By MATTHEW PERRONE, AP Health Writer

WASHINGTON (AP) — U.S. health officials are warning Americans about the risks of an opioid-related ingredient increasingly added to energy drinks, gummies and supplements sold at gas stations and convenience stores, recommending a nationwide ban.

The chemical, known as 7- hydroxymitragynine, is a component of kratom, a plant native to Southeast Asia that has gained popularity in the U.S. as an unapproved treatment for pain, anxiety and drug dependence.

In recent months, dietary supplement companies that sell kratom have been urging the Food and Drug Administration to crack down on the products containing 7-OH, portraying it as a dangerously concentrated, synthetic form of the original ingredient.

The FDA action “is not focused on natural kratom leaf products,” according to a statement Tuesday by the U.S. Department of Health and Human Services.

The agency said it was releasing a report to educate about the risks of “7-OH and its distinction from the kratom plant leaf.” Regulators are also recommending that the ingredient be placed on the federal government’s most restrictive list of illegal drugs, which includes LSD and heroin.

“7-OH is an opioid that can be more potent than morphine,” said FDA Commissioner Marty Makary. “We need regulation and public education to prevent another wave of the opioid epidemic.”

The agency’s recommendation will be reviewed by the Drug Enforcement Administration, which sets federal rules for high-risk drugs including prescription medicines and illicit substances. A federal ban wouldn’t take effect until the agency drafts and finalizes new rules governing the ingredient.

Federal regulators have been scrutinizing kratom for about a decade after reports of addiction, injury and overdose. But users and distributors have long opposed efforts to regulate it, saying kratom could be a safer alternative to opioid painkillers that sparked the ongoing drug addiction epidemic.

Last month, the FDA issued warning letters to seven companies selling drinks, gummies and powders infused with 7-OH. Regulators said the products violated FDA rules because they have not been evaluated for safety and, in some cases, claimed to treat medical conditions, including pain, arthritis and anxiety.

Supplement executives quickly applauded the move.

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The FDA “demonstrated the exact kind of data-driven, proactive regulatory excellence needed to safeguard unwitting consumers across the U.S.,” said Ryan Niddel of Diversified Botanics, a Utah-based company that sells kratom supplements.

An industry group, the American Kratom Association, has lobbied Congress for years against restrictions on the plant. Legislation supported by the group would prohibit the FDA from regulating kratom more strictly than food and dietary supplements

Nearly a decade ago, the federal government came close to banning the substance.

In 2016, the DEA announced plans to add kratom to the government’s most restrictive schedule 1, reserved for drugs that have no medial use and a high potential for abuse. But the plan stalled after a flood of public complaints, including a letter signed by more than 60 members of Congress.

The FDA then began studying the ingredient, concluding in 2018 that kratom contains many of the same chemicals as opioids, the addictive class of drugs that includes painkillers like OxyContin as well as heroin and fentanyl.

Since then, FDA regulators have continued to issue warnings about cases of injury, addiction and death with kratom supplements, which are usually sold in capsules or powders.

In recent months, the FDA has also issued warnings on other unapproved drugs sold as supplements or energy drinks, including the antidepressant tianeptine. Sometimes referred to collectively as “gas station heroin,” the drugs have been restricted by several states, but they are not scheduled at the federal level.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By HANNA ARHIROVA and ILLIA NOVIKOV

KYIV, Ukraine (AP) — Russian glide bombs and ballistic missiles struck a Ukrainian prison and a medical facility overnight as Russia’s relentless strikes on civilian areas killed at least 27 people across the country, officials said Tuesday, despite U.S. President Donald Trump’s threat to soon punish Russia with sanctions and tariffs unless it stops.

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Four powerful Russian glide bombs hit a prison in Ukraine’s southeastern Zaporizhzhia region, authorities said. They killed at least 16 inmates and wounded more than 90 others, Ukraine’s Justice Ministry said.

In the Dnipro region of central Ukraine, authorities said Russian missiles partially destroyed a three-story building and damaged nearby medical facilities, including a maternity hospital and a city hospital ward. At least three people were killed, including a 23-year-old pregnant woman, and two other people were killed elsewhere in the region, regional authorities said.

Ukrainian President Volodymyr Zelenskyy said that overnight Russian strikes across the country hit 73 cities, towns and villages. “These were conscious, deliberate strikes — not accidental,” Zelenskyy said on Telegram.

Trump said Monday he is giving Russian President Vladimir Putin 10 to 12 days to stop the killing in Ukraine after three years of war, moving up a 50-day deadline he had given the Russian leader two weeks ago. The move meant Trump wants peace efforts to make progress by Aug. 7-9.

Trump has repeatedly rebuked Putin for talking about ending the war but continuing to bombard Ukrainian civilians. But the Kremlin hasn’t changed its tactics.

“I’m disappointed in President Putin,” Trump said during a visit to Scotland.

Kremlin spokesman Dmitry Peskov said Tuesday that Russia is determined to achieve its goals in Ukraine, though he said Moscow has “taken note” of Trump’s announcement and is committed to seeking a peaceful solution.

Zelenskyy welcomed Trump’s shortening of the deadline. “Everyone needs peace — Ukraine, Europe, the United States and responsible leaders across the globe,” Zelenskyy wrote in a post on Telegram. “Everyone except Russia.”

The Kremlin pushes back against Trump

The Kremlin pushed back, with a top Putin lieutenant warning Trump against “playing the ultimatum game with Russia.”

“Russia isn’t Israel or even Iran,” former president Dmitry Medvedev, who is deputy head of the country’s Security Council, wrote on social platform X.

“Each new ultimatum is a threat and a step towards war. Not between Russia and Ukraine, but with his own country,” Medvedev said.

Since Russia’s full-scale invasion of its neighbor, the Kremlin has warned Kyiv’s Western backers that their involvement could end up broadening the war to NATO countries.

“Kremlin officials continue to frame Russia as in direct geopolitical confrontation with the West in order to generate domestic support for the war in Ukraine and future Russian aggression against NATO,” the Institute for the Study of War, a Washington think tank, said late Monday.

Russia attacks with glide bombs, drones and missiles

The Ukrainian air force said Russia launched two Iskander-M ballistic missiles along with 37 Shahed-type strike drones and decoys at Ukraine overnight. It said 32 Shahed drones were intercepted or neutralized by Ukrainian air defenses.

The Russian attack close to midnight Monday hit the Bilenkivska Correctional Facility with glide bombs, according to the State Criminal Executive Service of Ukraine.

Glide bombs, which are Soviet-era bombs retrofitted with retractable fins and guidance systems, have been laying waste to cities in eastern Ukraine, where the Russian army is trying to pierce Ukrainian defenses. The bombs carry up to 3,000 kilograms (6,600 pounds) of explosives.

At least 42 inmates were hospitalized with serious injuries, while another 40 people, including one staff member, sustained various injuries.

The strike destroyed the prison’s dining hall, damaged administrative and quarantine buildings, but the perimeter fence held and no escapes were reported, authorities said.

Ukrainian officials condemned the attack, saying that targeting civilian infrastructure, such as prisons, is a war crime under international conventions.

The assault occurred exactly three years after an explosion killed more than 50 people at the Olenivka detention facility in the Russia-occupied Donetsk region, where dozens of Ukrainian prisoners were killed.

Russia and Ukraine accused each other of shelling the prison. The Associated Press interviewed over a dozen people with direct knowledge of details of that attack, including survivors, investigators and families of the dead and missing. All described evidence they believed points directly to Russia as the culprit. The AP also obtained an internal United Nations analysis that found the same.

Russian forces also struck a grocery store in a village in the northeastern Kharkiv region, police said, killing five and wounding three civilians.

Authorities in the southern Kherson region reported one civilian killed and three wounded over the past 24 hours.

Alongside the barrages, Russia has also kept up its grinding war of attrition, which has slowly churned across the eastern side of Ukraine at a heavy cost in troop losses and military hardware.

The Russian Defense Ministry claimed Tuesday that Russian troops have captured the villages of Novoukrainka in the Donetsk region and Temyrivka in the Zaporizhzhia region.

Ukraine launches long-range drones

Ukraine has sought to fight back against Russian strikes by developing its own long-range drone technology, hitting oil depots, weapons plants and disrupting commercial flights.

Russia’s Defense Ministry said Tuesday that air defenses downed 74 Ukrainian drones over several regions overnight, including 43 over the Bryansk region.

Yuri Slyusar, the head of the Rostov region said a man in the city of Salsk was killed in a drone attack, which started a fire at the Salsk railway station.

Officials said a cargo train was set ablaze at the Salsk station and the railway traffic via Salsk was suspended. Explosions shattered windows in two cars of a passenger train and passengers were evacuated.

By EDDIE PELLS, AP National Writer

In its push to remove transgender athletes from Olympic sports, the Trump administration provided the U.S. Olympic and Paralympic Committee a detailed legal brief on how such a move would not conflict with the Ted Stevens Act, the landmark 1978 federal statute governing the Olympic movement.

That gave the USOPC the cover it needed to quietly change its policy, though the protection offers no guarantee the new policy won’t be challenged in court.

Olympic legal expert Jill Pilgrim called the Trump guidance “a well thought-out, well-reasoned set of arguments for people who want to look at it from that perspective.”

“But I’d be pretty shocked if this doesn’t get challenged if there is, somewhere along the line, a trans athlete who’s in contention for an Olympic team or world championship and gets excluded,” said Pilgrim, who has experience litigating eligibility rules for the Olympics and is a former general counsel for USA Track and Field.

The USOPC’s update of its athlete safety policy orders its 54 national governing bodies to rewrite their participation rules to ensure they are in sync with the executive order Trump signed in February called “Keeping Men Out of Women’s Sports.”

When the USOPC released the guidance, fewer than five had rules that would adhere to the new policy.

Among the first adopters was USA Fencing, which was pulled into a congressional hearing earlier this year about transgender women in sports when a woman refused to compete against a transgender opponent at a meet in Maryland.

One of the main concerns over the USOPC’s change is that rewriting the rules could conflict with a clause in the Ted Stevens Act stating that an NGB cannot have eligibility criteria “that are more restrictive than those of the appropriate international sports federation” that oversees its sport.

While some American federations such as USATF and USA Swimming follow rules set by their international counterparts, many others don’t. International federations have wrestled with eligibility criteria surrounding transgender sports, and not all have guidelines as strict as what Trump’s order calls for.

World Rowing, for example, has guidelines that call for specific medical conditions to be met for transgender athletes competing in the female category. Other federations, such as the one for skiing, are more vague.

White House lawyers provided the USOPC a seven-paragraph analysis that concluded that requiring “men’s participation in women’s sports cannot be squared with the rest of the” Ted Stevens Act.

“And in any event, permitting male athletes to compete against only other fellow males is not a ‘restriction’ on participation or eligibility, it is instead, a neutral channeling rule,” according to the analysis, a copy of which was obtained by The Associated Press.

Once the sports federations come into compliance, the question then becomes whether the new policy will be challenged, either by individual athletes or by states whose laws don’t conform with what the NGBs adopt. The guidance impacts everyone from Olympic-level athletes to grassroots players whose clubs are affiliated with the NGBs.

Shannon Minter, the legal director at the National Center for LGBTQ Rights, said it will not be hard to find a transgender athlete who is being harmed by the USOPC change, and that the White House guidance “will be challenged and is highly unlikely to succeed.”

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“There are transgender women. There are some international sporting organizations that have policies that permit transgender women to compete if they meet certain medical conditions,” Minter said. “Under the Ted Stevens Act, they can’t override that. So, their response is just to, by brute force, pretend there’s no such thing as a transgender woman. They can’t just dictate that by sheer force of will.”

Traditionally, athletes on the Olympic pathway who have issues with eligibility rules must first try to resolve those through what’s called a Section IX arbitration case before heading to the U.S. court system. Pilgrim spelled out one scenario in which an athlete wins an arbitration “and then the USOPC has a problem.”

“Then, it’s in the USOPC’s court to deny that person the opportunity to compete, and then they’ll be in court, no doubt about that,” she said.

All this comes against the backdrop of a 2020 law that passed that, in the wake of sex scandals in Olympic sports, gave Congress the power to dissolve the USOPC board.

That, combined with the upcoming Summer Games in Los Angeles and the president’s consistent effort to place his stamp on issues surrounding sports, is widely viewed as driving the USOPC’s traditionally cautious board toward making a decision that was being roundly criticized in some circles. The committee’s new policy replaces one that called for reliance on “real data and science-based evidence rather than ideology” to make decisions about transgender athletes in sports.

“As a federally chartered organization, we have an obligation to comply with federal expectations,” CEO Sarah Hirshland and board chair Gene Sykes wrote to Olympic stakeholders last week. “The guidance we’ve received aligns with the Ted Stevens Act, reinforcing our mandated responsibility to promote athlete safety and competitive fairness.”

The USOPC didn’t set a timeline on NGBs coming into compliance, though it’s believed most will get there by the end of the year.

CHICAGO — Twenty-year-old Eric Mun didn’t want to believe it: Only one kid in the family could make it to medical school — and it wasn’t going to be him.

Mun had done everything right. He graduated high school with honors, earned a scholarship at Northwestern University and breezed through his biology courses.

He immigrated to Alabama from Korea as a toddler. From the quiet stretches of the South, he dreamed of helping patients in a pressed white coat.

But dreams don’t pay tuition. And with new borrowing limits, Mun’s family can only support one child through school.

“My parents already implied that my older brother is probably going to be the one that gets to go,” Mun said.

President Donald Trump’s sweeping “big, beautiful” tax and spending bill, signed into law earlier this month, imposes strict new caps on federal student loans, capping borrowing for professional schools at $50,000 per year. The measure particularly affects medical students, whose tuition often exceeds $300,000 over four years.

Aspiring physicians like Mun have been thrown into financial uncertainty. Many members of the medical community say the measures will send shock waves through a system already laden with economic barriers, discouraging low-income students from pursuing a medical degree.

“It might mean there are people who want to be doctors that can’t be doctors because they can’t afford it,” said Dr. Richard Anderson, president of the Illinois State Medical Society.

Before the passage of Trump’s budget bill, the Grad PLUS loan program allowed graduate students to borrow their institution’s total cost of attendance, including living expenses. The program was slashed as part of a broader overhaul to the federal student loan system.

Now, beginning July 1, 2026, most graduate students will be capped at $20,500 in federal loans per year, with a total limit of $100,000. Students in professional schools, like medical, dental or law school, will face the $50,000 annual cap and a total limit of $200,000.

Through the Chicago Cancer Health Equity Collaborative Fellows program at Northwestern University, undergrads and recent graduates interested in medical school take part in a demonstration of fundamental laparoscopic surgery and a tour at a Northwestern surgical bio skills simulation lab on July 21, 2025. (Antonio Perez/Chicago Tribune)

Mun’s parents work at an automobile assembly plant. Throughout high school, he knew he would have to rely on scholarships and federal loans to pay his way through college.

Mun’s voice faltered. “I’m just trying to remain hopeful,” Mun said.

Also folded into the bill: the elimination of several Biden-era repayment plans, cuts to Pell Grants and limits to the Parent PLUS loans program, which allows parents of dependent undergraduates to borrow.

Proponents of the Republican-backed bill said the curbed borrowing will incentivize medical schools and other graduate programs to lower tuition. The tuition of most Chicago-area medical schools is nearly $300,000 for four years, not including cost-of-living expenses.

Northwestern University’s Feinberg School of Medicine has a $465,000 price tag after accounting for those indirect costs, according to the school’s website. Rosalind Franklin University of Medicine and Science trails closely behind at nearly $464,000.

“One of the main concerns about the Grad PLUS program is money that is going to subsidize institutions rather than extending access to students,” said Lesley Turner, an associate professor at the University of Chicago Harris School of Public Policy.

Still, many medical professionals expressed doubt that schools will adjust their costs in response to the bill. Tuition for both private and public schools has been steadily climbing for decades, up 81% from 2001 after adjusting for inflation, according to the Association of American Medical Colleges.

There’s some evidence that Grad PLUS may have contributed to those tuition hikes. A study co-authored by Turner in 2023 found that prices increased 65 cents per dollar after the program’s introduction in 2006. There was also little indication that Grad PLUS had fulfilled its intended goal of expanding access to underrepresented students.

Through the Chicago Cancer Health Equity Collaborative Fellows program at Northwestern University, undergraduates and recent graduates who are interested in medical school walk for a tour at a Northwestern surgical bio skills simulation lab on July 21, 2025. (Antonio Perez/Chicago Tribune)

But Turner cautioned against the abrupt reversal of the program. After accounting for inflation, the lifetime borrowing limits now placed on graduate students are lower than they were in 2005, she said. Many students may turn to private loans to cover the gap, often at higher interest rates.

More than half of medical students relied on Grad PLUS loans, according to AAMC. The median education debt for indebted medical students is around $200,000, with most repayment plans lasting 10 to 20 years. The median stipend for doctors’ first year post-MD was just $65,100 in 2024.

“I think for many reasons, it would have been reasonable to put some sort of limit on Grad PLUS loans, but I think this is a very blunt way of doing it,” Turner said.

In a high-rise on Northwestern’s downtown campus last week, 20 undergraduate students and alums from local colleges gathered for the Chicago Cancer Health Equity Collaborative Fellows program. The eight-week summer intensive offers aspiring medical professionals a deep dive into cancer health disparities information and research. Participants like Mun have been left reeling after the flurry of federal cuts.

Alexis Chappel, a 28-year-old graduate of Northeastern Illinois University, watched a family member struggle with addiction growing up. She was deeply moved by the doctors who supported his recovery, and it inspired her to pursue medicine. But she has no idea how she’ll cover tuition.

“I feel like it’s in God’s hands at this point,” Chappel said. “I just felt like it’s a direct attack on Black and brown students who plan on going to medical school.”

Through the Chicago Cancer Health Equity Collaborative Fellows program at Northwestern University, Alexis Chappel, center, takes part in a demonstration of fundamental laparoscopic surgery at a Northwestern surgical bio skills simulation lab on July 21, 2025. (Antonio Perez/Chicago Tribune)

Just 10% of medical students are Black and 12% are Latino, according to AAMC enrollment data. Socioeconomic diversity is also limited: A 2018 analysis found that 24% of students came from the wealthiest 5% of U.S. households.

Dr. Tricia Pendergrast, who graduated from Feinberg in 2023, relied entirely on Grad PLUS loans to fund her medical education. Juggling classes and clinicals, she had little money saved and no steady stream of income. Pendergrast was so strapped for cash that she enrolled in SNAP benefits — a program also cut under Trump’s budget bill.

Now an anesthesiologist at University of Michigan Health, she’s documented her concerns on TikTok for her 48,000 followers.

“It’s not going to improve representation, and it’s not going to improve access,” Pendergrast said. “It’s going to act as a deterrent for people who otherwise would be excellent physicians.”

For low-income students, the application process is already fraught with economic obstacles, Pendergrast said. Metrics like GPA and the Medical College Admissions Test, or MCAT, are heavily weighted in admissions, and may disadvantage students from underresourced schools. Many students also lack mentorships or networks to guide them through the process, she noted.

“I think the average medical student is going to be richer and whiter, and not from rural areas and not from underserved communities,” Pendergrast said.

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The elimination of Grad PLUS loans comes amid a mounting nationwide physician shortage. A recent AAMC report predicted a shortfall of 86,000 physicians by 2036. Meanwhile, a significant portion of the workforce is poised to enter retirement: The U.S. population aged 65 and older is expected to grow 34.1% over the next decade.

The shortage is particularly concentrated in primary care. In practice, that means longer waiting times for patients, and an increased caseload on physicians, who may already suffer from burnout.

“If the goal is truly to make America healthy again, then we need to have a strong physician workforce …  We should be coming up with ideas to make it more accessible for people who want to be doctors as opposed to hindering that,” Anderson said.

Sophia Tully, co-president of the Minority Association of Pre-Med Students at Northwestern, said she and her peers have struggled to reconcile with a system that often feels stacked against them. The 21-year-old plans on taking an extra gap year before medical school in an effort to save money.

Tully summed up the environment on campus: “For lack of a better word, people are panicking.”