NORTHAMPTON — The city’s Board of Health has passed a new regulation restricting the sale of synthetic products derived from kratom, a naturally occurring substance that can cause opioid-like effects.
Kratom is made from the leaves of the mitragyna speciosa tree, found across Southeast Asia. Alkaloids inside the leaf, particularly the alkaloids mitragynine and 7-hydroxymitragyne (also called 7-OH), can cause stimulant and sedative effects when taken in either low or high doses, according to the U.S. Drug Enforcement Administration (DEA).
Currently, kratom is not a federally controlled substance, although the Food and Drug Administration announced in July it plans on recommending a scheduling action to make it one. According to the FDA, there were 1.7 million Americans who took kratom as of 2021, often using it to self-treat conditions such as chronic pain or opioid withdrawal.
A Board of Health public hearing to gather feedback about the new regulation drew a variety of opinions, with several people condemning its potential for addiction and abuse and others praising its ability to treat debilitating conditions.
Shelly Berkowitz, a Northampton resident and retired doctor, said her 33-year-old son Eli had nearly died as a result of using kratom. She said a friend of her son had recommended it as a natural energy supplement, but that her son developed an addiction to the substance.
“I didn’t know about Eli’s addiction. I didn’t know until I witnessed him having near seizures, then suicidal attempts, and finally agreeing to inpatient detox,” Berkowitz said. “He almost lost his job as a therapist, his girlfriend, and virtually almost his life, and I almost lost my only son, all from kratom.”
But Misty Brown, a kratom advocate, described how her usage of kratom helped her overcome addiction to cocaine and pain pills.
“I’m a functioning member of society again. I’m a thriving mother again. I pay taxes again,” Brown said. “I am no longer a burden to my kids, and I am now a first-time grandma.”
The regulation approved by the board, subject to approval by the city solicitor, does not call for the banning of all kratom, but only for synthetic products containing it. The city’s Department of Health and Human Services Director Merridith O’Leary said that more research needed to be done regarding kratom and its natural form, but felt it pressing that synthetic versions that contain the 7-OH alkaloid needed to be addressed immediately.
“There was a sense of urgency that … the synthetic products that are out there, are sold in our convenience stores need to be taken off the shelf immediately,” O’Leary said. “They need to be prohibited in Northampton, and I didn’t want the board to get caught up in the raw form.”
Board of Health member Dr. Suzanne Smith also said that a distinction needed to be made between the natural kratom leaf and 7-OH, the latter’s effect being described as more similar to opioids.
“7-OH is present in the leaf and in the powder, but it’s at a very low percentage,” Smith said. “It’s not thought to be a high enough percentage to cause problems unless the substance is manipulated.”
Smith also said the data available regarding deaths resulting from kratom are confusing by a lack of distinction between kratom, its alkaloid substances, and the plant and tree itself. She also noted that the FDA’s drug scheduling plans only included 7-OH and not natural kratom leaf products.
“There’s not a widespread understanding, even among physicians, about what kratom is in the first place,” Smith said. “If kratom comes back as the cause of death, what does that mean? Is it mitragynine or is it 7-OH?”
In addition to synthetic kratom products, the regulation also bans the sale of synthetically derived THC, the chemical found in cannabis, unless it is a product lawfully regulated by the state. The rules also ban the sale of “unregulated novel intoxicating products,” defined as “any natural, synthetic, or semi-synthetic substance, compound, or mixture with psychoactive, intoxicating, or mood-altering effect” that is not approved by the FDA.
Amherst considers ban
Northampton isn’t the only local municipality taking a look at kratom. Amherst’s Board of Health this month began discussing possible restrictions on kratom, though no regulations have yet been proposed.
Health Director Kiko Malin told the board that O’Leary had reached out with information about what Northampton was considering. “Often, it’s really powerful when local boards of health are in sync on certain things,” Malin said.
Malin said kratom is complicated because health boards are trying to strike a balance between something that is dangerous to public health and something that is beneficial to people.
After hearing from several commenters, many from other parts of the United States, Amherst board members agreed to have an in-depth discussion on kratom this fall.
“I think it’s definitely, in my opinion, worth looking into,” said board member Premila Nair.