What happens when a drug people can buy in everyday stores behaves like an opioid—yet regulators still treat it as a “gray zone”?

In The Lancet Pulse episode, host Matthew Gilbert and co-host Niall Boyce are joined by Dr. Liza Hutchison, Assistant Professor of Family Medicine at the University of Michigan, an addiction medicine physician overseeing services at a federally qualified health center in Washtenaw County, Michigan, and supervising a statewide telehealth on-demand buprenorphine service. Dr. Hutchison explains how natural leaf kratom contains multiple alkaloids (serotonergic, noradrenergic, and opioid-acting), with only about 1% opioid-active component, while concentrated 7-hydroxymitragynine (7-OH) products are reported to be 15–20 times more potent and can drive rapid tolerance, opioid-like withdrawal, and overdose risk.

They also discuss the clinical use of buprenorphine/Suboxone (reducing overdose death risk by 50%+ in traditional opioid use disorder), policy proposals in Michigan (including a prohibition bill), and why naloxone reverses the opioid-like breathing suppression but not other causes like seizure or liver injury.

The Lancet Pulse is part of the Lancet Group podcast offering.

Editorial team: Chloe Wilson, Ben Abbott, Matthew Gilbert, and Jonathan Pimm

Podcast editing and production: Matteo Simonetti

Visit https://www.thelancet.com/multimedia to learn more about our multimedia offering.

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In this episode of The Lancet Pulse, Chloe Wilson joins Helena Teede and Terhi Piltonen to discuss a recent health policy published in The Lancet that details a global consensus process that puts forward a new name for PCOS - termed PMOS (polyendocrine metabolic ovarian syndrome) to more accurately reflect the disease process. Listen now to hear more about the process and how it is hoped the name change will lead to better care for those affected by the condition.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00717-8/fulltext

The Lancet Pulse is part of the Lancet Group podcast offering.

Editorial team: Chloe Wilson, Ben Abbott, Matthew Gilbert, and Jonathan Pimm

Podcast editing and production: Matteo Simonetti

Visit https://www.thelancet.com/multimedia to learn more about our multimedia offering.

Find the best science for better lives at https://www.thelancet.com

Follow us today at... https://thelancet.bsky.social/ https://instagram.com/thelancetgroup https://facebook.com/thelancetmedicaljournal https://linkedIn.com/company/the-lancet https://youtube.com/thelancettv

In this episode of The Lancet Pulse, Niall Boyce and Matt Gilbert speak with Professor Daniel Smith about the emerging connection between diet and mental health, with a focus on the ketogenic diet and bipolar disorder. Together, they explore what bipolar disorder is, why its depressive phases can be so difficult to treat, and why researchers are beginning to investigate whether changes in metabolism and brain energy use could play a role in improving symptoms.

The conversation also looks at the bigger picture: how much evidence is there so far, what makes this area of research so promising, and where caution is still needed. From early feasibility studies to questions about long-term safety, affordability, and dietitian support, this episode offers a thoughtful look at a fast-evolving field — and asks whether nutritional approaches could become a meaningful add-on to mental health care in the future.

The Lancet Pulse is part of the Lancet Group podcast offering.

Editorial team: Chloe Wilson, Ben Abbott, Matthew Gilbert, and Jonathan Pimm

Podcast editing and production: Matteo Simonetti

Visit https://www.thelancet.com/multimedia to learn more about our multimedia offering.

Find the best science for better lives at https://www.thelancet.com

Follow us today at... https://thelancet.bsky.social/ https://instagram.com/thelancetgroup https://facebook.com/thelancetmedicaljournal https://linkedIn.com/company/the-lancet https://youtube.com/thelancettv