With the state’s recent classification of kratom and its derivatives as Schedule I substances, the Boards of Health in Westfield and Southwick are having the potentially dangerous herbal extract removed from shelves of mostly convenience stores or gas stations in both communities.
“They have until Friday, Aug. 28 to take it off their shelves,” said Southwick Board of Health’s Health Director Caileen Simonds about the three stores in town that stock kratom and the derivatives or synthetics created using the active ingredients in the plant’s leaves.
While Hunter Pelkey, the substance-use coordinator for Westfield’s Board of Health, doesn’t believe many stores are selling the products, he has sent letters to every store licensed to sell tobacco and the city’s smoke shops, letting them know they have until Friday to remove them.
Neither believes kratom is widely used, nor disputes its danger.
“It’s not used by a lot of people, but it is dangerous, and overdoses have happened,” Simonds said.
In fact, when a person overdoses on kratom, which slows or stops their breathing, naloxone, commonly called Narcan, reverses the effects by blocking the opioid receptors in the brain. It is the same medication used to reverse the effects of accidental overdoses of narcotics such as fentanyl and heroin.
Kratom, like other narcotics, can lead to physical dependence and withdrawal symptoms similar to those of opioids.
Pelkey said the risk of a kratom overdose increases for polysubstance abusers who may combine it with alcohol, benzodiazepines or other sedatives.
Kratom is a tropical tree called Mitragyna speciosa, and its leaves contain two chemical compounds with psychoactive properties, mainly mitragynine and 7-hydroxymitragynine, which act on the brain’s opioid receptors.
Low doses tend to act as a stimulant, increasing energy, alertness and sociability, while high doses can act as a sedative, reducing pain and inducing calmness.
Pelkey said that when the leaves are crushed or ground, they contain 1% to 2% mitragynine and only trace amounts of 7-hydroxymitragynine, also called 7-OH.
He doesn’t suggest that ingesting the leafy material is safe. He said derivatives extracted from the leaves and chemical synthetics mimic mitragynine and 7-hydroxymitragynine, which are created in laboratories and significantly increase potency, and are dangerous.
The compounds are mitragynine pseudoindoxyl, dihydro-7-hydroxymitragynine and 9-fluoro-7-hydroxymitragynine.
It’s those products, especially in liquid, synthetic or semi-synthetic kratom often sold as “shots,” tinctures, concentrated drinks, gummies or dissolvable strips, that are the most dangerous because their potency can vary significantly.
Until now, in the commonwealth, the products have been “unregulated”, Pelkey said. When classified as a Schedule I substance, they are then considered to have a high potential for abuse and no accepted medical uses.
However, some use kratom to relieve pain or to manage the effects of withdrawal from narcotics.
Pelkey said he knows someone recovering from opioid use who uses kratom for pain relief.
“It has the capability to help some people,” he said.
Simonds said that when she was earning her degree in public health, she learned that kratom might have some benefit for those withdrawing from narcotics.
That feeds the popular but unproven belief that veterans who became addicted to heroin after returning from Southeast Asia during the Vietnam War used kratom, which some learned about from Thai forces who used the plant, to treat their withdrawal symptoms.
However, it’s believed that kratom use correlates with the emergence of the internet in the 2000s and its use as a diversion or substitute for narcotics at the apex of the opioid epidemic, starting in 2015.
If any of the establishments notified by the boards of health still have kratom products for sale after Friday, they’ll face suspension of their municipal business license or their tobacco license.
Simonds said any store that flouts the regulation will be referred for law enforcement action.
