Local Authorities Responding to State's Action on Kratom
WILLIAMSTOWN, Mass. — The Board of Health on Monday began a discussion about regulating the sale of kratom products in town.
The board's monthly meeting came four days after the governor's office in Boston announced that the commonwealth temporarily will designate kratom, also known by its chemical name and marketed with the term "7-OH" as a Schedule I drug, greatly restricting its sale in Massachusetts as of Aug. 28.
The board already was meeting virtually with the director of South County's Tri-Town Health Department on a different matter. Jim Wilusz stayed on the conference call to discuss the implications of Gov. Maura Healey's Thursday announcement on 7-OH, which the U.S. Food and Drug Administration has called potentially "The Next Wave of the Opioid Epidemic."
Kratom is a Southeast Asian tropical tree, the leaves of which can produce either stimulative or sedative results depending on dosage. Its two psychoactive ingredients are mitragynine and 7-hydroxymytragynine (7-OH).
Wilusz said he already was working on draft regulations for Tri-Town based, in part, on an ordinance enacted by Northampton before Gov. Maura Healey's announcement. But in the wake of the announcement and the classification of kratom as a Schedule I drug, he might have to change the language of the proposed ordinance.
Healey's emergency order of Aug. 14 is intended to "give local boards of health and other municipal officials additional authority to take enforcement action against retailers selling kratom products," according to a news release announcing the move.
"I was actually hoping they were going to pass a statewide ban on this thing," Wilusz said. "This goes into effect Aug. 28, so effective the 28th, they can't have kratom in the entire state on their shelves with a one-year [period] to give not only boards of health but, possibly, the Legislature, time to enact regulation.
"I don't know if the intent is to work on a statewide Department of Public Health regulation, which would be ideal, where you would have uniformity across the entire state. It does authorize the boards of health to enact local regulations."
Wilusz recommended that local boards not wait and see whether the commonwealth does move toward a statewide regime.
Kratom is a plant native to Southeast Asia. One of its components is 7-hydroxymitragynine, also known as 7-OH, which can produce, "stimulant-like or opioid-like effects," according to the state.
Part of the problem is that the sale of kratom and a synthetic version of 7-OH is completely unregulated, with consumers having no idea how much of the drug they are ingesting, let alone what side effects may accompany the products they are sold.
"In public health, we need to be nimble, responding to new and emerging threats with evidence-based actions," DPH Commissioner Robbie Goldstein said in last week's news release. "Kratom is increasingly being used by youth and adults, and many are unaware of the risks, including overdose, dependence, and serious health consequences. Our goal is to protect the public while getting those who need treatment or support the care they deserve."
Wilusz recommended that Board of Health members join town Health Agent Ruth Russell in signing up for one of DPH's webinars about the emergency order and what steps local boards can take during the next year.
One initial step he recommended was generating a news release that can be posted on the town's website alerting residents to the issue with kratom. Russell also said she would reach out to local retailers to let them know about the coming Aug. 28 restriction on the product's sale.
"Because it's a 'natural' product that comes from a plant, people have a sense that it's OK, and I can take it and mix it with cannabinoids or other benzo-diazopenes or alcohol or other substances, which is just not the case," Board of Health Chair Devan Bartels said. "I think that's where the danger lies, this false sense of security with it. And also a big question mark, which is what it actually contains and how much of it it actually contains. Neither of those are regulated, because it's an unregulated product."
Bartels, an attending anesthesiologist at Berkshire Medical Center, shared her own professional concerns about 7-OH.
"I see patients taking these before surgery," she said. "I'm about to anesthetize someone who is taking a medication, and it's almost like they're taking heroin. I don't know how much they're taking, what exactly they're putting in their bodies. So it just increases risk around how their pain is going to be controlled around surgery and how they're going to tolerate the anesthetic.
"And then the ongoing dependency related to it, people driving under the influence of these substances, etc."
Board of Health member Marzio Gusmaroli said he wished that kratom and its associated substances could be regulated at the federal or state level, rather than leaving it to local regulations.
"It does get complicated," Wilusz said. "We are in a commonwealth with 351 cities or towns. Massachusetts is pretty progressive with tobacco control and other areas compared to other parts of the country.
"But they've gutted [the U.S. Centers for Disease Control and Prevention], they've gutted the FDA, they've gutted [the U.S. Department of Agriculture]. Historically speaking in Massachusetts, boards of health are where the rubber hits the road. Many times over the years, including tobacco control and vaping and stuff, we at the local level take it on, and then we get to a tipping point that forces the legislature to do something.
"But our lives would be so much easier if the state just did it statewide. Because what's going to end up happening with this kratom, is you're going to have gaps or holes with boards of health that may want to do something different or municipalities that don't have any staffing and don't do anything with kratom. And then they're selling in Berkshire County where there are gaps."
Tags: board of health, drugs,
