretically) causes symptoms of autism spectrum disorders (ASD).

Research has shown that a subset of people with ASD have high levels of these antibodies, but those studies are very small. Many also found that parents or neurotypical siblings also have these antibodies, just at slightly lower rates, so it’s not a conclusive theory about a cause of ASD. Some very limited research also shows that supplementing those people's diets with leucovorin, which is a prescription version of folinic acid, reverses or eases those symptoms.

The report is likely not talking about folate deficiency as a cause of ASD as much as it’s talking about folinic acid supplementation as a “cure.” 

So, it’s not based on anything, but the evidence is limited. We don’t really know how prevalent these autoantibodies are in the population, so even if it does work it won’t help everyone with ASD. And a lot of neurotypical people also have autoantibodies, so there’s likely something else going on. We would need a lot more research to learn the proper dosage and timing and learn who might benefit most.
 

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
• Watching on WABE's YouTube channel