A newly published national study is raising concerns about how adolescents perceive the dangers of fentanyl. Researchers found that many middle and high school students significantly underestimate the risks associated with fentanyl use, despite the drug’s role in the overwhelming majority of adolescent opioid overdose deaths.

The study, published in JAMA Network Open, analyzed data from the 2025 Monitoring the Future survey, a nationally representative survey of eighth-, tenth-, and twelfth-grade students. The findings revealed that 52% of eighth-grade students did not consider trying fentanyl once or twice to be highly dangerous. Even among older students, risk perception remained lower than expected, with approximately 30% of twelfth graders failing to view experimenting with fentanyl as carrying great risk.

These findings are particularly concerning because fentanyl is involved in at least three out of every four adolescent overdose deaths in the United States. Researchers noted that many young people may not fully appreciate that even a single exposure can be fatal, especially when fentanyl is unknowingly mixed into counterfeit pills or other illicit substances.

For CASACs, the study reinforces the importance of prevention, education, and honest conversations with youth and families. Traditional fear-based messaging alone is unlikely to be effective. Instead, counselors can provide clear, evidence-based information about counterfeit pills, accidental fentanyl exposure, overdose recognition, naloxone, and harm reduction strategies while creating opportunities for open dialogue with adolescents.

The findings also highlight an important opportunity for schools, parents, prevention professionals, and behavioral health providers to work together to improve fentanyl education before experimentation occurs. Increasing awareness of the real risks associated with fentanyl may help prevent future overdoses and encourage young people to make safer decisions.

As New York continues responding to the evolving overdose crisis, this study serves as another reminder that prevention begins with accurate information. CASACs remain on the front lines of educating individuals, families, and communities about the dangers of today’s illicit drug supply.

Read the original article:
MedicalXpress: US Teens Underestimate Risks of Fentanyl Use, Survey Finds

The New York State Association of CASAC Professionals has submitted formal public comments to the New York State Office of Addiction Services and Supports regarding proposed amendments to 14 NYCRR Parts 800 and 836. The proposed changes were published in the July 1, 2026, New York State Register.

The Association supports OASAS’s proposal to include Credentialed Prevention Professionals within the definition of a Qualified Health Professional. This change recognizes the evolving education, competency, and responsibilities of credentialed behavioral health professionals while helping providers respond more effectively to workforce shortages and increasing demand for prevention and treatment services.

The Association also used the public comment opportunity to raise a larger workforce issue: whether New York’s current regulatory framework fully reflects the responsibilities already assigned to professionals holding the CASAC Advanced credential.

Today, CASAC Advanced professionals may conduct comprehensive substance use disorder assessments, complete the LOCADTR, determine appropriate levels of care, develop treatment recommendations, supervise clinical staff, and serve as program directors when regulatory qualifications are met. These responsibilities demonstrate how far the substance use counseling profession has evolved and how much clinical trust OASAS has already placed in advanced credentialed professionals.

Although the Association did not request changes to Part 822 through this specific rulemaking, it encouraged OASAS to review whether current admission approval requirements remain aligned with the work CASAC Advanced professionals already perform.

The Association formally requested that OASAS continue modernizing the behavioral health workforce, evaluate how advanced addiction professionals are used across the regulatory system, engage professional associations and other stakeholders in future discussions, and undertake a comprehensive review of the regulatory authority associated with the CASAC Advanced credential.

This public comment reflects the Association’s commitment to ensuring that regulations keep pace with the real responsibilities CASACs carry every day. Stronger recognition of advanced credentials can improve workforce flexibility, support professional advancement, reduce unnecessary barriers, and strengthen access to high-quality care across New York State.

The full public comment is available for download through the NYS CASAC Association

Kratom in 2026: What CASACs Need to Know About Dependence, Withdrawal, Tolerance, and High-Potency Products

Five years ago, most substance use counselors in New York barely heard clients mention kratom.

Now it is everywhere.

Gas stations. Vape shops. Convenience stores. Wellness websites. Social media ads promising “natural energy,” “focus,” “pain relief,” or “opioid recovery support.”

And more clients are walking into treatment already using it.

That matters because the kratom market in 2026 is not the same market people were talking about ten years ago. The products are stronger. The extracts are more concentrated. The marketing is more aggressive. And many people using it do not fully understand the risks involving tolerance, dependence, and withdrawal until they are already stuck in the cycle.

As CASACs, we need to stop viewing kratom as a fringe issue. This is becoming a real part of the modern substance use landscape.

Kratom Use Is Rising Fast

Research from the Recovery Research Institute found that kratom use is rising significantly across the United States, especially among younger adults and individuals already using other substances.

That trend should not surprise anyone working in behavioral health.

People are looking for:

• Pain relief
• Anxiety relief
• Energy
• Sleep support
• Mood regulation
• Alternatives to opioids

And kratom is being marketed as a safer, “natural” option.

The problem is that “natural” does not automatically mean safe.

Tobacco is natural.
Opium is natural.
Poison ivy is natural.

Kratom contains active alkaloids, primarily mitragynine and 7-hydroxymitragynine, that interact with opioid receptors and other systems in the brain. According to the  National Institute on Drug Abuse (NIDA), kratom can produce stimulant-like effects at lower doses and sedative effects at higher doses.

That combination is part of why some people initially feel it “helps.”

It is also why tolerance and dependence can develop.

Tolerance: When “Just a Little” Stops Working

This is where many clients start sliding deeper into the pattern without realizing it.

At first:

• One capsule works
• One tea works
• One shot works

Then it doesn’t.

Tolerance develops as the body adapts to repeated use, leading a person to need larger amounts to achieve the same effect.  Cardinal Recovery describes this pattern as increasingly common among regular kratom users, especially those using extracts or concentrated products.

You start hearing:

• “It used to work better.”
• “I just need a stronger one.”
• “The regular powder doesn’t hit anymore.”

This is not harmless experimentation anymore.

It is the beginning of the physiology of dependence.

And newer products on the market accelerate this process.

Dependence and Withdrawal Are Real

One of the biggest myths floating around online is that kratom does not produce withdrawal.

That is false.

The  American Addiction Centers notes that regular kratom use can produce physical dependence and withdrawal symptoms that resemble mild-to-moderate opioid withdrawal in some individuals.

Clients may experience:

• Anxiety
• Irritability
• Insomnia
• Restlessness
• Muscle aches
• Sweating
• Nausea
• Depression
• Intense cravings

Some people also report emotional instability and difficulty functioning when trying to stop.

This matters clinically because many clients do not expect withdrawal from something marketed as “herbal” or “legal.”

And once withdrawal starts, use often shifts from:
“I want to take it.”

to

“I need to take it so I feel normal.”

That is dependence.

The 7-OH Problem: Why High-Potency Products Changed the Conversation

This is the part CASACs need to pay close attention to in 2026.

The kratom market is no longer just leaf powder.

There are now:

• Potency-enhanced shots
• Concentrated extracts
• Gummies
• Tablets
• Products containing elevated levels of 7-hydroxymitragynine, often called 7-OH

According to  Partnership to End Addiction, 7-OH is significantly more potent than mitragynine and has stronger opioid receptor activity. Some companies are isolating or concentrating this compound to create stronger effects.

That changes the entire risk profile.

A client drinking concentrated 7-OH products every day is not using the same thing as someone casually drinking traditional kratom tea.

The higher the potency:

• The faster tolerance develops
• The higher the dependence risk
• The more severe withdrawal can become
• The greater the overdose and polysubstance danger becomes

And many products are poorly regulated or inaccurately labeled.

Clients often have no idea how strong the product actually is.

What CASACs Are Seeing in the Field

You are probably already hearing this language in sessions:

“It helps my anxiety.”
“It keeps me off fentanyl.”
“It’s legal.”
“It’s just herbal.”
“It helps me work.”
“I only use the shots.”

The clinical goal is not panic or judgment.

The goal is assessment.

You need to understand:

• What form are they using?
• How often are they using?
• Whether tolerance is increasing
• Whether withdrawal appears between doses
• Whether they are mixing substances

Because kratom rarely exists alone.

Many clients are also using:

• Alcohol
• Benzodiazepines
• Cannabis
• Stimulants
• Opioids

That combination changes the risk picture fast.

Harm Reduction Conversations Matter

This is where CASACs play a critical role.

Clients need honest information, not scare tactics.

A productive conversation may include:

• Discussing tolerance escalation
• Talking openly about withdrawal symptoms
• Identifying dependence patterns early
• Encouraging clients to avoid high-potency extracts
• Exploring safer coping strategies
• Monitoring polysubstance combinations

Some clients genuinely report using kratom to reduce opioid use. That reality should not be ignored.

But harm reduction also means recognizing when the substitute itself is becoming harmful.

Why This Matters for New York

New York CASACs are practicing in a fentanyl-era environment where clients are navigating increasingly unpredictable and potent substances.

Kratom now exists inside that landscape.

And the newer high-potency products blur the line between:

• Herbal supplement
• Psychoactive substance
• Dependence-producing product

That means counselors need updated knowledge.

Not internet myths.
Not outdated assumptions.
Not fear-based headlines.

Real clinical understanding.

Because once tolerance, withdrawal, and dependence enter the picture, this stops being “just an energy drink.”

The Bottom Line

Kratom is not a joke substance.

It is also not a one-sentence conversation.

It is a plant with active compounds that interact with opioid receptors and other brain systems. It is increasingly sold in concentrated forms that raise the risks of tolerance, dependence, and withdrawal. And national trends show use is rising fast.

The most important thing CASACs can do is stay informed and ask better questions.

Because in 2026, the difference between occasional kratom use and serious dependence often comes down to one thing:

Potency.

And many clients do not realize how far things have progressed until they cannot stop.

NYS Overdose Deaths Dropped 32% in 2024. Here Is What That Number Does Not Tell You.

The headline is real. The full picture is more complicated. CASACs on the front lines need both.

An estimated 4,567 New Yorkers died of a drug overdose in 2024, down from 6,688 in 2023, according to provisional data from the Centers for Disease Control and Prevention. That is a 32% decline in a single year. For a state that watched overdose deaths climb nearly 300% between 2010 and 2020, that number is significant.

It is also provisional. And it is not the whole story.

As a working CASAC, you deserve the full picture, not because the progress is not real, but because the conditions driving your caseload are more complex than any single headline captures.

What drove the decline

New York’s investment in harm reduction is measurable and specific. Through a first-in-nation online portal, the state distributed more than 296,000 naloxone kits and 13 million fentanyl test strips statewide. OASAS expanded treatment capacity. Governor Hochul’s 2023 Harm Reduction Delivered initiative expanded access to naloxone and education in communities with limited access.

These programs moved the number. That is not speculation. It is documented in the state’s own data and confirmed by public health researchers who called the decline substantial and attributable to specific interventions.

The progress is real. It is also fragile.

What the number does not tell you

Racial disparities in overdose mortality widened in 2024 even as total deaths declined. The overall improvement was not distributed equally across New York communities. Black and Latino New Yorkers continue to die at disproportionate rates, and the gap grew during the same period that the headline number improved.

If your caseload includes clients from communities of color, you already know this on the ground. The data confirms it.

The drug supply also did not simplify. Fentanyl remains present in approximately 77% of NYS overdose deaths. Xylazine, a veterinary sedative with no approved reversal agent, now appears in more than 21% of fentanyl samples statewide, according to Millennium Health’s 2025 Signals Report. Heroin re-emerged in fentanyl-using populations in late 2024 for the first time in years.

Naloxone is still essential. It is no longer sufficient on its own for every overdose presentation.

What is at risk right now

The programs that drove the 2024 decline depend on sustained funding. Federal uncertainty about behavioral health allocations in 2025 threatens the harm-reduction infrastructure New York has built over the past three years. Researchers who praised the decline used the word “tenuous” to describe whether it holds.

OASAS and the NYS Department of Health have $400 million in Opioid Settlement Funds committed to treatment and recovery services. Whether that money reaches the programs and providers doing the work is a policy and advocacy question that directly affects what CASACs can offer clients.

What does this mean in your practice right now?

Update your harm reduction conversations. Clients using opioids need to know about xylazine, what wounds it causes, and why naloxone alone may not be enough. Fentanyl test strips are available through the state portal. If your agency is not actively distributing them, find out why.

Track the equity gaps in your own caseload. If certain clients are not accessing harm reduction or treatment at the same rate as others, that is clinical information worth naming in supervision and in advocacy conversations.

The 32% drop is the best news this field has had in years. It was earned by counselors, harm reduction workers, and clients who stayed alive long enough for help to reach them.

Do not let the headline be the end of the conversation.

Maria Mendez (Founder) attended the SOMOS Conference in Albany on April 18, 2026. She had the opportunity to introduce the NYS Association of CASAC Professionals and to engage in meaningful conversations with the OASAS Commissioner, Dr. Chinazo Cunningham, and Senator Nathalia Fernandez, a great advocate and supporter of the SUD field.

During the conference, the topics discussed included the NYS CASAC Association’s mission and goals, as well as the critical need to elevate and support the CASAC workforce across New York State. This is exactly why our Association exists – for YOU! Maria is committed to advocating, building strong relationships, and ensuring that CASACs have a powerful and respected voice at the table.

Senator Nathalia Fernandez and Maria Mendez 

* Senator Nathalia Fernandez is a Democratic member of the New York State Senate, representing the 34th District (covering parts of the Bronx and Westchester) since January 1, 2023. She chairs the Committee on Alcoholism and Substance Use Disorders, focusing on addiction recovery, mental health, and community