HomeMy WebLinkAboutBOH MEETING PACKET 12_01_2025Board of Heatth
Hittard Boskey, M.D
Mary Craig
Chartes T. Hotway
Laurance Venezia DVM
Eric Weston
Assistant Hoatth
Director
Barry Lewis
Town ofYarmouth Board of Heatth
1 146 Route 28, South Yarmouth, MA 02664
(5O8)39&2231
BOARD OF HEALTH MEETING AGENDA
December 1, 2025 at 5:00 PM
This meeting wilt be conducted in person at the date, time and tocation identified above. This moans that at least a quorum
of the members of the pubtic body witt afiend the meeting in person and members ol the pubtic are welcome to attend in
person as wetl. As a counesy onty, access to the meeting is atso being provided via remote means in accordance with
applicebte law. Ptease note thatwhite an option for remote attendance and/or participation is being provided as a counesy
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panicutar interest in any specific item on this agenda, which includes an appticant and its representatives, shoutd make
ptans for in-person vs. virtual attendance accordingly.
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It is rocommended that phone participants access materiats in advance ofthe meeting
PLease note that forany item tisted betowthe Board of Heatth maytake officialaction includingvotes.
1 . Cat[ to order
2. Dectaration of a Quorum3. Pubtic comment
The open meetlng law discourages publlc bod,es from discussing toprc s not listed on the agenda. fhe public
should thetatorc not expect the Board to respord to guestlors or statements made during the Public Commant
pottion of the meetin+
4. Smoke Detector Awareness & Education - Yarmouth Fire Department
5. Variance- 97 Hetmsman Drive, Yarmouth Port, MA6. Nicotine Free Generation - Discussion
7. Kratom - Discussion
8. Review & Approve Minutes
a. November 3, 2025b. December 18,2023
9. New/Otd Business
10. Ad.iournment
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310 CMR: DEPARTME..NT oF ENVIRONMENTAL PROTECTION
15.222: continued
(7) The building sewer shallbe laid on a continuous Srade and as nearly as possible in a straight
line in accordance wrth accepled tngineering praclice.
(8) Manholes, with metal fiames and covers at grade, sweeping bends, or a cleanout accessible
at thc surface of the ground, shall be provided at the junction of two or morc sewers. at all
changes in direction or a change in grade ofthe sewers, altd at intervals no greater than 100 feet.
All gravity sewer manholes shall have an open charuel depth equal to or greater than the
diameter ofthe inlet sewer and the change ofdirection in each manhole shall not exceed 90'.
(Change ofdirection is the interior angle between the new direction of flow and the projected
extension ofthe original direction of flow.)
(9) The building sewer shall b€ vented through the vent stack or main vent ofthe brilding
served by it. No trap shall be installed in the building sewer ot building drain.
(10) All building sewers shall be constntcted in accordance with the State Plunbing Code,
248 CMR 2.00.
( I) Scptic lanks shall havc thc lollo\\ ing capacitics:
(a) f'or a siDglc lamily drvcllurg unit $' ith a design flow of less than I .000 gallons pcr day.
a rninimum cffcctive liquid capacit) ol l01)9'o of thc rlesign flou or a nrrnlmunr hldraulic
tlctention flo* of ,l8 hours. *hichercr is grealer. shall Lrc rcquired In no casc shall the
cf'fectivc liquid capacitv ofthe tank as nreasured belo\\ the outlct invcrl.lcvationbe lcss than
1.500 gallons.
lb) Whcn designed to ser\e facililies othcr tharr a single ianrily dwe)ling unit or rvhcncler
thc calculatcd dcsign flo\\ is 1.000 gnllons pcr day or elcatar, a t\4 o companmcnt tank or
1\\o tar is in series are rcquircd. Thc d.sigrr ol tlrc tanks shall be in accordancc \\ith
3l0 CMR 15 221 for multiplc compartmcnt lanks and I l0 CN{R 15.215 ibr tanks in series.
At a rrrinimum. the total. cornbined c'ffcctivc liquid capacity olboth tanks in scrics or ofthe
mlrhiplc compartmcnt lank shall not bc less than 1,500 Ballons.(c) When a domestic garbage grinder is propos€d or installed, the minimum liquid capacity
of the septic tank shall be 200% of the design flow with a mhimum tank size of 1,500
gallons and a two compartment tank or two tanks in series shall be required which meet the
design criteria specified in 310 CMR 15.223( I )(b). Domestic garbage ginders are prohibited
in facilities which include an elevated septic tank constructed in accordance with 310 CMR
15.213 (construction in V-zones).
(2) The liquid depth ofthe tank, measued from the outlet tee invert to the tank bottom, shall
be a minimum offour feel. A tank with a minimum depth olthree feet below the outlet tee
invert maybe permitted only for upgrade ofexisting nonconforming or failed systems, pursuant
to 3 l0 CMR l5.405 (local upgrade approvals), where installation ofa tanl( with a four foot liquid
depth is not feasible and shall be pumped on an annual basis with the results submitted to the
Approving Authority.
(3) Tanks which are rectangular in crcss-section shall have a minimum inside length to width
ratio ofno less than 1.5 to l. Round tanks may be allowed. The inside len$h ofall tanks.
measured from the inlet tee to the outlel tee. shall be a minimum ofsix feet. The inside uidrh of
the tank shall be a minimum of three feet. t-arger length to width ratios are preferred.
(4) Venical cylindrical tanks shall have a minimum diameter offivc feet.
(5) Horizontal cylindrical tanks shall have a minimum length ofsix feet and a minimum rvidth
at the liquid sudace ofthree feet.
I5.224: Multiplc Compartment Tanks
Tanks with multiple compartments shall be required as specified in 310 CMR 15.223(t)
When multiple compaftment tanks are used the following shall be rcquircd:
15.223: Septic Tanks
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HHS Public Access
Author manuscript
Int J Dntg Policy. Author manuscript; available in PMC 2021 February l3
Published in final edited form as:
lnt J Drug Policy.20l9 August ; 70 '10-77 . doi:10.10164.dru9po.2019.05.003
Kratom policy: The challenge of balancing therapeutic potential
with public safety
Walter C. Prozialecka,', Bonnie A. Averyb, Edward W. Boyef, Oliver Grundmannd, Jack E.
Henningfielde, Andrew C. Kruegelf, Lance R. McMahons, Christopher R. McCurdyd, Marc T.
Swoggef . Charles A. Veltrii, Darshan SinghJ
aDepartment of Pharmacology, Midwestern University, 555 31st Street, Downers Grove, lL 60515,
USA
bDepartment of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL
32610, USA
cDepartment of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA 021 15, USA
dDepartment of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL
32610, USA
.Research, Health Policy and Abuse, Liability, Pinney Associates And Department of Psychiatry
and Behavioral Sciences, The Johns Hopkins University School of Medicine, 4800 Montgomery
Lane, Suite 400, Bethesda, MD 20814, USA
rDepartment of Chemistry, Columbia University, 3000 Broadway, New York, NY 10027, USA
sDepartment of Pharmacodynamics, college of Pharmacy, University of Florida, Gainesville, FL
32610, USA
hDepartment of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd.,
Rochester, NY 14682, USA
iDepartment of Pharmaceutical Sciences, Midwestern University, 19555 N.59th Avenue,
Glendale, AZ 85308, USA
icentre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
Abstract
This is an op€n access article under the CC BY-NC-ND licens€ (http: /ereltrv,r.onmroN ors ir(.ns.s:UY,NC-\D I 0 ).'Correspondins aulhor- wprozi@midwcstcm.cdu (WC. Prozialeck).
Authors' roles in writing manuscript
Drs. Walter Prozialeck and Darshe Singh conceived th€ manuscript and wrole the first dmft. All ofthe authors provided significant
input into the writing and editing of the manuscript- AII authoN have .pproved the 6nal version of the manuscript.
Authors' conflicl of interesl stat€m€nt
Drs. Prozialeck. Avcry, Mccurdy, McMahon, Grundmann and singh havc no potcntial conflicrs of intcrcst to disclosc.
Dr Edward Boyer is a Fulbright Scholar sludying the efccrs ofkarom.
Dr. Andrew Kruegel has served as a non-compei$ated consultant to the American Kratom Association and is a co-invenror on several
katom-related patent applications filed by Columbia University.
D. Jack E. HenninSfield provides consulting suppo( tfuough Pinney Associares. on rhe developmenl of abuse porenrial assessmenrs
and reSulation ol new mediches and formulatiotrr for the treatment ofpaiD, addiclioL epilepsy. and other central nervous system
disordeB. He has also sewed as a consultant for the Amencan Kratom Assocrarion (see more ar s$r prlrnerasJo.rrr.\ !onr).
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Kratorn (MitragJala speciosa) is a tree-like plant indigenous to South€ast Asia. Its leaves, and
the teas brewed from them have long been used by peoplc in that region to stave olf fatigue
and to manage pain and opioid withdrawal. Evidence suggcsts kratom is being increasingly used
by people in the United States and Europc lor the self-managcmcnt ofopioid withdrawal and
treatment ofpain. Rccent studies have confirmed that kratom and its chemical constituents have
potentiatly useful pharmacological actions. However, there havc also been incrcasing numbers of
reports ofadverse effects resulting ftom use of katom products. In August 2016, the US Drug
Enforcement Administntion announced plans to classiry kratom and its mitragynine constituents
as Schedule I Controlled Substances, a movc that triggercd a massive response from pro-kratom
advocates. The debate regarding the risks, and benefits and safety of katom continues to intensiry.
Kratom proponents tout kratom as a safer and less addictive altemative to opioids for the
management ofpain and opioid addiction. The anti-katom faction argues that kratom, itself, is a
dangerous and addictive drug that ought to bc banned. Given thc widespread use ofkratom and the
extensive media attention it is receiving. it is impoflant for physicians. scientists and policy makers
to be knowledgeable about thc subject. Thc purpose ofthis comnrenlary is to update readers
about recent developments and controversics in this rapidly evolving area- All ofthc authors are
engaged in various aspccts of katom rcsearch and it is our intention to provide a fair and balanced
overview that can form the basis for informcd dccisions on kmtom policy. Our conclusions fiom
these analyses are: (a) User reports and rcsults ofpreclinical studies in animals strongly suggest
that katom and its main constituent alkaloid, mitragl.ninc may have useful activity in alleviatiug
pain and managing symptoms ofopioid withdrawal, even though well-controlled clinical trials
have yet to be done. (b) Even though kratom lacks many ofthe toxicities ofclassic opioids,
there are legitimate concems about the safety and lack ofquality control of purported "kratom"
products that are being sold in the US. (c) Thc issues rcgarding the safety and cllcacy of kmtom
and its mitragymine constituent can only bc rcsolved by additional research. Classification ofthe
Mitragyna alkaloids as Schedule I controlled substances would substantially impede this importanl
research on kratom.
lntroduction and background
Kratom (also known as ketum in Malaysia) is a tree-likc plant (Mitragyna speciosa, Kotth.
Havil) native to T'bailand, Malaysia. lndonesia and other regions ofSouthcast Asia. When
the plant's lcaves are ingested in the form ofteas or other extracts/decoctions, kratom
leaves produce complex, dose-dependent stimulant and analEesic eflects. For generations,
indigenous people in Southeast Asia have used katom to treat common health maladies
(e.g. diarrhea, hypertension, cough, fever, etc.), enhance work performance, combat fatigue,
alleviate pain, and manage opioid dependence (hereafter referred to as opioid use disorder
(OUD)) (Adkins, Boyel & McCurdy, 201 1; Cinosi et a1.,2015; Jansen & Prast, 1988;
Vicknasingam, Narayanan, Beng, & Mansor, 2010). This suggests that raditional use of
katom has therapeutic potential, or at least that it is used by people seeking improved
health and well-being- In considering the uses of kratom, in this commcntary we distinguish
Int ! Drug Policy. /rlt\hd manuscript: availablc in PMC 2021 Fehruary 13
Keywords
Kratom; Ketum; Mitragynine; Opioid use disorder (OUD); Pain management; Drug policy
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traditional use from "therapeutic use", which in the United States (US) and many countries
is defined by whether a substanc€ or product has been officially approved by a regulatory
authority such as the US Food and Drug Administration (FDA), gpically with reliancc
upon randomized controlled clinical trials for new drugs. We recognize that kratom has
not yet met standards for therapeutic use claims and has not been approved in the US for
"therapeutic use", despite the widespread and growing use of katom as a self-treatme[t for
a number ofdisorders, including pain, OUD, and depression or anxiety (Grundmann, 2017)
Rather, it is curently marketed and regulated in the US as a food and/or dietary ingedient
that is not subject to thc same strict regulations that are used for approval of new drugs.
Since kiatom has not been apptoved for therapeutic use in the U.S, it cannor legally be
advertised as a remedy for any medical condition.
Despite its long history oftraditional use in Southeast Asia, kratom has only recently
received significant aftention as a plant-based temedy in thc West. The emergence of katom
as a product of interest in the West, and particularly in the US, is evident fiom the results
of several recent suryeys, analyses of oflline user reports, and reviews of the scientific
litcrature (Prozialcck, 2016, Adkins et al.. 201 l; Grundmann, 2017; Kruegel & Grundmann'
2018; Pain News Network,20t8; Prozialeck, Jivan, & Andurkar,2012; Smith & Lawson,
2017; Swogger & Walsh, 2018; Swogger et al., 2015). Results ofthose analyses yield clear
evidence that a large number ofindividuals in North America and Europe are using katom
products for the self-management ofa number ofmedical conditions, including pain, OUD,
anxiety, and depression (Grundmann, 2017). In the US, for example, current estimates from
the American Kratom Association suggest that more than I million individuals in the USA
may be using kratom (American Kratom Association, 2018a), although incidence ofuse has
not been rigorously studied. At the same time, some unscrupulous marketers are promoting
kratom as an opioidJike "legal high" (Babu, McCurdy, & Boyer, 2008; G ffin, Daniels,
& Gardner, 2016: Rech, Donahey, Cappiello Dziedzic, Oh, & Greenhalgh, 2015; Schmidt,
Sharma, Schifano, & Fcinmana, 201 I ). Thc unregulatcd sale of kntom via the intemet
and deceitful marketing practices may have prompted some individuals to use katom as
a recreational drug. This poorly regulated market, wide distribution, and reported risks of
toxicity associated with katom use, are all likely to have encouraged regulatory agencies to
suggest the removal ofthis product fiom the market.
ln the West, a wide variety of kmtom products-including raw leaves, capsules, tablets,
and concentrated cxtracts-are available either from Intemet-based suppliers or specialty
stores commonly known as "head shops", "vaping shops" or "smoke shops". (Adkins et al.,
201 I ; Boodman, 2016; Kroll, 2016; Prozialeck et al., 2012), unlike in traditional setlings
where kratom is usually sold as freshly-brewed teas and decoctions (Singh, Narayanan, &
Mcknasingam, 2016). The growth of kratom usc in the West parallels increasing concerns
about the safety and abuse potential of katom. The emerging coltroversies regarding
katom were highlighted in August of 2016, when the US Drug Enforcement Administration
(DEA) announced plans to place the main active constitucnt of katom, mitragynine, and
a stnrcturally related compound, 7-hydroxymitragynine, in Schedule I ofthe Controlled
Substances Act (CSA), using its emergency scheduling authority (DEA,20l6b). This action
would have restricted the use ofkratom in the US and made it extremely dilfcult for
researchers to investigale the medicinal potential of katom (Prozialeck, 2016). The DEA's
lnt J Drug Policy. A\thot manuscript: available in PMC 2021 February tj
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proposed action sparked an unprecedented public debate and protesr, with thousands of
kratom users filing comments in thc Federal Register supporting the uset'ulness of katom
for the self-featment ofchronic pain or OUD without major abuse potential (DEA, 2016a).
In response to the intensc public outcry the DEA withdrew its notice of intent to schedule
kratom and has placed thc final dccision on indefinite hold pending an 8-factor ana:ysis
by the US !'DA (DEA, 2016b,2016c; Icoll,20l6; Prozialeck, 2016). As ofthis writing,
kratom remains lcgal throughout most ofthe US, although a few states. including Alabama,
Arkansas, lndiana, Vermont, and Wisconsin, havc banned it. On Octobcr 17,201'7,the
US Department of Health and Human Services asserted in a new letter to the DEA
that mitragynine and 7-hydoxynitragynine should be classified as Schedule I controlled
substance, a move that would severely restrict kratom use in the United States (Swetlitz,
2018). The details and timeframe tbr such a policy have yet to be worked out.
With regard to intemational regulatory agencies, neither kratom. nor any ofits alkaloids, are
currently listed in the 1961 and l97l Schedules of the United Nations Drug Conventions,
although kratom has been criminalized in Thailand. Malaysia, Myanmar, and Australia,
as well as several European nations. Notably, officials in Thailand have tfuice considered
endilg their katom ban since 2000, citing no known cases ofoverdose, death, or violence
following at least 100 years oftraditional use- Kratom-based drugs are curently classified
as New Psychoactive Substances (NPS) by the United Nations Office on Drugs and Crime
(UNODC), but do not appear on the agency's list ofemerging drug threats (UNDOC, 2019).
The European Union has taken a position that there is no approved use of kmtom or its
alkaloids in modem medicine (EMCDDA,20l5).
The legal uncertainty surrounding kratom appears to arise from two opposing nanatives. The
first is that kratom has potcntial therapeutic value as a substitutc for classical opioids (e.g.
morphinc. oxycodone, heroin, etc.), providing safer pain management and a novel way for
people who have OUD to wean themselves from the morc dangerous opioids (Grundmann,
Browa, Henningfield, Swogger, & Walsh.20l8; Henningfield, l'ant, & Wang,2018; Ward,
Rosenbaum, Hcmon, McCurdy, & Boyer, 201 I ). Thc sccond narrative is that kratom is a
dangerous and addictive opioid, and thcrcfore. should be classificd in Schedule I ofthe US
CSA (Gauvin & Zimmermann, 2018; HHS,201{t).
Given the widespread use ofkratom and the extensive media attention it is receiving,
physicians, scientists, and policy makers must be kno\trledgeable about the science of
l(Iatom. The purpose ofthis commentary is to proyide an update about recent dsvelopments
and controvercies in this rapidly evolving area from the perspective ofscientists who
are actively engagcd in various aspects ofkratom research. In this commentary, we will
address several key issues related to the opioid-like effects ofkratom, uncertainties about its
toxicities and addictive potential, as well as questions about its efficacy in the treahnent of
pain and OUD.
Int I Drug Policy. A$h$ manuscripl: availablc in PMC 2021 Fcbnrary 1l
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In describing their rationale for scheduling kratom (DEA,20l6b), the DEA emphasized
that the mitragynine-type indole alkaloids can interact with opioid receptors and produce
some opioidlike effects (Adkins et al., 201l; Kruegel & Grundmann, 2018; Matsumoto
et al., 2006; Thongpradichote et al., t998). In 2018, thc FDA went further by publishing
the rcsults ofits own molecular modeling study suggcsting that there were more than 20
substances in kratom that could theoretically intemct with opioid rcceptors (FDA, 2018c).
A major shon-coming ofthese molecular modeling studies is that the molecules were
never tested to determine if they did, in fact, have opioid agonist activity in living cells
or organisms (Grundmann et al., 2018). In considering the active compounds in kmtom,
it is important to note that the most well-documented pharmacological effects ofkratom.
namely analgesic activity and attenuation ofopioid withdrawal symptorns, can bc explained
largely by the actions ofmitragynine, thc primary alkaloid and also the most sludied
(Krucgel & Grundmam, 2018; Takayama ct al., 2002). Other alkaloids arc either devoid
ofknown pharmacological activity and/or, like 7-hydroxymitagynine, are present at such
low levels as to not be considered factors in kratom effects or toxicity (Adkins et al., 201 l;
Kruegel & Grundmann, 2018; Takayama et al., 2002; Takayama, 2004). It is also important
to note that mitragynine has other pharmacological actions that remain understudied. For
example, in preclinical studies, mitragynine has been found to modulate central serotonergic
and adrenergic transmission (Matsumoto et al., 1996) and inhibit prostaglandin production
(Utar, Majid, Adenan, Jamil, & Lan, 201 I ). Furthermore, mitBgynine has becn shown to
interact direcdy with other CNS drug targets, rendering it distinct from classical opioids
(Boyer, Babu, Adkins, McCurdy, & Halpem,2008; Kruegel & Crundmann. 2018). [t is also
important to note that the functional activity ofmitragynine at these targets may vary from
agonist to antagonist, but this is yet to be determined.
Most ofthe scientific evidence on kratom's opioid-like activity is derived fiom findings
in csll and animal studies, where mitragynine has been found to bind to and activate
opioid receptors, and induce opioid receptor-dependent analgesic effects (Adkins et al.,
201 I j Boyer et al., 2008; Kruegel & Grundmann, 2018; Prozialeck et al., 2012; Stolt et al.,
2014; Yusoff et a1.,2016). While no well-controlled trials ofkratom in humans have been
conducted, anecdotal reports and largel carefully conducted surveys have shown that people
have used kratom to successfully treal pain and OUD effects (Grundmann, 2017; Swogger
& Walsh, 2018), consistcnt with actions at opioid receptors. In addition, anecdotal reports
and commentaries indicate that some cflects ofkratom in humans, such as mild euphoria,
may resemble those ofopioid agonist drugs (Singh, Muller, Vicknasingam, & Mansor,20l5,
2016; Vicknasingam et al., 2010), but there is also strong evidence indicating thar kratom's
eflects are distinct from those ofclassical opioids (Henningfield et al., 2018; Singh, Muller,
& Vickmsingam,20l4,20l5,20l6; Mcknasingam er a1.,2010). For example, at low to
moderate doses, kratom has mild stimulant properties, unlike the sedating efects often
exhibited by opioids. In addition, katom does not seem ro produce an intense high or
euphoria at t,?ical doses (Cinosi et al., 2015; Erowid, 2016; Prozialeck et al., 2012;
speciosa.org, 2016; Wisdom, 2016). The most signilicant difference from opioids is that,
Pagc 5
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Should mitragynine and/or other kratom constituents be classified as
opioids?
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even at very high doses. kmtom is much less likely to depress respiration (to a fatal degree)
than classical opioids (Singh, Narayanan et aI..2018.2016: Varadi et al.,2016). Further,
at the molecular leyel, mitragyninc has a chemical structure that is quite diflerent from
classical opioids such as morphine, which are mostly derived lrom the alkaloids ofthe
opium poppy (Adkins et al., 201 I : Kruegel & Crundmann, 2018; Prozialeck el a1..201,2:
Takayama,2004). Recent studies indicate that even though mitragynine acts on opioid
recaptors, its over-all molecular actions arc quitc different from those ofclassical opioids
(Henningfield et a1.,2018; Prozialeck et a1.,2012). tn two recent studies, Varadi et al. (2016)
and Kruegel et al. (2016) demonstrated that mitragyninc and sevcral rclated compounds act
as G protein-biased agodsts at the mu-opioid receptor (MOR). ln other words, although they
actiyated G protein-mediated signaling pathways, much like classical opioids, they did not
activate the g-arrestin-2 signaling pathway. which has been implicated as a mediator of some
opioid-induced side effects, including respiratory depression (Raehal & Bohn,20l4; Schmid
et aI.,2017). Accordingly, the avoidance ofp-anestin-2 activation may in part explain the
apparent respiratory safety ofkratom, despite other opioid-like effects. These studies also
showed mitragynine to be a partial agonist at MOR, as compared to most classical opioids,
which are full agonists. Partial activity is also expected to attenuate the severity ofside
ellects. For example, buprenorphine, a partial agonist at MOR, cxhibits a dose ceiling for
respiratory depression (Dahan et aI.,2005).
lmportanrly, the improved side effect profile of mitragyrine and related compounds has
also been supported by preliminary animal studies. An early study with mitragynine
demonstrated attenuated respiratory depression and constipation for this compound
compared to the classical opioid morphine in several animal species (Macko, Weisbach,
& Douglas, 1972). Further, the Varadi study (Varadi et al., 201 6) dcmonstrated in mice that
a mitragyninc-dcrived compound, mitragynine pseudoindoxyl, induced marked analgesic
effects, but with attenuated respiratory depression, slower developmcnt oftolerancc, and
lower rewarding effects than morphine. Accordingly, both the natural compounds in katom
(e.9. mitragynine) and synthetic derivatires thereofmay represent a new class ofopioid-
acting drugs with an improved window between therapeutic elfccts and negative side effects.
As a result of its ability to interact with opioid receptors, mitragynine is often referred to
as an "opioid". On the other hand, a large volume ofevidence indicates that mitragynine
produces physiological. biochemical and behavioral effects that differ from those ofclassical
opioids. Even though some effects ofmitragyninc may involve partial activation ofMOR,
mitragynin€ is abl€ to interact v/ith many other receptors that classical opioids do not bind
(Boyer et al., 2008). In light ofthis evidence. mitagynine and its analogs can best be
described as "atypical opioids" (Raffa. Pergolizzi. Taylor, Ossipov. & Group, 2018), and
may actually represent a uniquc class ofdrugs.
ls kratom effective for the management of pain and/or OUD?
OUD continues to be a growing problem in the US. and the federal govemment has
begun to addrcss the challenge (Frieden & Houry, 2016; Harris' 2016; Nelson, Juurlink,
& Penone, 2015; NIDA, 2018b). Among actiqns taken by the federal govemment' the
most significant has been thc devclopment ofncw guidelines by the Centers for Diseas€
lntID g Policy. A\tthot manuscripl: availablc in PM( 2021 fcbruary l3
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Control and Prevention (CDC) for the prescribing ofopioids, tbr non-cancer pain (Dowell,
Haegerich, & Chou,20l6). In this environment, physicians are discouraged from prescribing
opioids. especially for long-term usage, a strategy that has compelled patients with chronic
pain conditioDs to seek altcmatives to prescription opioid analgesics (Anson, 2016; Pain
News Network, 20 [ 8; Smith & Lawson, 2017; Swogger et al., 2015). ln addition, many
patielts receiving opioids for chronic pain seck altomatives that have fewer side effects and
lower addiction potential than opioids (Anson, 2016; Pain News Network, 2018; Smith &
Lawson, 2017; Swogger et al., 2015).
Many individuals in the West have tumed to katom in the be lief that it may provide
an effective and safe altemative to prescription or illicit opioids, a view voiced by peers
on psychoactive substance websites such as l.:rorr rd rrlg (Erowid, 2016), Sage\\ isdom.org
(Wisdom,20l6), speciosa.org (2016) and Ilcddit.conr r'kratol (Reddit,20l8). Howeveq
kratom has not been eyaluated in thc t,?es ofmulti-center, controlled clinical trials that
are required by regulatory authorities, such as the US FDA, to conclude that a drug is safe
and ellective for thc tcatment of OUD or other indications. Nonetheless, katom has a long
history of such use that is widely accepted in the general population in Southeast Asia,
where it is commonly used as an affordable substitute for sheet heroin or other opioids
(Vicknasingam et al., 2010). For example, a study conducted in northem Malaysia used
convenience sampling to identiry and survey 136 kratom users (99% male) in areas where
heatry katom use was reported (vicknasingam et al., 2010). Results indicated that 90%
ofthe subjects were using kratom as a substitute for illicit opioids and 8470 reported that
kratom helped to reduce their dependence on opioids and severity of withdrawal symptoms.
Another Malaysian survey (Singh et aI.,2015) used snowball sampling to enroll 293
adult males. most ofwhom were manual laborers who had used katom for at least six
months. Fifty perccnt indicated that they had used kratom to climinate addictions to illicit
substances, including opioids and cannabis, and/or to relieve withdrawal symploms. Such
use has increasingly been reported in the US through intemet suweys of katom users
(Grundmann, 2017; Grundmanr et aI..2018: Smith & Lawsoo,20l7), and in more than
23,000 comments to the DEA and FDA (DEA,20l6a; Henningfield et a1.,2018). Thus,
even though we do not makc the claim that kratom should be viewed as a medically proven
effective and safe therapy for OUD, we believe it is wananted to take seriously the extensive
user reports and analyical surveillance indicating that many people are self-managing their
OUD using katom. Such information may be considered a form of Real-World Evidence
that is taken seriously by users and many scientists and should not be ignored by the FDA
which has stated that "Real world data (RWD) and real world evidence (RWE) are playing
an increasing role in health care decisions" and is used to make "regulatory" decisions.
The situation is analogous with respect to the management ofpain, where kmtom has not
been approved as an analgesic medicine, but reliefofpain is among the more commonly
rcported uscs (Grundmann, 2017; Henningfield et a1.,2018; Pain News Network,20l8;
Swogger et al., 2015). Caution is wananted in comparing results from these studies, as doing
so requires accounting for potendal cultual, demographic, and prcduct-related moderators
ofeffects and bias introduced due to research methodology. Nonethelcss, the results of
observational studies of kratom users in the US converge with case reports and descriptions
oftraditional katom use in Southeast Asia to suggest that kratom does have utility as a
Int I Dtug Polict. Anthcl manuscripr; avaitablc in pMC 2021 Fcbruary Il
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substitute for potentially more dangerous classical opioids in treating pain and OUD and
should be studicd in well-controlled clinical trials for such indications (Henningfield et al.,
2018). [t is also worth noting that thc extensive anecdotal reports ofanalgesic afiiviry in
humans are consistent with the partial agonisl activity ol'mitragynine at MOR and findings
in animal models ofpain. where mitragynine and kmtom extracts cxhibit analgesic activity.
With respect to the use of katom for self-management ofOUD, the statements by the
US National Institute on Drug Abuse (NIDA) and the FDA are quite distinct. The FDA's
position is that kratom usc can cause deleterious health risks and that katom users
should tum to approved ffeatments (FDA, 2018c), despite the reality that many such
usen have comment€d to the DEA and FDA that such aeatments were not available or
acceptable, whereas katom was accessible and helpful. In contrast. without discouraging
or encouraging kratom usc. NIDA simply states the facts on its wcbsite that kratom ( l)
is used by people to self-manage withdrawal and OUD and (2) that katom has not been
demonstrated to be safe and effectivc for pain treatment, in contrast to available opioid
medications (NIDA, 2018b).
The many positive user comrnents on l:ro$ rti org (Erowid, 2016), Sag.-Wisdorr.org
(Wisdom,2016), Reddit.c(,r1r./rrkretoor (Reddil,2018) and Speciosu org (speciosa.org, 2016)
comprise an extensive collection ofanecdotal data documenting klatom use. Scientific
analyses ofsuch user reports clearly indicate that the therapeutic potential of kratom
is too large to be ignored (Swogger et al., 2015). The 23,000+ comments submitted to
the federal register in response to the DEA's proposed scheduling action also provide
a vast collection of anecdotal data suggesting profound therapeutic benefits for kratom
(DEA, 2016a). Another piece ofevidence suggesting that kratom may havc significant
therapeutic potential is that US patents have been issued for companies and individuals
who are interested in devcloping kratom-based drugs (Hcyworth, 1964; Takayama, Kitajima,
Matsumoto, & Horie,2008). Togethcr, these observations provide evidence that katom may
have poteltially useful therapeutic effects, and that well-controlled clinical trials are urgently
needed to evaluate the safety and efficacy of katom and its principal alkaloid mitragynine.
Many katom advocates have claimed that kratom is a safe and effective altemative to
opioids for the treatment of OUD (Erowid, 2016; Singh et al., 2016; Toce, Chai, Bums,
& Boyer, 2018). [n this context, kratom is analogous to agents such as methadone and
buprenorphine, which are widely used as replacement therapies in the treatment ofOUD
despite the fact that the treatment agents themselvcs may have significant potential for abuse
(Eibl. Morin-Taus, & Marsh.20l6l HHS,20l6: Toce et a|.,2018). Kratom (or compounds
derived therefrom) may, in fact, have even greater therapeutic potential, especially in light
ofevidence suggcsting that it lacks the severe overdose risk ofclassical opioid drugs,
including methadone (Singh ct al., 2014. 20 t 5; Singh ct al., 2016; Toce et al., 2018). ln
fact, more than 3,000 methadone-related fatalities were reported in the US in 2017 (NIDA,
2018a), suggesting that existing FDA-approved therapics for OUD have significant safcty
shortcomings that might be addressed in part by altemative kratom-based therapies'
IDt J Drug Poticy. Authot manuscriptr availabl€ in PM('2021 lcbruarv l3
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How serious are the abuse and addiction potentials of kratom?
Regular use of kmtom, particularly at higher doses, can lead to tolerance and dependence
(Galbis-Reig, 2016; Singh et a1.,2014; Swogger & Walsh,20l8; Yusoffet al.,2016).
However, available human reports suggest that abstinencc from kratom is typically
associated with milder symptomatology than abstinence from classical opioids (Erowid,
2016; Singh, Narayanan et al., 2018, 2014; Singh et al., 2016). At the same time, although
these reports indicate that the effects of katom can, in some ways, resemble those of
opioids, many individuals rcport that the subjective effccts ofkratom are quite different from
those ofopioids. As noted previously, low to moderate doses of katom t€nd to be somewhat
stimulating, mther than sedatiflg, and do not produce the "high" or strong euphoric effects
associated with opioids, although some users have reponed intoxication and euphoria afler
using higher doses (Erowid, 2016; Singh et al., 2016i speciosa.org, 2016; Swogger et al.,
2015; Wisdom,20l6). This distinct spectrum ofeffects, including attenuated euphoria and
abuse potential, is supported by fwo recent preclinical studies, which found that mitragynine
is not self-administored by rats (Henrby, Mclntosh, Lcon, Cutler, & McCurdy,20l8; Yue,
Kopajtic, & Katz, 2018). Further, even at high doses, kratom does not appear to severely
depress respiration as do classical opioids (Singh et al., 2014, 2016). Thus, even though
katom has some potential for abuse and dependence, several investigators have concluded
that katom has both less abuse liability and much lower risk of fatal overdose than
traditional opioids and that the potential benefits of kratom in the treatment ofouD may
outweigh these risks (Henningfield et al., 2018; Singh et al., 2014, 2015; Singh et al., 2016;
Swogger ct al., 2015). This does rlot mean that kratom is not som€times used by people
to get high and/or intoxicated because such use has been documented (Swogger et al.,
2015). Such findings were also considered by Henningfield et al. (201E), who concluded that
the oyerall assessmcnt ofkratom did not warrant it being listed as a controlled substance.
They noted that many substances, including over-the-counter drugs (for cough and cold
symptoms) and dietary ingredients, are also sometimes misused and abused for the purposes
ofcausing intoxication and to get high, yet overall, seem appropriately left unscheduled.
Are kratom products safe?
In recent years, kratom use has been associated with increasing reports ofadverse health
effects, including death in rare cases (Anwar, Law, & Schier,2016; Forrester,20l3; Ulb cht
et a1.,2013; Wamer, Kaufman, & Grundmann,20l6). These increases in adverse events
were cited as a major mtionale for the DEA's proposal to ban kratom (DEA, 2016b).
However, there is no concrete evidence to prove that kratom was the main culprit in all 44
total fatalities reported worldwide by the FDA as of 2018 (FDA, 2018c). At Iow to moderate
doses of5 g of raw leaves or less, the adverse effects vary markedly &om one individual
to another, but generally appear to be mild (Anwar et al., 2016; prozialeck et al., 2012;
Singh et al., 2014, 2016). The most common adyerse effects are auiety, irritability, nausea
and vomiting (Anwar et al., 20t6; prozialeck et al., 2012; Singh et al., 2014; Swogger et
al., 2015). More troubling have been occasional reports of more serious toxicities, often
associated with high dose usage or usage ofconcentrated extracts in the west. somc ofthe
reported adyelse ellects include tachycardia, liver damage, and seizures (Doman, Wong,
& Kian,20l5; Kapp, Maurer, Auwartet Winkelmann, & Hermanns-Clausen, 201 l; Lu et
Int J Drug Policy. A\ttiot manuscript; avaitable in pM(j 2021 Fcbruary tl
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al.,20l4i Nelsen, Lapoint, Hodgman, & Aldous,2010i Pantano et a1.,2016). In addition,
several deaths have been attributed to the use of"kratom" products (Anwar et al., 2016;
DEA,20l6b: FDA.20l8c: cershman ct a1..2019; Karinen, Fosen, Rogde, & Vindenes,
2014; MclntJre, Trochta, Stolberg, & Campman,2015: Neerman. Frost, & Deking,20l3;
Wamer et al., 20161 Wing, 2018), although in many such cases causality was not clearly
linked given that little is known about lethal dose levels of katom in humans (Gershman
et al., 2019; Wing, 2018). Further, in some cascs, sevcrc adverse events may stem from
the use of adulterated "kratom" prcducts contaminated with other substances (including
potent synthetic opioids) or where the content ofthe principal alkaloids mitragynine and
7-hydroxymitragynine is enriched compared to natural leafmaterial (Kronstrand, Roman,
Thelander, & Eriksson, 201 l; Lydecker et al., 2016). In contrast, when used in its traditional
context, pure kratom leafis unlikely to produce serious adverse effects in the vast majority
ofuse$ (Trakulsrichai et al., 2013). ln fact, thcre have been no reported deaths attributed to
kratom in Southeast Asia whcn used in the traditional setting as unadulterated. pure kmtom
leaf.
While the foregoing summary indicates why the FDA's and DEA's concems about the
safety of kratom are reasonable, several factors require consideration in evaluating whether
the FDA's and DEA's proposed bans are justified. Filst are the rclative statistics. ln
announcing their decision to ban kratom, the DEA emphasized that between January 20[0
and December 2015 there had been 600 calls to poison control centers regarding adve$e
reactions to kmtom products (DEA, 2016b). More recently, the FDA has rcported ,14 total
deaths associated with use of katom products worldwide (FDA, 2018c). While these might
seem on their face to be alarming numbers, they are actually rather small compared to the
49,000+ opioid overdose deathstn20lT tlonc (NIDA, 2018a). ln addition, the extent to
which kratom playcd a role in the available lethal case reports is uncertain. In the majority of
these cas€ reports associating kratom with lethal outcomes, patients haye had confounding
health conditions, have been using othcr drugs along with katom, or both (Galbis-Reig,
2016; Gershman et al., 2019: Prozialeck et al., 2012; Singh et al.. 2015, 2016; Wing, 2018).
Moreover, in the absence ofevidence for a defined mechanism by which katom would
Iead to death (e.g. rcspiratory depression), these anecdotal reports involve considerable
speculation and do little to establish a scientific backing for the proposition that kratom is
potentially deadly.
One ofthe major problems in evaluating the potential uscs and safety ofan herbal agent
such as kratom is the lack ofunderstanding ofhow mitragyninc and other substances irr
kratom may intemct with each other. prescription medications, drugs ofabuse, or even
herbal supplements (Prozialeck et al.,2012r Ulbricht et a1.,2013). Recent findings show
that kntom and its alkaloids are direct inhibitors and/or transcriptional inducers ofa
number of cl.tochrome P450 enzymes and P-glycoprotein, suggcsting a significant potential
for katom to cause complex herb-drug interactions that requirc further study (Hanapi,
Ismail, & Mansor, 2013; Kong et al.. 201 l; Lim et al., 2013; M atda et al.,2014' 2011'1.
These issues are compounded by a lack ofregulations and standardization related to the
production and sale of "krutom" products. Further, an increasing body ofevidence supports
the h)?othesis that many unscrupulous purveyors of"kratom" are adulterating their products
with potentially toxic drugs (Chittakam, Penjamras, & Keawpradub, 2012; Griffrn et al',
IntJ Drug Policy. Anthot manuscript; available in PMC 2021 Fcbruary ll
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2016; Lydecker et a1.,2016; Scott, Yeakel, & Logan,20l4). Probably the most notorious
example ofsuch adulteration involved a product known as "Krypton", which was touted as
a very potent form of katom. lt was sold mainly in Europe and was found to be a factor in
at least 9 deaths (Kronstrand et a1.,2011;Nelsen et a1.,2010). Detailed forensic analyses,
however, revealed that Krypton was adulteratcd with large amounts ofthe synthetic opioid
Adesmethyltamadol, which has potent opioid and neuromodulator activity (Kronstm[d
et al., 20l l). Even though mitragynine was also detected in the products, it was not
determined how the two subslances may have interacted to cause death. ln another study,
several purported kratom products wete found to contain 7-hydroxymitragynine (a more
potent opioid alkaloid) at concentrations significantly higher than those found in plain leaf
products (Lydecker et al., 2016). The source of the high levels of 7-hydroxyminagynine
reported in that study remains unclear More recently, the FDA has raised concems about the
contamination of kratom products with Salmonella (FDA, 2018a) and toxic metals (FDA,
2018b). These reports ofcontamination ofsome kratom products highlight the need for
quality control policies in the production and sale of kratom.
Without standardization, use ofgood manufacturing practices, and strict quality control
measures by manufacturcrs and distributers, individuals who ingest "katom" products
cannot be sure what they are taking. This problem suggests that systematic and cautious
regulation of katom products is likely to improve their safety. Such rcgulation and
standardization is cenainly needed, but it is unclear how such quality control progams
can be developed and administered. One possible approach mighl be to use mical
concentmtions ofmitragynine and 7-hydroxymitragynine found in kntom leafas ceilings
for alkaloid content ofall products. It would also be essential that the products be tested to
show that they have not been fortified or contaminated with other substances. particularly
opioid derivatives. The American Kratom Association has recently announced plans to
address many ofthese issues by adopting a set of"Good Manufacturing" standards for the
katom industry (American Kratom Association, 2018b).
Despite the quality cont ol issues with katom products in the Wcst, a largc numbcr
ofscientists havc statcd that in its traditionally used form (kratom leafdecoction or
powdered leaf form), katom appears to be relatively benign, especially in comparison to
classical opioids such as hydrocodone, oxycodone, or heroin (Singh et al., 2015, 2016;
Trakulsrichai et al., 2013). In writing these conlments, we wish to emphasize that we, too,
have concems about the safety ofso-called "k.atom" products. Moreover, since kratom
contains pharmacologically active compounds (which it clearly does), it ccrtainly has
potential toxiciti€s. Nevertheless, the scientific litcrature supports the conclusion that, in
pure herbal form and in moderate doses of lcss than 5 g, purc leafkratom appears far
less dangerous than classical opioids. Rccent kratom studies from Southeast Asia show that
Iong-term kratom use does not appear to alter hematological and biochemical parameters
(Singh, Mullcr ct al., 2018) or intcrfcre with uscrs' abilities to function in society (Singh et
al., 2015). So far, no serious health incidents associated with katom use have been reported
among regular users in traditional settings.
Int J Drug Policy. A]ulhot manuscript;availablc in PM(l202, Fcbruary 13
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Summary
PaSe 12
and perspective
Kratom is widely used in thc West and Southeast Asia as a relativcly safe herbal supplement
(traditional medicine) for the self-treatment ofmcdical disorders, including pain and OUD.
Extensive reports from kratom uscrs, considcred alongside limitcd basic science and clinical
research studies, suggest that kmtom and its constituent compounds (especially mitragynine)
may in fact have beneficial pharmacological and therapeutic propeflies. Unfortunately, no
well-conkolled clinical trials haye becn performcd to date to dctermine the true risks and
benefits of katom use in humans. The high monetary costs of such clinical trials greatly
complicate this issue, given that sufficient intellectual property protection to justiry the large
capital investments necessary for formal drug approval is often challenging to obtain for
natural products like kratom. In response to the growing concems about safety and abuse/
addiction potential. it appears that the DEA is planning to classify kratom, mitragynine,
and 7-hydroxymitragynine as Schedule I confolled substances, despite the preponderance
ofpreclinical and anecdotal human evidence indicating that kratom is Iess harmful than
prescription opioid analgesics or illicit opioids.
We believe that actions by the FDA and DEA to classify mitragyninc as a Schedule I
controlled substance could have several unintended consequences. First, such a classification
would likely foster a significant "black market" for kratom products. Many thousands of
individuals in the US have been using kratom as a means ofavoiding use of more dangerous
classical opioids and are terrified of losing what they vielv as a life-line to sobriety (Anson,
2016; DEA,20l6c; FDA,20l8c; Henningfield et al.,2018). It is reasonable to conclude
that under Schedule I restrictions. a subsct ofkratom users would tum to or retum to
prescription or illicit opioids. resulting in an increase in unintended negative public health
consequences, including higher incidence ofOUD, incarceration, and overdose death. A
second potential problem is that a move ofkratom or its cons(ituents to Schedule I will make
it much more difficult for researchers lo conduct necessary research exploring katom's
medicinal potential (Chen, 2016). In this regard, thc legal milicu surrounding katom
is comparable to what has happcned with "medical marijuana" and psychedelic-assisted
therapies, where federal policies, including classification as a Schedule I substancc, havc
impeded hypothesis{riven research investigations (Belouin & Henningfield, 2018; Stith &
Vigil,2016). Many institutions and govemment agencies are reluctant to fund research on
Schedule I substances because such work involves infrastructure and resources that many
institutions lack (Belouin & Henningfield, 2018).
Even in the absence ofcumbersome controllcd substance rcgulation, many practical issues
complicate research on herbal products such as kratom. For cxample, what type of
katom products (extracts or leafmaterials) should bc evaluated? How would products
be "standardized" for activity? Sincc kralom contains a mixture ofactive compounds,
this would be ar exfiemely complex problem to rqsolvc. One solution might involve
focusing on specific chemical constituents, such as mitragyninc. However, in studying
single molecular entities, researchers might miss important contributions ofother active
constituents in kratom. This would require additional studies on the interactions of mixtures
ofcompounds from kratom. Another major challenge is presented by the conelation
ofhuman consumption practices with laboratory animal models. Clcarly, more scientific
IntJ Drug Policy. A]lhor manuscript; availablc in PM( 2021 I'cbruary 13
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References
Page Il
research is needed to address these issues, which would be much more challenging under
Schedule I regulatory policies.
While this manuscript was under review. one of our co-authors, Dr. Bonnie Avcry pass€d away after a courageous
balrl€ with canccr. Dr. Avcry $as a leader in kralom rcsearch, an outstandrng colleague and a wondcrful person- wc
hercby dcdicatc the paper to Dr. Avcry. Shc will be missed. bul not forgolten.
Adkins JE, Boyer EW & McCurdy CR (201l). Mitragyna speciosa, a psychoactive tlee ftom
Southcast Asia with opioid activity. Cunent Topics in Medicinal Chemistry, I l(9), I 165 I I75
doi:BSP/CTMCE-Pub/-00019-l l-l [pii]. [PubMed: 21050173]
American Kratom Association (2018a). Retrieved fiom hltf ,,*rv*.aurcricrnlralitor.otg.
American Kmtom Association (2018b). American Kratom Association
announces good maaufacturing practice (GMP) standars ior
vendors. Retrieved iiomhttp5:./r ww w. prncu r \\ ir!. col, ilr'ws-rt lcas csr nm c ricil n-k rir I urll-:r 1\oc rJl ro n-
irnnounccs-tLood-nr.rnulrcruflDglnLratlcr-gnrp-srllrJarrl'-tbrrcrdrrrs-]lr();5ll5lhtrnl.
Anson P (2016). K.atom users say Ban will lead to more drug abuse. 2016, Retrieved fromPain
NetworkNewshrlp:/;!!\{!\.litirncNsnrl\rork.org,\l(r'l!'s2{}L69,l1lkra()nr-uscrs-sat-bau-will-laad-
tl>nl,n!-dnlr-Jbus!.
Anwar M, Law R, & Schier J (2016). Notes from the Field: Kralom (Mitragyna speciosa) exposures
reported to poison centers - United States,20l0-2015- MMWR Morbidity and Mortality Weekly
Report, 65(29), 748-749. I0. 15585/mmwrmm6529a4. [Pr$Med: 27 466822)
lnt I Dn,s Policy. L\lthot manu$ripI; alailable in PMC 2021 I:cbruary I3
Acknowledgement
Kratom/ketum has been traditionally used in Southeast Asia for at least the last century for
its medicinal properties. This traditional use of unadulterated, natural kratom lsafhas not
resulted in large-scale abuse and toxicity. Further, significant evidence ofthe bcnefits of
kratom gleaoed from this traditional use certainly warrants fi[ther study. We conclude that
well-designed, controlled human clinical trials are needed to more thoroughly investigate
thc therapeutic and addictivc potentialof katom; to establish safety and toxicology limits;
and also, to evaluate pharmacological responses among various populations who might
consume kratom. The effects of kratom in the general population are poorly described, while
data on special populations, such as children, elderly, pregnant females and the developing
fetus, and patients with confounding health conditions, are essentially non-existent. Finally,
almost nothing is known about how kratom might intoract with other drugs or he6al agents
that subiects may be using. Unfonunately, future control as a Schedule I substance would
erect substantial barriers to this necessary research. Furthermore, the source offtrnding for
such work is unclear, given the limited commercial oppoltunity provided by unpatentablq
natural products. One possible approach to begin flrnding rcsearch might be for katom
trade organizations and./or vendors to prcvide research grants to members ofthe scientific
cornmunity. Also, kalom provides avenues for entrepreneurial-driven research, much like
what is now happening in the burgeoning marijuana industry. Despite these significant
challenges, clinical trials into the safety and efficacy of kratom and mitragynine can and
should be done. It is our sincere hope, as katom researchers, that this commentary will
facilitate an informed discussion about katom and lbster thc necessary research to resolve
thc scientific and regulatory issues pr€sented here.
Page 14
Babu KM, McCurdy CR. & Boyer EW (2008). Opioid receptors and legal highs: Salvia
divinorum and Kratom. Clinical Toxicology (Philadelphia. Pa.). 46(2\,146 152 doi1789497982
lpiil; 10. 1 080/I 5563650'7 01241795.
Belouin SJ, & Henningfield JE (2018). Psychcdelics: whcre we are now' why we got here. what we
must do. Neuropharmacology. 10. l0l6/j.neuropharm.20l8.02.0l8.
Boodman E (2016). Lawmakers urge DEA to reconsider' hasty'ban ofopioid-like kratom 2016,
RetrievedfromSTAThltp\'w\\\strrnc\r'\.conl2lll6.{)921kra(nfi-ban-d!-r-congrc\\.
Boyer EW, Babu KM, Adkins JE, Mccurdy CR, & Halpem JH (2008). Self-treatmeot ofopioid
wirhdrawalusing kratom (Mifagynia speciosa korth). Addiction, 103(6), lM8-1050 doi:ADD2209
lpiil; l0.l I I l/j. 1360{443.2008.02209.x. [PubMed: 184E2427]
Chen A (2016). Kratom drug ban may cripple promising painkiller research. Scientific
Afieican.9l27 /2016, Retrieved liom htlf\:' \\ \! \\' !!icntilicamcrican.r{,rr'rfliclcrkralonr-drug-
tran-rnar-criflrlc-promising-painkillcr-rescar'cht.
Chittrakarn S. Penjamras B & Keawpradub N (2012). Quantitative analysis ofmitragynine, codeine,
caffeine, chlorpheniramine and phenylephrine in a kratom (Mitragyna speciosa Korth.) cocktail
using high-performance liquid chromatography. Forensic Science Intemational, 217(l -3), 8l-86
doi:S0379-0738(l l)00502-0 [pii]:10.1016/j.forsciint.20l 1.10.027. [PubMed: 22018854]
Cinosi E, Martinotti G, Simonato R Singh D, Dcmetrovics Z, Roman-Urrestamzu A, ---Corszz O
(2015). Following "the roots" ofIc-atom (Mitragyna speciosa): The evolution ofan enhancer from
a ffaditional use to increase work and productivity in Southeast Asia to a recreational psychoactive
drug in westem countries. BioMed Research lntcmational, 2015, 968786. 10.I 155/2015/968786.
IPubMed: 26640804]
Dahan A, Yassen A, Bijl H, Romberg R, Saaon E, Tcppema L, ... DanhofM (2005). Comparison
ofthe respiratory ellects ofintmvenous buprenorphine and fentanyl in humans and rats. British
Joumal of Anaesthesia, 94(6), 825 834. 10.1093/bja,taeil45. [PubMed: 15833777]
DEA (2016a). Docket folder summary/schedules ofcontrolled substances: Temporary
placement ofmitragynine and 7-hydroxymitragyninc into schedule I. Retricved from hrt|s:/,'
u u \.r tqulalions.r0r.do( l.r7l) DI:,\-2016-001i.
DEA (2016b). Schedules ofconaolled substances: Tcmporary placement
ofmitragynine and 7-hydroxymitragynine into schedule I-
Noles: Document number: 2016-20803. 2016. Retrieved fromFederal
Registerhlms:,.r\\1\\\lcdcrrir.gistcr.gor,rii(unrLrnls20la),{18.1i,2016-:()l0irsch.dulos-o1-
conlrollcd-sul-"tlnrc"-rcnrl\)l'0n-pliru.nr('f1i)l-rrilra!!nnrc-lrnd-l-h\dft)\.yn1i(r.r!\rinc-rnro
DEA (2016c). Withdrawal ofnotice ofintont to temporarily place mitragynine and
7-hy&oxymitagynine into schedule l. 2016, Retrieved fiomlederal Register hflps'
wwrv.deadiver sion Lrsrlol.g(r',1'c(l r.g\rrlrlL'si20l fr lillrl l l)(nr.
Dorman C, Wong M, & Kian A (2015). Cholestatic hepatitis from prolonged kmtom use: A case
.eport. Hepatofogy, 61(3 ). 108& 1087. 10.1002Aep.27612. [PubMed: 25418457]
Dowell D, Haegerich TM, & Chou R (2016). CDC guideline for prescribing opioids for chronic
pain - United States, 2016. MMWR Recommendarions and Repofts,65(l), l-49. http\:. doi.org,
1(). I 55351lnur\rr.11650 l. l.
Eibl JK, Morin-Taus KA. & Mush DC (2016). Too much or never enough: A response to heatment
ofopioid disorders in Canada: Looking at the' other epidemic'. Substance Abuse Treatment.
Prevention, and Policy, I I ( 1), 33. l0.l 186/sll0l l -016-0076-2 10.I l86Al30l 1-016-0076-2 [pii].
EMCDDA (2015). Kratorn (Mitragyna speciosa) drug profile- Retrieved fiom hup:r:
\rw\r'.cnrcdda cnropx cu,nublicltions drugjrrol jlcs. krrbnr.
Erowid (2016). Ic-atom. 9/30/2016, Retrieved frofiErowid htp\:r,cr(Nid.orlrllanls,'kratom/
kratoln.shrrnl.
FDA (2018a). FDA investigated multistate outbreak ofsalmonella infcctions lnked to
products reportcd to containyJatorl], [Press release&elrieved fromhtlp\. u\\\\ Iila.go\ lbod
, c(allsoolblcakserrrcucncics oulbralrk,'tlcnr.597265.hlnt.
FDA (2018b). Statement by FDA commisioner scott goftlieb, M.D., On risk of heavy metals,
including nickel and lead, found in some kratom products /Press releas4 Retrieved fiom htll)sr'l
*rru fd;r gor \crrsl;rents,'Nerr:r'rxrrI Prc\s,\l)lr,)ulrUcrn. 1s,ucln.6267j3.htrD.
E
=o
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Int J Drug Policy. A,nthot manuscript;available in PMC 2021 Fcbruary 13
PROHIBITING THE MANUFACTURING, SALE AND DISTRIBUTION OF KRATOM
A. Statement of Purpose and Authority:
Whereas, Kratom, a tree-like plant indigenous to Southeast Asia, produces stimulant and sedative
effects when orally ingested in tablet, capsule, or extract form. Kratom leaves can be chewed or
dried and ingested as a tea. Use of Kratom can lead to psychotic symptoms, and psychological and
physiological dependence because it contains mitragynine and 7-hydroxymitragynine, two major
psychoactive ingredientsl.
Whereas, Kratom is not regulated by the State of Massachusetts or the federal government
Whereas, the Massachusetts Supreme ludicial Court has held that "[t]he riSht to engage in business
must yield to the paramount right of government to protect public health by any rational means."2
Therefore, in furtherance of its mission to protect, promote and preserve the health and well-being
of its residents, and pursuant to the authority granted to the Dracut Board of Health pursuant to
G. L. c. 111, S3L, the Board of Health enacts this Regulation Restricting the Sale and Distribution of
Kratom.
B. Definitions:
For the purposes ofthis regulation, the following words shall have the following meanings:
Board:The Dracut Board of Health
Business Aaent: An individual who has been designated by the owner or operator of any business to
be the manager or otherwise in charge of said establishment
Compliance Check: An enforcement activity where a person is sent into an establishment to attempt
to purchase a restricted or prohibited product.
Kratom: Refers to the leaves or an herbal extract from the leaves or the other parts of an evergreen
tree in the Rubioceoe family native to Southeast Asia called Mitrogyno Specioso, that contains as its
primary compounds, mitragynine and 7-hydroxymitragynine, which produces stimulant-like effects
in low dosages and opioid-like effects in high dosages, and it may be marketed in different forms,
including but not limited to smokeable products, tea, capsules, and as an additive to soft drinks or
other products.
1 DRUG ENFORCEMENT ADMlN., GET SMART ABOUT DRUGS, available at
http:l/www.eetsmartaboutd ruas. gov (last visited February 13, 2023).
2 Druzik v. Bd. Of Health of Haverhill, 324 Mass. t29, t3g l7g4gl
Med., 239 Mass. 424, 428 (1921)).
1
citins Lawrence v. Bd. Of Res istration in
REGULATION OF THE DRACUT BOARD OF HEATTH
Person: Any individual, firm, partnership, association, corporation, company, or organization of any
kind, including, but not limited to an owner, operator, manager, proprietor, or person in charge of
any establishment, business or retail store.
C. Sale of Kratom Products:
1. No person shall manufacture, distribute, sell, or offer for sale Kratom i!_q!Jg!!LDIqt as
defined herein, or any Kratom derived products, or any products containing Kratom as an
additive in the Town of Dracut
D. Violations:
1. Any person or entity charged with violating this regulation shall receive a notice of violation
from the Dracut Board of Health or its designated agent(s).
2. lt shall be the responsibility ofthe establishment owner and/or his or her manager or
business agent to ensure compliance with this regulation. The violator shall receive:
It,
ln the case of a first violation within a 35-month period, a fine of one thousand
dollars (S1000.00),
ln the case of a second violation within 36 months from the first violation, a fine
of two thousand dollars (52000.00), and a suspension of any permit issued by
the Board, including but not limited to a permit to sell tobacco products, for
seven (7) consecutive business days.
ln the case of three or more violations within a 36-month period, a fine of five
thousand dollars (55000.00) and a revocation of any permit issued by the Board,
including but not limited to a permit to sell tobacco products.
3. Every day that a violation exists shall be deemed a separate offense. lf multiple violations
occur stemming from the same inspection or compliance check, they shall be treated as
separate violations.
4. Failure to pay a fine issued pursuant to this regulation within 21 days of its date of receipt by
the violator shall constitute a separate and subsequent violation of this regulation subject to
the penalties set forth at paragraph 2 of this section. Payment of a fine is not required while
an appeal is pending.
5. Any person who receives notice of a violation of this regulation may request and appeal
hearing before the Board. The request must be made in writing, signed by the violator or the
violato/s attorney, filed with, and received by the Dracut Health Department within ten (10)
business days of the date the notice of violation was received by the violator.
6. Any resident who desires to register a complaint pursuant to this regulation may do so by
contacting the Dracut Health Department.
7. Before suspending or revoking any permit issued by the Dracut Board of Health, including a
permit to Selltobacco products, the Board shall provide notice ofthe intent to suspend or
revoke such permit, which notice shall contain the reasons therefor and shall establish a
2
time and date for a hearing, to be held no earlier than ten (10) business days from the date
of receipt of the notice. The permit holder or their designee shall have the opportunity to be
heard and shall be notified of the Board's decision and the reasons therefor in writing. lf
after hearing, the Board finds that a violation of this regulation occurred, the Board shall
suspend or revoke the subject permit. Such suspension or revocation shall not be carried
out sooner than ten (10) business days of the date of receipt of the Board's decision. For
purposes of such suspensions or revocations, the Board shall carry them out unless it
receives an order of stay or injunction from the appropriate court before the date the
suspension or revocation is set to go into effect. Upon suspension or revocation of a permit,
all products subject to that permit must be removed from the retail establishment. Failure
to remove such products shall constitute a separate violation of this regulation. Multiple
permit suspension may not be served concurrently.
8. Failure to comply with the terms of a permit suspension imposed pursuant to this regulation
may subject the permit holder to additional fines, as provided in paragraph 2 of this section,
and suspension of all Board-issued permits for thirty (30) consecutive business days.
E- Enforcement:
Enforcement of this regulation shall be carried out by the Dracut Board of Health or its
designated agent(s).
F. Severability:
lf any provision of this regulation is found to violate State or Federal preemption laws or is
declared invalid or unenforceable, all other provisions shall not be affected thereby but shall be
in full force and effect. This provision shall not apply if section C (1) of this regulation is found to
violate State or Federal preemption laws or is declared invalid or un-enforceable.
G. Effective Date:
This regulation shall take effect on April 1, 2025
(Signature on file)
Dr. Louis Rousseau, Chairman
(Signature on file)
Cynthia Campbell R.N., Vice-Chairman
(Signature on File)
3
Tom Bomil, Clerk
REGUTATION OF THE DRACUT BOARD OF HEALTH
PROHIBITING THE MANUFACTURING, SAIE AND DISTRIBUTION OF KRATOM
A, Statement of Purpose and Authority:
Whereas, Kratom, a tree-like plant indigenous to southeast Asia, produces stimulant and sedative
effects when orally ingested in tablet, capsule, or extract form. Kratom leaves can be chewed or
dried and ingested as a tea. Use of Kratom can lead to psychotic symptoms, and psychological and
physiological dependence because it contains mitragynine and 7-hydroxymitragynine, two major
psychoactive ingredientsl.
Whereas, Kratom is not regulated by the State of Massachusetts or the federal government
Whereas, the Massachusetts supreme ludicial Court has held that "[t]he right to engage in business
must yield to the paramount right of government to protect public health by any rational means."2
Therefore, in furtherance of its mission to protect, promote and preserve the health and well-being
of its residents, and pursuant to the authority granted to the Dracut Board of Health pursuant to
G. L. c. 111, 931, the Board of Health enacts this Regulation Restricting the Sale and Distribution of
Kratom.
B. Definitions:
For the purposes of this regulation, the following words shall have the following meanings
Board: The Dracut Board of Health
Business Asent; An individual who has been designated by the owner or operator of any business to
be the manager or otherwise in charge of said establishment
Compliance Check: An enforcement activity where a person is sent into an establishment to attempt
to purchase a restricted or prohibited product.
Kratom: Refers to the leaves or an herbal extract from the leaves or the other parts of an evergreen
tree in the Rubloceoe family native to Southeast Asia called Mitrogyno Specioso, that contains as its
primary compounds, mitragynine and 7-hydroxymitragynine, which produces stimulantlike effects
in low dosages and opioid-like effects in high dosages, and it may be marketed in different forms,
including but not limited to smokeable products, tea, capsules, and as an additive to soft drinks or
other products.
1 DRUG ENFORCEMENT ADMIN,, GET SMART ABOUT DRUGS, AVAiIAbIE At
htt smartaboutdru OV (last visited February 13, 2023)s
2 Druzik v. Bd. Of Health of Haverhill 324 Mass. 129, 139 (1949) (
1
Med.. 239 Mass. 424, 428 (1921))
citing Lawrence v. Bd. Of Reeistration in
Person: Any individual, firm, partnership, association, corporation, company, or organization of any
kind, including, but not limited to an owner, operator, manager, proprietor, or person in charge of
any establishment, business or retail store.
C. Sale of Kratom Products:
1. No person shall manufacture, distribute, sell,or offer for sale Kratom in any of its forms, as
defined herein, or any Kratom derived products,or any products containing Kratom as an
additive in the Town of Dracut
D. Violations:
1.. Any person or entity charged with violating this regulation shall receive a notice of violation
from the Dracut Board of Health or its designated agent(s).
2. lt shall be the responsibility of the establishment owner and/or his or her manager or
business agent to ensure compliance with this regulation. The violator shall receive:
t
ln the case of a first violation within a 36-month period, a fine of one thousand
dollars ($1000.00),
ln the case of a second violation within 36 months from the first violation, a fine
of two thousand dollars (52000.00), and a suspension of any permit issued by
the Board, including but not limited to a permit to sell tobacco products, for
seven (7) consecutive business days.
ln the case of three or more violations within a 36-month period, a fine of five
thousand dollars (S5000.00) and a revocation of any permit issued by the Board,
including but not limited to a permit to sell tobacco products.
3. Every day that a violation exists shall be deemed a separate offense. lf multiple violations
occur stemming from the same inspection or compliance check, they shall be treated as
separate violations.
4. Failure to pay a fine issued pursuant to this regulation within 21 days of its date of receipt by
the violator shall constitute a separate and subsequent violation of this regulation subject to
the penalties set forth at paragraph 2 of this section. Payment of a fine is not required while
an appeal is pending.
5. Any person who receives notice of a violation of this regulation may request and appeal
hearing before the Board. The request must be made in writing, signed by the violator or the
violator's attorney, filed with, and received by the Dracut Health Department within ten (10)
business days of the date the notice of violation was received by the violator.
6. Any resident who desires to register a complaint pursuant to this regulation may do so by
contacting the Dracut Health Department.
Before suspending or revoking any permit issued by the Dracut Board of Health, including a
permit to sell tobacco products, the Board shall provide notice of the intent to suspend or
revoke such permit, which notice shall contain the reasons therefor and shall establish a
7
2
time and date for a hearing, to be held no earlier than ten (10) business days from the date
of receipt of the notice. The permit holder or their designee shall have the opportunity to be
heard and shall be notified of the Board's decision and the reasons therefor in writing. If
after hearing, the Board finds that a violation of this regulation occurred, the Board shall
suspend or revoke the subject permit. Such suspension or revocation shall not be carried
out sooner than ten (10) business days ofthe date of receipt ofthe Board's decision. For
purposes of such suspensions or revocations, the Board shall carry them out unless it
receives an order of stay or injunction from the appropriate court before the date the
suspension or revocatlon is set to go into effect. Upon suspension or revocation of a permit,
all products subject to that permit must be removed from the retail establishment. Failure
to remove such products shall constitute a separate violation of this regulation. Multiple
permit suspension may not be served concurrently.
8. Failure to comply with the terms of a permit suspension imposed pursuant to this regulation
may sub.iect the permit holder to additional fines, as provided in paragraph 2 of this section,
and suspension of all Board-issued permits for thirty (30) consecutive business days.
E. Enforcement:
Enforcement of this regulation shall be carried out by the Dracut Board of Health or its
designated agent(s).
F. severability:
lf any provision of this regulation is found to violate state or Federal preemption laws or is
declared invalid or unenforceable, all other provisions shall not be affected thereby but shall be
in full force and effect. This provision shall not apply if section C (1) of this regulation is found to
violate state or Federal preemption laws or is declared invalid or un-enforceable.
G. Effective Date:
This regulation shall take effect on ril L 2
(Signature on file)
Dr. Louis Rousseau, Chairman
(Signature on file)
cynthia campbell R.N., Vice-Chairman
(Signature on File)
Tom Bomil, Clerk
CITY OF MARLBOROUGH BOARD OF HEALTH
REGULATION R.ESTRIC TING THE MANUFACTURING
SECTION
1. Purpose & Scope
2. Authority
3. Definitions
4, Distribution of Kratom Products
5, Enforcement and Penalties
6. Severability
7. Effective Date
l. Purpose & Scooe
The purpose of this regulation is to protect the health ofthe residents and general public in the
City of Marlborough.
Whereas Kratom, a tree-like plant indigenous to Southeast Asia, produccs stimulant and
sedative effects when orally ingested in tablet, capsule, or extract form. Kratom leaves can be
chewed or dried and ingested as tea. Use ofKratom can lead to psychotic symptoms, and
psychological and physiological dependence because it contains mitragynine and 7-
hydroxymitragyninc, two major psychoactivc ingredients.r
Whereas Kratom is not regulated by the federal government or in Massachusetts.
2. Authoriw
Whereas, the Massachusetts Supreme Judicial Court has held that "the right to engage in business
must yield to the paramount right of govemment to protect public health by any rational means."'z
Therefore, in furtherance of its mission to protect, promote, and preserve the health and well-
being of its residents, this regulation is promulgated under the authority granted to the
Marlborough Board of Health pursuant to Massachusetts General Laws Chapter l1l, Section
3 I that "boards of health may make reasonable health regulations," the Board ol Health enacts
this Regulation Restricting the Manufacturing, Salc, and Distribution of Kratom.
I ONUG ENNORCEMENT ADMIN., GET SMART ABOUT DRUGS, AVAiIAbIC At
hftp://wr.\,w.getsmartaboutdrugs.gov (last visited February 13, 2023).
2 Dmzik v Bd. of Ileallh ol Haverhill 324 Mass. 129, 139 (1949) (
239 Mass. 424, 428 ( 1 921 \\
citine Lawrence v. Bd. ofResistation in Med..
,
SALE.AND DISTRIBUTION OF KRATO}I
1
3. Definitions
Board fH th: The Marlborou gh Board of Health and its designated board ofhealth agents.
Board of Health Agent: The Director ofPublic Health and any city employee designated by
the board ofhealth, which may include board ofhealth and hcalth dcpartment staff, and code
enforcement officers.
Business Agent: An individual who has been designated by the owner or operator of any
business to manage or oversee the establishment.
Kratom: Refers to the leaves or an herbal extract from the leaves or other parts ofan
evergreen tree in the Rubiaceae famlly, Mitag,,na speciosa, that contains mitragynine and
7-hydroxymitragynine. These compounds produce stimulantlike effects in low dosages and
opioidJike effects in high dosages.
Person: Any individual, firm, partnership, association, corporation, company, or organization
ofany kind, including, but not limited to an owner, operator, manager, proprietor, or person in
charge of any establishment, business, cultivation property, or retail store.
4. Distribution of Kratom Products
(A) No person shall manufacture, distribute, sell, or offer for sale Kratom in any of its
forms, as defined herein, or any Kratom-derivcd products, or any products containing
Kratom as an additive in the City of Marlborough.
5. Enforcement and Penalties
(A) Any person or entity charged with violating this regulation shall receive a notice of
violation from the Board of Health or Board of Health Agent.
(B) lt shall be the responsibility ofany cstablishmcnt owncr and/or the establishment
owner's manager or business agent to ensurc compliancc with this regulation. The
owner or manager ofany establishmcnt in which Kratom is manufactured, distributed,
sold, or oflered for sale by any person in lawful conkol ofthe establishment, shall be
responsible for the violation whether, or not, they authorized or were aware that the
violation was taking place.
(C) In the case ofa violation, the violator shall receive:
( I ) In the case of a first violation, a fine of one thousand dollars ($ 1000.00).
(2) ln the case ofa second violation within 36 months ofa previous violation, a
fine of two thousand dollars ($2000.00), and a suspension ofany permit issued
by thc Board, including but not limited to a Tobacco Products Sales Permit, for
scven (7) consecutive business days.
(3) In the case ofthree or more violations within a 36-month period, a fine offive
thousand dollars ($5000.00), and a suspension ofany permit issued by the
2
(D)
(E)
(F)
(G)
(H)
Board, including but not limited to a Tobacco Products Sales Permit, for thirty
(30) consecutive business days.
In accordance with applicable law, the Board of Health may modify, suspend, or
rescind any license or permit to conduct a business issued by the Board ofany person
or entity who is found in violation of this regulation by manufacturing, distributing,
selling, or offenng tbr sale Kratom or Kratom products on the premises that is the
subject of the license or pcrmit.
The authority to inspect establishments for compliance and to enforce this regulation
shall be held by the Marlborough Board of Health and its agent(s).
Any person may rcgister a complaint pursuant to this rcgulation to initiate an
investigation and enforcement with the Marlborough Board of Health and its agent(s)
Volations of this regulation may be enforced by thc non-criminal method of
disposition as provided in M.G.L. c. 40, $ 2lD and as enabled pursuant to the
Marlborough enabling ordinance.
Each day a violalion exists shall be deemed to be a separate offense.
(t)A person who reccivcs notice ofa violation of this regulation can request a hearing
before the Board of Health. This request must be made in writing and filed within
seven (7) days after the date the violation was served or actually received.
6. Severabili8
Ifany paragraph or provision of this Regulation is found to be invalid or unenforceable,
against public policy or unconstitutional, it shalI not affect the legality ofany remaining
paragraphs or provisions and shall continue in full force and effect.
Signed this day October 7, 2025.
Board of Health:
By the Marlborough
h.-14*7T---7-
ldames Griffin. Chairman
3
n, MD. Vice-Chair
7. Effective Date
This Regulation shall take effect for the City of Marlborough on the lst day of December
2025.
CITY OF MARLBOROUGH BOARD OF HEALTH
REGULATION RESTRICTING THE MANUFACTURING,
SECTION
l. Purpose & Scope
2. Authority
3. Delinitions
4. Distribution of Kratom Products
5. Enforcement and Penalties
6. Severability
7. Effective Date
1. Purpose & Scooe
The purpose of this regulation is to protect the health ofthe residents and general public in the
City of Marlborough.
Whereas Kratom, a tree-like plant indigenous to Southeast Asia, produces stimulant and
sedative effects when orally ingested in tablet, capsule, or extract form. Kratom leaves can be
chewed or dried and ingested as tea. Use of Kratom can lead to psychotic symptoms, and
psychological and physiological dependence because it contains mitragynine and 7-
hydroxymitragyninc, two major psychoactivc ingrcdients.r
Whereas Kratom is not regulated by the federal govemment or in Massachusetts.
2. Authoritv
Whereas, the Massachusetts Supreme Judicial Court has held that "the right to engage in business
must yield to the paramount right ofgovernment to protect public health by any rational means." ?
Therefore, in furtherance of its mission to protect, promote, and preserve the health and well-
being of its residents, this regulation is promulgated under the authority granted to the
Marlborough Board of Health pursuant to Massachusetts General Laws Chapter I I l, Section
3l that "boards ofhealth may make reasonable health regulations," the Board of Health enacts
this Regulation Restricting the Manufacturing, Sale, and Distribution of Kratom.
I ONUG ENFORCEMENT ADMIN., GET SMART ABOUT DRUGS, AVAiIAbIE AI
http://www.getsmartaboutdrugs.gov (last visited February 13, 2023).
2 Druzrkr-Bd-pIllcqlthpl tlcyqhill, 32,1Mass. 129, 139 (1949)
239 Mass. 424, 428 (1921))
1
!Ltrng La Rtl of Reeistration in Med
SALE. AND DISTRIBUTION OF KRATOM
Business Agent: An individual who has been designated by the owner or operator of any
business to manage or oversee the establishment.
Kratom: Refers to the leaves or an herbal extract from the leaves or other parts ofan
evergreen tree in the Rubiaceae family, Mitrag;na speciosa, that contains mitragynine and
7-hydroxymitragyninc. These compounds producc stimulant-like effects in low dosages and
opioidJike effects in high dosages.
Person: Any individual, firm, partnership, association, corporation, company, or organization
ofany kind. including. but not limited to an owner. operator. manager. propnetor. or person in
charge of any establishment, business, cultivation property, or retail store.
4. Distribution of Kratom Products
(A) No person shall manufacture, distribute, sell, or offer for sale Kratom in any of its
forms, as defined herein, or any Kratom-derived products, or any products containing
Kratom as an additive in the City of Marlborough.
5. Enforcement and Penalties
(A) Any person or entity charged with violating this regulation shall receive a notice of
violation from the Board of Health or Board of Health Agent.
(B) lt shall be the responsibility ofany establishment owner and/or the establishment
owner's manager or business agent to ensure compliance with this regulation. The
owner or manager ofany establishment in which Kratom is manufactured, distributed,
sold, or offered for sale by any person in lawful control ofthe establishment, shall be
responsible for the violation whether, or not, they authorized or were aware that the
violation was taking place.
(C) In the case ofa violation, the violator shall receive:
(l) In the case ofa first violation, a fine ofone thousand dollars (S1000.00)
(2) In the case ofa second violation within 36 months of a previous violation, a
fine of two thousand dollars ($2000.00), and a suspension ofany permit issued
by the Board, including but not limitcd to a Tobacco Products Sales Permit, for
seven (7) consecutive business days.
(3) ln the case ofthree or morc violations within a 36-month period, a fine offive
thousand dollars ($5000.00), and a suspension ofany permit issued by the
2
3. Definitions
Board of Health: The Marlborough Board of Health and its designated board ofhealth agents.
Board of Health Agent: The Director of Public Health and any city employee designated by
the board ofhealth, which may include board ofhcalth and health department staff, and code
enforcement officers.
Board, including but not limited to a Tobacco Products Sales Permit, for thirty
130) consecutive business days.
(D)In accordance with applicable law, the Board of Health may modifu, suspend, or
rescind any license or permit to conduct a business issued by the Board ofany person
or entity who is found in violation ofthis regulation by manufacturing, distributing,
selling, or offering for sale Kratom or Kratom products on the premises that is the
subject ofthe license or permit.
(E)The authority to inspect establishments for compliance and to enforce this regulation
shall be held by the Marlborough Board of Health and its agent(s).
(F) Any person may register a complaint pursuant to this regulation to initiate an
investigation and enforcemenl with the Marlborough Board of Health and its agent(s)
(G) Violations of this regulation may be enforced by the non-criminal method of
disposition as provided in M.G.L. c. 40, $ 21D and as enabled pursuant to the
Marlborough enabling ordinance.
(H) Each day a violation exists shall be deemed to be a separate offense.
0) A person who receivcs notice ofa violation of this rcgulation can request a hearing
before the Board of Health. This request must be made in writing and filed within
seven (7) days after the date the violation was served or actually received.
6. Severabili$
Ifany paragraph or provision of this Regulation is found to be invalid or unenforceable,
against public policy or unconstitutional, it shall not affect the legality ofany remaining
paragraphs or provisions and shall continue in full force and effect.
Signed this day October 7, 2025.
Board of Health:
By the Marlborough
ames Griffin. Chairman
3
p . MD. Vice-Charr
7. Effectivc Date
This Regulation shall take effect for the City of Marlborough on the fq! day of ])qDgI
2025.
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DRUGS
The Kratom Conundrum Comes to Outer
Cape Cod
Health oflicials scrutinize a substance saidto ofler addiction - or its cure
BY JACK STYLER . OCT 29, 2025
PRoVINCETOWN - Often locked in a glass case next to the rack of erectile dysfunction pills and
in front of a wall of shining lottery tickets, kratom, an opiate{ike substance made from tree
leaves native to Southeast Asia, has quietly found a niche on convenience-store counters across
the country. Kratom is here on the Outer Cape, too.
3 pages left I Sign tn I subscribe
The Gulf Station in Provincetown sells products advertised as both kratom and 7-OH. (Photo
by Jack Style0
But for a growing number of people, kratom, which can be sold as shotiike drinks, pills, or
powde5 has become a major pull - for some as an addictive, dangerous drug and for others as an
alternative product for pain management or energy enhancement.
In recent months, regulators at the federal, state, and local levels have been taking a harder Iook
at kratom and its synthetic derivative, 7-Hydroxymitragynine (7-OH), which "produces
respiratory depression, physical dependence, and withdrawal symptoms characteristic of classical
opiates," according to a report released in lune by the U.S. Food and Drug Administration.
Eliza Morrison, the director of harm reduction services at the AIDS Support Group of Cape Cod
(ASGCC), told the Independent that she has heard "quite a bit" about both kratom and 7-OH from
) pages lcft I Sign In Subscribe
I
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Iooking for help to stop using it. The other is people who say they are experimenting with it as a
Foteniial alternative to the use of opiates or even alcohol.
Either way, Morrison said that most users coming to ASGCC reported some adverse effects of
taking kratom, including nausea, vomiting, heart palpitations, and seizures. They've told her that
kratom can be extremely hard to stop using once they've started taking it regularly.
The director of substance use disorder and outreach programs at the Duffy Health Center in
Hyannis, Daniel Rodrigues, said that he has started to hear about kratom use as well.
Rodrigues runs a recovery-based program for adolescents in Falmouth and Dennis and said one
recently admitted adolescent in a group of 11 reported that kratom was her primary substance of
choice. Rodrigues also said that his family support counselors have reported that families of other
adolescents have become more anxious about the ubiquity of kratom in recent weeks.
Kratom Versus 7-OH
Kratom comes from a subtropical tree called Mitrogyno speciosa indigenous to Southeast Asia,
where people used its leaves to treat pain, enhance work, and act as a social lubrlcant for
centuries, according to a leading kratom researcher at the University of Florida, Chris McCurdy,
who appeared on the health and science podcast "Huberman Lab" in fuly to discuss the substance.
3 pages left I Sign In I Subscribe
"We're also hearing about a lot of young people who are using it," said Morrison, who added that
kratom is not detected by drug tests.
The leaves ofthe kratom tree are used to produce the substances being ottored forwellness and lor highs. (Photo by Thor
Porre/CC 3.0)
Though the kratom tree is in the coffee family, the chemical compounds present in kratom have
both stimulant and opiate-like properties. Users say that, in low doses, kratom can have an
energizing effect similar to caffeine. But at higher doses, kratom consumers are more likely to
experience sedative effects and a euphoric "high" feeling, according to McCurdy.
Estimates of the number of kratom users in the U.S. vary widely, but McCurdy said on the podcast
that according to manufacturers' sales figures, well over 20 million Americans are daily kratom
users.
The type of kratom experience those 20 million people are having will depend on whether they
are taking kratom in something like its natural form or from companies selling its synthetic
derivative, 7-OH.
Orrin Hatch's Pain Relief
C.M. "Mac" Haddow, the senior fellow on public policy at the American Kratom Association, told
thelnilepenilentthat the U.S. kratom industrywas hijackedin2023 by sawy entrepreneurs who
increased the level of 7-OH to make it a "chemically manipulated full-blown opiate."
I pagcs left I Sign In I Subscribe
J
€
I
ftt
I !
I
Haddow said that the association, which advocates for kratom education and the right to use it,
ivants-the government to ban the sale of 7-OH products.
"They're appealing to the drug seekers, and they're creating addictionsi' said Haddow. "They're
creating serious adverse events from a product that should not be on the market."
Haddow said that he's been a daily kratom user since being introduced to the substance in 2015 by
former U.S. Sen. Orrin Hatch, who told him he'd been taking kratom for years for chronic pain.
Haddow, who ran Sen. Hatch's first Senate campaign in 1976 and worked as the chief of staff in the
U.S. Dept. of Health and Human Services during the Reagan administration, told the lndependent
that he, too, uses kratom to manage chronic pain, as do thousands of Americans'
But Can It Kill You?
The U.S. Drug Enforcement Administration had announced that it would make kratom's active
compounds a Schedule 1 drug - that is, one with no accepted medical use and a high potential for
abuse - in September 2016. Following a public outcry and pushback from the American Kratom
Association, scientists, and lawmakers, who argued that a ban would curtail research, the agency
decided not to proceed, according to an investigation by the TampaBay Times.
Haddow, however, told the Times that its death toll figures were "grossly overstated" and said that
underlying medical conditions or mixing other substances may have been the main factor in
those fatalities.
In )une, the FDA recommended to the DEA that 7-OH products be scheduled as controlled
substances.
Haddow told the Independent that he had expected 7-OH products to be scheduled and removed
from the market in the next month or two, but because of the government shutdown, the timeline
for federal regulation moving forward is unclear.
The Cumberland Farms convenience stores in Provincetown, Wellfleet, and Eastham all carry
kratom in shot-like containers, but until a couple of months ago, Cumberland Farms had also sold
"Mr. Mx" products, according to fuina Brown, the store manager in Provincetown. According to
the company's website, "Mr. Mx" sells "precision-formulated" 7-OH tablets to "maximize your
t pages lcit Sigrr ln i Srrhsr'ribt.
The Times found that there had been over 2,000 kratom-related overdose deaths in 40 states and
Washington, D.C. between 2021 and the time it published its investigation in December 2023.
Brown said that before the corporate office told her to stop ordering the "Mr. Mx" products, a
small group of customers would regularly come in and spend hundreds of doUars on the proaucts:
Now, Brown said, the kratom bottles that they currently sell, which are not advertised as 7-OH, are
a "waste of space."
"We need these back," said Brown, speaking of the "Mr. Mx" products. "Or we are just going to
discontinue everything."
Cumberland Farms' parent company, EG Group, did not respond to a request for comment about
its decision to stop selling 7-OH products in time for this issue's deadline.
All Outer Cape convenience store clerks at retailers that sell kratom interviewed by the
lndepenilentfor this story said that they require customers to be at least 21 years old to purchase
the product. There is no federal age restriction on kratom purchases, and in Massachusetts there
is no minimum legal age to purchase kratom.
State and Local Regulation
As the federal bureaucracy remains in gridlock, the Massachusetts legislature and some local
boards of health have taken action to limit the sale of kratom or at least of 7-OH.
During its Oct. 22 meeting, the Bourne Board of Health heard from more than 20 speakers, some
ofwhom called in from other states, to advocate for or against a proposal to ban kratom sales in
the town. Many ofthe speakers told the board that kratom had given them new life after
struggling with chronic pain or opioid use disorder. But five mothers, each of whom said she had
lost a child to a kratom-related overdose, also called in, sometimes speaking through tears, to
urge the board to ban the substance outright.
That board voted unanimously to ban kratom sales, making it the first Cape Cod town to do so.
Several other Massachusetts municipalities have also outlawed the sale of kratom, including
Lowell, Canton, Belchertown, Chelmsford, Marlborough, and Dracut.
Six states and the District of Columbia have passed statewide kratom bans, including Rhode
Island and Vermont. Before his death earlier this year, state Sen. Edward l. Kennedy introduced a
bill in Massachusetts that would ban the sale of kratom statewide. It has been referred to the joint
committee on public health, on which Sen. fulian Cyr of Provincetown serves as vice chair.
Cyr told the Independentthathe would be taking a look at the bill, and the committee has until
the first Wednesdav in December to take action - unless the deadline is extended.
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HOME STORIES SHORTCUTS INDIE'S LJP SHOP ABOUT DONATE q
CHOICE
DRU GS
The Kratom Conundrum Comes to Outer
Cape Cod
Health officials scrutinize a substance said to ofler adiliction - or its cure
BY JACK STYLER . OCT 29, 2025
PROVINCETOWN - Often locked in a glass case next to the rack of erectile dysfunction pills and
in front of a wall of shining lottery tickets, kratom, an opiate-like substance made from tree
leaves native to Southeast Asia, has quietly found a niche on convenience-store counters across
the country. Kratom is here on the Outer Cape, too.
3 pages left I Sign ln I subscribe
--1
The Gulf Station in Provincetown sells products advsrtised as both kratom and 7-oH. (Photo
bY Jack Styler)
But for a growing number of people, kratom, which can be sold as shot-like drinks, pills, or
powder, has become a major pull - for some as an addictive, dangerous drug and for others as an
alternative product for pain management or energy enhancement.
In recent months, regulators at the federal, state, and local levels have been taking a harder look
at kratom and its synthetic derivative, 7-Hydroxymitraglmine (7-OH), which "produces
respiratory depression, physical dependence, and withdrawal symptoms characteristic of classical
opiates," according to a report released in June by the U.S. Food and Drug Administration.
Eliza Morrison, the director of harm reduction services at the AIDS Support Group of Cape Cod
(ASGCC), told the Inilependent that she has heard "quite a bit" about both kratom and 7-OH from
t pages left I sign In Suhscribe
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Iooking for help to stop using it. The other is people who say they are experimenting with it as a
potential alternative to the use of opiates or even alcohol.
Either way, Morrison said that most users coming to ASGCC reported some adverse effects of
taking kratom, including nausea, vomiting, heart palpitations, and seizures. They've told her that
kratom can be extremely hard to stop using once they've started taking it regularly.
"We're also hearing about a lot of young people who are using it," said Morrison, who added that
kratom is not detected by drug tests.
The director of substance use disorder and outreach programs at the Duffu Health Center in
Hyannis, Daniel Rodrigues, said that he has started to hear about kratom use as well.
Rodrigues runs a recovery-based program for adolescents in Falmouth and Dennis and said one
recently admitted adolescent in a group of 1l reported that kratom was her primary substance of
choice. Rodrigues also said that his family support counselors have reported that families of other
adolescents have become more anxious about the ubiquity of kratom in recent weeks.
Kratom Versus 7-OH
Kratom comes from a subtropical tree called Mitragyno specioso indigenous to Southeast Asia,
where people used its leaves to treat pain, enhance work, and act as a social lubricant for
centuries, according to a leading kratom researcher at the University of Florida, Chris McCurdy,
who appeared on the health and science podcast "Huberman Lab" in July to discuss the substance.
}pageslcft lsignln I Subscribe
The leaves ofthe kratom tree are used to produce the substances being offered forwellness and lor highs. (Photo byThor
Porre/CC 3.0)
Though the kratom tree is in the coffee family, the chemical compounds present in kratom have
both stimulant and opiate-like properties. Users say that, in low doses, kratom can have an
energizing effect similar to caffeine. But at higher doses, kratom consumers are more likely to
experience sedative effects and a euphoric "high" feeling, according to McCurdy.
Estimates of the number of kratom users in the U.S. vary widely, but Mccurdy said on the podcast
that according to manufacturers' sales figures, well over 20 million Americans are daily kratom
users.
The type of kratom experience those 20 million people are having will depend on whether they
are taking kratom in something like its natural form or from companies selling its synthetic
derivative, 7-OH.
Orrin Hatch's Pain Relief
C.M. "Mac" Haddow, the senior fellow on public policy at the American Kratom Association, told
the Indepenilent that the U.S. kratom industry was hijacked in 2023 by sawy entrepreneurs who
increased the level of 7-OH to make it a "chemically manipulated full-blown opiate."
) pagos lcft I sign In I subscribe
I
'-/N
I I
I
Haddow said that the association, which advocates for kratom education and the right to use it,' wan-ts the government to ban the sale of 7-OH products.
"They're appealing to the drug seekers, and they're creating addictionsi' said Haddow. "They're
creating serious adverse events from a product that should not be on the market."
Haddow said that he's been a daily kratom user since being introduced to the substance in 2015 by
former U.S. Sen. Orrin Hatch, who told him he d been taking kratom for years for chronic pain.
Haddow, who ran Sen. Hatch's first Senate campaign in 1976 and worked as the chief of staff in the
U.S. Dept. of Health and Human Services during the Reagan administration, told the Independent
that he, too, uses kratom to manage chronic pain, as do thousands of Americans.
But Can It Kill You?
The U.S. Drug Enforcement Administration had announced that it would make kratom's active
compounds a Schedule 1 drug - that is, one with no accepted medical use and a high potential for
abuse - in September 2016. Following a public outcry and pushback from the American Kratom
Association, scientists, and lawmakers, who argued that a ban would curtail research, the agency
decided not to proceed, according to an investigation by the TampaBay Times'
The Times found that there had been over 2,000 kratom-related overdose deaths in 40 states and
washington, D.C. betvveen 2021 and the time it published its investigation in December 2023.
Haddow, however, told the Times that its death toll figures were "grossly overstated" and said that
underlying medical conditions or mixing other substances may have been the main factor in
those fatalities.
In June, the FDA recommended to the DEA that 7-OH products be scheduled as controlled
substances.
Haddow told the lnilependentthat he had expected 7-OH products to be scheduled and removed
from the market in the next month or two, but because of the government shutdown, the timeline
for federal regulation moving forward is unclear.
The Cumberland Farms convenience stores in Provincetown, Wellfleet, and Eastham all carry
kratom in shot-like containers, but until a couple of months ago, Cumberland Farms had also sold
"Mr. Mx" products, according to Arina Brown, the store manager in Provincetown. According to
the company's website, "Mr. Mx" sells "precision-formulated" T-OH tablets to "maximize your
:i pagt,s lciL ] Sigrr ln I Subslribl
"We need these backi' said Brown, speaking of the "Mr. Mx" products. "Or we are just going to
discontinue everything."
Cumberland Farms' parent company, EG Group, did not respond to a request for comment about
its decision to stop selling 7-OH products in time for this issue's deadline.
All Outer Cape convenience store clerks at retailers that sell kratom interviewed by the
lnilepenilent for this story said that they require customers to be at least 21 years old to purchase
the product. There is no federal age restriction on kratom purchases, and in Massachusetts there
is no minimum legal age to purchase kratom.
State and Local Regulation
As the federal bureaucracy remains in gridlock, the Massachusetts legislature and some local
boards of health have taken action to limit the sale of kratom or at least of 7-OH.
During its Oct. 22 meeting, the Bourne Board of Health heard from more than 20 speakers, some
ofwhom called in from other states, to advocate for or against a proposal to ban kratom sales in
the town. Many of the speakers told the board that kratom had given them new life after
struggling with chronic pain or opioid use disorder. But five mothers, each of whom said she had
Iost a child to a kratom-related overdose, also called in, sometimes speaking through tears, to
urge the board to ban the substance outright.
That board voted unanimously to ban kratom sales, making it the first Cape Cod town to do so.
Several other Massachusetts municipalities have also outlawed the sale of kratom, including
Lowell, Canton, Belchertown, Chelmsford, Marlborough, and Dracut.
Six states and the District of Columbia have passed statewide kratom bans, including Rhode
Island and Vermont. Before his death earlier this yea! state Sen. Edward f. Kennedy introduced a
bill in Massachusetts that would ban the sale of kratom statewide. It has been referred to the joint
committee on public health, on which Sen. Iulian Cyr of Provincetown serves as vice chair.
Cyr told the Independentthathe would be taking a look at the bill, and the committee has until
the first Wednesday in December to take action - unless the deadline is extended.
I pagps lcft I Sign In I Subscribc
Brown said that before the corporate office told her to stop ordering the "Mr. Mx" products, a
small group of customers would regulad come in and spend hundreds of dollars on the prodrfcts.
Now, Brown said, the kratom bottles that they currently sell, which are not advertised as 7-OH, are
a "waste of space."
Town of Dover, MA Board of Health Regulations
Chapter 220 Smoking; Sale of Tobacco and Nicotine Delivery Products
Proposed amenclmenls lo Section 220-2 Findings; purpose:
There exists conclusivc cvidencc that tobacco smoke causes canccr, respiratory diseascs, various cardiac
problems, allerges, and irritations to the eyes. nose and throat ofboth the smokerand nonsmoker exposed
to secondhand smoke. Evidence further demonstrates that nicotine, present in tobacco, is extremely
addictive. Almost 90% of all smokers begin smoking before the age 18, and every day an estimated
additional 3,000 minors begin smoking in thc United States. Thcre is an urgcnt health nced to reduce easy
access by youths to tobacco and nicotine products through strict enfbrcement of the state law prohibiting
sales to minors, MGL c. 210, $ 6, and additional measures. Therefore, these regulations are adopted
pursuant to MGL c. I I l, $ 3 l, as reasonable health regulations designed to protect and improve the healh
of the residents of the Town of Dover.
Proposed amendments to Section 220-6 Retail sale of tobacco products..
B. No person, firm, corporation, establishment, or agency shall sell tobacco, nicotine, or e-cigarette
products to anyone born on or after January l, 2005,
Current
D. All clerks selling tobacco products or nicotine delivery products shall verify by means of government-
issued photogaphrc identification containing the bearer's date ol birth that no person purchasing the
tobacco or nicoline contairung products is yormger than 2 I years ofage. No such verification is required
fbr any pcrson over thc age of 26. No clcrk shall sell tobacco products or nicotine dclivery products to a
person under 2l years of age who has a note from an adult requesting such sale.
Proposed
D. All clerks selling tobacco products or n icotine delivery products shall verify by means ofgovernment-
issued photographic identification conlaining the bcarer's date of birth that no person purchasing the
tobacco or nicotine containlng products was born on or after January l, 2005.
Proposed amendments to sectk)n 220-10 Posting of state law required;
All retail establishments shall conspicuously post signage, made available from the Board of Healtlt"
Such signage shall include: (i) a copy of G.L. c. 270, $$ 6 and 6A; (ii) rcferral information for
smoking cessation resourcesl (iii) a statement that sale oftobacco products, including e-cigarettes,
to a person born on or aft€r January l, 2005 is prohibited; (iv) health warnings associated rvith
using electronic nicotine delivery systemsl and (v) except in the case of smoking bars, notice t0
consumers that the sale offlavored tobacco products are prohibited at all times. Such signage shall
be posted conspicuously in the retail establishment or other place in such a manner so that it may
be readily seen by a person standing at or approaching the cash register. The notice shall directly
face the purchaser and shall not be obstructed from view or placed at a height ofless than four feet
or greater than nine feet from the floor. The signage may be in a form developed and made
available by the Massachusetts Department of Public Health'
Proposed amendmenls to section 220-16 Ellective date; amendments:
This regulation shall take effect 30 days aftcr publication of a summary o fthe regrrlation in a newspaper
disxibuted in the Torvn of Dover'. As requiredby M(iL c. I I l. \\ 31. an attested copy has been filed u'ith
DEP on Junc 8. I 994. 'l-his rcgu lation was votccl by a majority o I th is Board on April 25. 1994. amcndcd
on Mav f f , l 998, Scptembe r 24.200l . Novcnrbcr l.3.20l3.July l0. 2023, and llNSERT DATE OF
voTEl.
I'l'hat is Nicotine:
The term nicotine includes all tobacco and synthetically derived nicotine products such as vapes or e-
cigarettes, cigarettes, cigars, chew, and pouches.
The Problem:
Nicotine containing tobacco products remain the single greatest cause of addiction and death in Massachusetts
with over 9,000 deaths each year,l more than three times the number of deaths from the state's opioid crisis.
Tobacco kills onc-half of its users,ll accounting tir I out ol'cver-v- -5 tlcaths in the US.lll Despite decades of
control efforts, the tobacco industry continually innovates new products and nicotine delivery methods,
undermining regulation and targeting susceptible young adult populations.
Nicotine-Free (;cneration :
Nicotine-Frce Generation (NFG) proposes a definitive, streamlined approach to tobacco control. NFG policy
prohibits the sale of nicotine products to anyone bom after a chosen datc (c.g. January 1, 2004). Thosc born
before this date, who curently usc nicotine, may be sold products indefinitcly. The policy prevents sales to the
next generation, phasing out sales slowly over time.
Respects the rishts of users: Those who alrcady use nicotine products can continuc to be sold
nicotine indefinitely. NFG doesn't shame or stigmatize users.
Considers retailer needs: NFG is gradual, proyiding retailcrs time to adjust their business model so
it does not depend on selling a deadly, addictive product-thc markct dcclines only- margrnally cach
ycnr.
ls socilllv reinlbrcing: Olcr timc. tccns anrl young adults will bc lllthcr rcmovcd irr agc fiofir those
rvho can bc sold nicotinc. dccrcasing carly oicotiuc initiation that sparks lilclong addiction
,\ccounts for personal riglrts and frccdoms: I-he l{assiichusctts SLrpreme (iourt unanirrrousiv
upheld the policy in Ulookline.iV Like asbestos or lead paint. selling tohacco is nol a constitutional
right. Thc purchasc, usc. or possession o1'tobacco is never crirninalizcd. Tobacco dcpcndcncc nrcans
thc loss of free choice and l'r'eedom--alnrost all tobacco users wish thev'd never starled.
Prolidcs a smooth transition: NF'G avoids blrck markct salcs. rrs clrrrcrlt dcpcndcnt uscrs arc ncver
cul oll-from legal nicoline access. Additionally. NFG curlails fulure demand try preventing th'l next
gencratioll lrom becorrring addicted.
. C0nrcs at the ht tinre and Iace:NFC policy is spreading quickly ud has alrcady bccn adopted
by ninc Massachusctts lowns. MA has lcd thc corullry in spcahcading nicotinc policics such as
tlavor restrictioN and minimum sales age of 2l . Many places are meaningtirlly considering NFG.
including other jurisdictions in the US and the countries of UK. EU. Malaysia. Singapore. Ireland.
Denmark. France, Spain. and Canada.
()pposed stronglv b\, Big Tobacco: Will rcducc salcs over time, and improvc public hcalth
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Nicotine-Free Generation (Nl-G) Overview
NFG:
Municipalities That Have Adopted Nicotine Free Generation
Betc he rtown
Brookline
Chetsea
Concord
Conway
Dover (added Nov.1, 2025)
Hopkinton
Malden
Ma nchester-By-The-Sea
Metrose
Needham
Newton
Pelham
Reading
Somervitte
South Hadtey
Stoneham
Wakefietd
Winchester
Massachusetts update ASH Monday. November3.2025 12:00 PM
Good morning.
We've had a very busy year and l'm happy to report that we have
severat updates for you.
Eighteen Massachusetts municipatities have adopted NFG, and
580,000 MA residents now Live in a community that has an NFG
poticy. South Hadtey was the latest - - just two weeks ago.
Amherst held a pubtic hearing this past Thursday. Dover is
hotding a pubtic hearing this evening. As we say, stay tuned.
ln January 2025 NFG bilts were fited in the State Senate and in
the House.
ln Juty the State's Joint Commiftee on Pubtic Heatth hetd a
Pubtic Hearing. So many peopte showed up to testify they had to
cut us off and not everyone got to speak. But there witt probabty
be at teast one more hearing before the Joint Gommittee on
Pubtic Heatth and a hearing before Ways and Means. Written
testimony is always wetcome!
The Gommittee on Pubtic Heatth has reported out favorabty on
an internet sates ban bitt. This legistation was proposed by a 16
year-old Natick high schoot student.
The MA Tobacco Cessation and Prevention Program at DPH
funds technicaI assistance providers to support municipatities
in promulgating tocat policies. Nicotine Free Generation is
inctuded in the TA "model reg", which is a guidance document
so any Board of Heath consideringtobacco control updates wilt
have readyaccess to the regutation tanguage.
My direct supervisor, who is the Heatth Director for three
Massachusetts municipalities, and I wilt be presenting at the
Massachusetts Heatth Off icers Association's Annua I
Conference later this week, atong with Dr. Howard Koh, whom
many of you probably know. Dr. Koh is a former Massachusetts
Commissioner of Pubtic Heatth. He also served as Assistant
Secretary of Heatth and Human Services in the Obama
Administration. Dr. Koh is currently at The Harvard Chan School
of Public Heatth and witt receive the Btake Cady award from
Tobacco Free Mass on December 4th
When Anthony and I first started thinking about NFG (catted TFG
at the time) back ln 2O23 we knew we needed to make sure we
had support, especiattyfrom municipat leaders, but from other
community stakeholders as well.
We tatked to Mayors, Town Managers, City and Town Council
members, Schoot Committee members, educators, students,
parents, coaches, heatth care professionals, hospitat
administrators, and others. ln addition to youth, some of the
most important support came from locat substance use
prevention coatitions.
The 84 Movement, a youth advocacy program funded by MTCP, is
offering a stipend projectto engage and understand youth
perspective and awareness related to NFG policies. Youth from
across the state are being asked to share their voice and hetp
inform and lead progress being made around NFG and other
tobacco regulation policies.
We soticited support from both individuals and groups, some of
whom testified in person, and others who submitted written
testimony. Support from subject matter experts is very hetpfut.
However, it's most important to hear from tocal residents,
especialty youth!
The tobacco industry, as you can imagine, is not in favor of this
poticy. Retailers, distributors, trade association execs, and
smokers'rights groups show up to testify against the poticy.
Municipa[ [eaders received robo emails. Window and counter
ftyers as wett as petitions were delivered to locaI stores
encouraging owners and customers to speak out against the
poticy and to show up at public hearings.
Lastty, l'm sure you've a[[ seen or heard about some of the newer
products that are being peddted to our children by a predatory
industry intent on continuing to make bittions.
. Toy guitar
. Teddy bear
. A CD styte device so you can play music or video games white
you vape.
There are vapes with LED screens that tett you how much battery
tife and who many puffs you have left. You know, so you'll be
sure to gas up before you run out.
At the National Conference on Tobacco Or HeaLth I learned
about the next iteration of vape devices which wit[ collect data
on the user's puffing habits to send backto the manufacturers
so they can recatibrate - to make sure you get higher and higher
nicotine levels which witt of course increase the chance you, or
your young child, wilt become addicted and the industry gets
another customer-for-tife. Because, as we a[[ know, that is the
goal.
Thank you!
Nicotine-Free Generation Frequently Asked Questions and Answers
Won't youth just go to the next town over?
When Needham Massachusetts became the first town to enact Tobacco 21, opponents of the
policy made the argument that youth between 18-21 would jusi buy from the next town over. Yet
following the passage of Tobacco 21, Needham witnessed over a 50o/o decrease in high school
smoking. The percentage of high schoolers who smoked declined at nearly kiple the rate in
Needham compared to surrounding towns that had not adopted the policy (Winickoff 20141
Sc hneider 2016). Decreasin g access to tobacco in even one town has been proven to work.
Doesn't NFG take away free choice for adults? Doesn't it infringe on personal rights?
The tobacco industry likes to frame NFG as a free choice issue. However, 95% of tobacco use
beqins before the aqe of 21. and 99% before 26. Early tobacco use is more likely to lead to
addiction, which by definition means the loss of free choice. There rs no free choice when
addiction drives desire. Tobacco is nol a freedom, it is an addiction to nicotine and a burden-
just ask people who use tobacco. Do they smoke because they want to, or because they need
to? Almost all current smokers wish they had never started. People who are addicted to nicotine
continue to use tobacco not because they enjoy it but because they are treating the intolerable
negative effects of nicotine withdrawal whenever the level gets too low in their brain.
Because tobacco has been sold legally for so long, it's understandable why it might feel
like a right or freedom. However, halting the sales of lead paints, asbestos, or FDA-banned
supplements for public health reasons obviously don't take away any "personal rights." Tobacco
has caused the greatest health detriment of any consumer product in history, causing more
annual deaths than AIDS , alcohol, care accid ents, illeqal druqs,murders. and suicides
combined. NFG does not take away personal rights or freedoms, it phases out the sale of a
dangerous and addiciive product over years.
ls NFG constitutional?
Nicotine is not a constitutional right. The Massachusetts Supreme Judicial Court upheld the
legality of NFG policy in Brookline, affirming that it was "not inconsistent with the Constitution"
and was "ratronally related to the town's legitimate interest tn mitigating tobacco use overall and
in particular by minors'(see Six Brothers lnc. v. Town of Brookllne pg. 11 and 32).
Doesn't NFG split adults into two groups? Why are we judging who is "adult enough" to
buy nicotine?
It is important to remember that tobacco products are dangerous at all ages; there is no safe
age of nicotine sale. NFG recogntzes that tobacco industry nicotrne is a harmful and highly
addictive product that should not be sold to anyone: it's not about who is an adult or not. The
goal of the cutoff date is to ensure a smooth, practical transition lo a nicotine-free future. The
distinction NFG makes is rational, because it allows sale to individuals already using nicotine,
and curtails sales to those too young to be using at the time the law is passed. This approach
avoids a black market, safeguards future generations from addiction, gives retailers time to
adjust, and continues nicotine access for current users.
What about our military readiness?
Men and women who serve in the United States armed forces have greater military readiness,
including increased stamina, fitness, and work capacity, when they do not use tobacco
products. (lnstitute of Medicine 2009). Someone who is addicted to tobacco will have more
trouble hauling gear over distance due to their diminished lung capacity. Additionally, non-users
enjoy superior wound healing so they can get back faster after injuries (Silverstein 1992) and
are nearly tvvice as likely to successfully complete basic kaining (Klesqes 2000). The US
military now views E-cigarette and cigarette use as a military threat. (Keltner 2021). The US
military has banned the sale of all E-cigarette products from their bases. NFG will improve our
military readiness over time because fewer and fewer recruits will use lobacco products. NFG
aids the creation of a stronger and more resilient American fighting force.
What about the history of tobacco and our military?
The tobacco industry has targeted military personnel since the beginning of the 20'r'century,
marketing products to servicemen at deeply discounted rates in order to get young recruits
addicted for life. (Fahev 2020). The US N/ilitary has seen the toll tobacco has taken on its
servicemen and veterans. The Department of Defense spends 1.6 billion dollars a year on
medical and non-medical costs related to tobacco use. (CDC.qov). Tobacco causes more
deaths each year in the United States than the number of US soldiers who died in all of WWll.
What about our Yeterans?
Following service, veterans who are dependent on nicotine are more likely to experience
psychiatric and medical conditions including alcohol use disorder, depression, and PTSD.
Baldassarri 2022 Over time NFG will lessen the number of veterans addicted to nicotine,
thereby supporting the mental health and well-being of our veterans. NFG does not change
current veterans access to tobacco in any way.
What about young people who have already been trapped by their tobacco addiction?
What happens to them with NFG?
Over time, there will be fewer and fewer users who fall into this category. However, safe and
effective FDA-approved nicotine (NRT) is available throughout Massachusetts over the counter
and is covered by all Massachusetts insurance programs. ln addition, the lvlA quitline gives
away free NRT as part of their program. As an outcome of NFG, those who are already addicted
to tobacco products will now use safe and freely available FDA-approved nicotine, retaining
more money to spend on basic necessities, experiencing a lower incidence of disease, and
living longer, more productive lives.
What about those who smoke and want to switch to less harmful forms of nicotine like e-
cigarettes?
NFG prevents addictive products from falling into the hands of those who have never tried
nicotine, and doesn't limit access for those who already smoke. While established cigarette
smokers may switch to e-cigarette products in an effort to reduce their risk of health
complications, young adults and adolescents covered by NFG policies are commonly becoming
Will a "Black Market" develop?
NFG doesn't create additional black market sales. ln fact, the policy attem pts to avoid further
black market nicotine, because current users can continue to legally be sold nicotine, and
therefore have nO need to tUrn lo a black market. NFG also prevents future generalions from
becoming addicted, gradually shrrnking the dependent user base the black market relies on.
Reducing demand for nicotine products means reducing black market sales. A 2015 study found
that banning menthol cigarettes resulted in no su e in illicit c rettes. NFG is even safer than
menthol bans because it never removes access to nicotine where a demand exists. NFG allows
safe, FDA approved nicotine to be sold over the counter in the form of nicotine patches, nicotine
gum, and nicotine lozenges. These forms of nicotine have low addicttve potential because of the
slow onset of their effect. Keeping these slow release forms of nicotine on the market is
important so that people who are addicted to tobacco products can continue transitioning to
safer, FDA approved products.
lsn't NFG like Prohibition?
NFG is nothing like Prohibition. Prohibition fueled a massive Black Market because it
immediately removed access to a substance that at least half of the adult population wanted to
ggg. lt removed the supply of alcohol while demand remained high, creating a huge economic
incentive for illegal Sales. On the other hand, NFG naturally reduces nicotine demand over time
by preventing those under a certain age from becoming addicted. Additionally, NFG never
removes the nicotine access of cunent users like Prohibition did, preventing any increase in
illegal sales. ln addition, safer FDA approved nicotine will continue to be available.
How can lsuppo( this while Marijuana access is increasing, etc.? what about existing
tobacco control programs
Nicotine-Free Generation addresses the specific issue of nicotine use, and does not hinder
other public health initiatives in any way. Supporters of NFG recognize that nicotine is uniquely
dangerous and addictive, and that the policy offers a practical way to prevent tobacco-related
deaths among the next generation. Additionally, as NFG starts to reduce the scope of the
tobacco issue, it will allow more public health resources to be allocated towards addressing
other problems over time.
Whydon'twejustwaitfortheStateortheFederalGovernmenttoenactNFG?
Histcrically, local tobacco control regulation has led to state level action. The more cities and
towns thai pass Nicotine Free Generation, the greater the chance that a state level bill will pass
and protect the entire state. ln the case of Tobacco 21and the state flavor restriction law, over
100 cities and towns in MA passed their regulations before state laws was passed. Tobacco 21
won federal passage after 19 states passed their own laws. Flavor restriction bills are also
following the lead of Massachusefts and spreading across the country Local action first is the
addicted to nicotane by those same vape products. NFG retains alternatives for current
combustible tobacco users who might seek harm reduction through vapes, while limiting the
most common source of youth nicotine initiation and use (Centers for Disease Control and
Prevention 2023, American Lunq Association 2024).
primary way that state and federal bills gain traction. ln summary, putting a local regulation in
place now will help make a state law possible and will protect your community sooner lhan
waiting for any potential state or federal action in the future.
ls NFG too experimental? ls it actually being considered anywhere else?
NFG is innovative, and builds on the success of tobacco age restrictions such as Tobacco-21.
Though it is a relatively new approach, NFG has already received serious consideration
globally. British Prime Minister Sunak proposed an NFG law in 2023, which received
endorsemenl from King Charles and the Opposition Party. ln New Zealand, NFG was nearly
enacted on a nationwide scale unlil a new government came in and succumbed to tobacco
industry pressure in eady 2024. Balls have been forwarded in California, Hawaii, Minnesota, the
Philippines, Singapore, ltilalaysia, Denmark, Spain, France, and the European Union. Nine
towns in Massachusetts have already adopted the policy, likely with more to come following the
l\,4A Supreme Judicial Court ruling that upheld the policy in Brookline. Policymakers everywhere
are recognizing the ef{ective approach and public benefit that NFG provides.
Will NFG hurt small-business retailers?
Nicotine-Free Generation laws are gradual, and the market for tobacco will only decline
gradually each year. Most retailers won't see a difference tor years. The policy provides time for
retailers to develop their business model so as to not depend on selling a harmful and
exploitative product. Since Brookline enacled their policy in 2019, not a single tobacco retailer
has gone out of business.
Why are we preventing nicotine from being sold to adults? Shouldn't we focus on youth
use?
NFG aims to tackle youth nicotine addiction first, by preventing youth from ever trying nicotine
and becoming addicted. 99% of smokers start before they are 26 (2014 Surqeon General
Report). The tobacco industry relies on older peers sharing and distributing tobacco to youth
Over time, youth will be further removed in age from anyone who can be sold nicotine legally
and any peers who use. The 2024 Surgeon General Report states that endgame efforts to
eliminate tobacco-related disease, disability, and death should create opportunities and
conditions for all people to live healthy lives that are free from commercial tobacco.l
Are there equity issues to consider with NFG?
Tobacco product use is highest among lower income and other disadvantaged populations.
Tobacco product addiction itself can worsen the cycle of poverty for families because each pack
of cigarettes for example costs over $10. Nicotine addiction takes no days off, therefore the
pack a day smoker spends over $3,500 on their nicotine addiction after taxes instead of better
food, clothing, and rent for lhejr family. ln addition, tobacco retailer density tends to be highest in
poorer neighborhoods, placing lhose community members at higher risk of exposure to
1 u.s. Depaftment of Health and Human services. Eliminating Tobacco-Related oisease and Death:Addressing Disparities-A Report of the surgeon General. Ailanta, GA: u.s. Department of Health andHuman Services, Centers for Disease Control and Prevention, National Center for Chronic DiseasePrevention and Health Promotion, Office on Smoking and Heafth,2024.
advertising and greater access to unsafe products. These facts make lobacco use an equity
issue and protecting the next generation from worsening economic and health harms due to
nicotine will disproportionately benefit disadvantaged groups.l
How does NFG help level the playing field with municipal employment opportunities?
Tobacco use is prohibited in all basic military, police, and fire fighter training programs.2 For a
person to get to be one of these respected members of our communities they cannot be
addicted to tobacco products. Fire fighters and police officers cannot be smokers and keep their
jobs, it is prohibited by law.3 Therefore, NFG is an important step toward these high paying and
upstanding opportunities to be fully available for all our community members.
Suggested Citation for this NFG FAQ: Savage T., lshak A., Silbaugh K., Chadwick G.,
Haftmann L., Goftlieb M., Buzby M.. Winickoff JP. Nicotine-Free Generation Frequently Asked
Questions and Answers. Version 12072024
z DOD.httos:rwww.mititarvonesource.mil/militarv-basics/new-to{he-militarv/what-to-oack-for-basic-
traininq/ Imilitarvonesource.mill; httos://msotroooer.oro/wo-content/uoload si 2016/04/Ma-State-Police-
Rules-and -Reo ulations-Combined. gdf Imsotroooer.orol ;
ranklinma.qov/sit es/o/files/vvhlif 1 0036/f/uoloads/academv {rained -o atro l-o ff ic er-Dostinq-11-httos://www.f
19-24.dl Ifranklin a.oovl mas u
3/download Imass.qovl sectiion ll. D
3 httDS://casetext,com/statute/qeneral-laws-of-massachusetts/oart-j-ad ministration-of {he-oovemmenUtitle-
,ii-"il,es-towns-and{ istricts/chaoter-41-of f icers-and+moloveesof +ities{owns-anddistricts/section-
4'1'101a-police-of f icers-o r-f iref io hters-to b acco-s mo k ino [casetext coml
Other ideas for inclusion:
Economic argument... consider keeping that money in the community rather than funding
factories in China where much of the newer tobacco product is created.
IrcTHINGSTOK}IOW
ABOUT NFG
Policy innovotion lo end nicotine crddiction
A policy thot prohibits soles of
niiotin6 orodlcts to indivlduols
born ofidr o certoin dote {e.g. Jon
l,2OO4).li phoses out soles over
trme, preventrng youth initiotion
without offecting current users.
.. nicotine concentrotions. These newer
devices ore of'ten pockoged in child
{riendly desrgns (eg. teddy beors, toy
guitors), cleorly oppeoling to very young
users ond undermining prevention e{fort
NFG's phosed opprooch
gives retoilers time to odopt
therr business models, with
soles declining slightly eoch
yeor.
The Mossochusetts Supreme Jud icio I
Court upheld the policy in Brookline.
NFG does not criminolize Dossessron
or use-just retoil soles to {uture
generotions.
lncludes tobocco ond
syntheticolly derived nicotin
products: vopes, e-
cigoreties, cigorettes, Icigors, chew, ond pouches.
e 1
,
The nicotine industry is evolving. creoting
more oddictive producis with higher Curreni nrcotine users ore not
restricted-ihey con continue
buying products. NFG ovoids
stigmo or shoming ond
supports groduol chonge.
,,&
As time posses, new
generotrons grow {urther
removed lrom those who con
legolly buy nicotine-decreosing
peer inf luence ond eorly
initiotion.
By preserving occess for
current users ond cuiting
demond from future ones, NFG
reduces risk of illicit soles.
NFG threotens iobocco
industrv Drof its-which is
exoctlf why i{s o strong public
heolth policy.
lllrt
S
a
A.I1
)
Whot is t{icotine?
OEOT'
E
Why Now?
Retoiler-Friendly Reinforces Sociol Norms
Prolecls Personol Ri hts Prevents Block Morkets
Opposed by Big Tobocco
Adopted in '17 MA towns, with
growing interest f rom
iurisdictions in ihe US, UK, EU,
Singopore, Moloysio ond more
lr
Whor is NFG?
Respacts Aduh Ueera
Growing Momenlum
1
BOARD OF HEALTH MEETING MINUTES 1146 Route 28, South Yarmouth November 3, 2025 Board Members Present: Hillard Boskey, M.D., Charles T. Holway, Mary Craig, Laurance Venezia DVM, Eric
Weston Others Present: Barry Lewis, Assistant Health Director, Riley Niederberger, Division Assistant 1. Call to Order
The meeting was called to order at 5:00 p.m. 2. Declaration of a Quorum
Quorum Present
3. Public Comment
None
4. Smoke Detector Awareness & Education – Yarmouth Fire Department
Rescheduled to next meeting.
5. 24 Grove St, West Yarmouth, MA 02673 – Variance Request
David Coughanowr, R.S. attended the meeting as a representative for 24 Grove Street, West Yarmouth,
MA 02673 to request septic variances due to the small size of the property. Barry noted design options are
limited for this property and supported the engineer plan.
Variances requested:
- 310 CMR 15.211(1) Septic tank to cellar wall ten (10) foot minimum required. Variance to seven (7)
foot separation requested.
- 310 CMR 15.211(1) Septic tank to property line ten (10) foot minimum required. Variance to five (5)
foot separation requested.
- 310 CMR 15.211(1) Soil absorption system to cellar wall twenty (20) foot minimum required. Variance
to five (5) foot separation requested.
- 310 CMR 15.211(1) Soil absorption system to property line ten (10) foot minimum required. Variance
to five (5) foot separation requested.
The existing cesspool is starting to fail and there is an Accessory Dwelling Unit (ADU) currently on the
property. The system upgrade will be in compliance with MA Title five (5) regulations.
The Board raised concerns with abutters. David showed certified mailing receipts that he notified beyond
direct abutters.
Motion: Eric Weston moved to approve all four (4) septic variances for the property located at 24 Grove
Street, West Yarmouth, MA 02673.
Second: Mary Craig
T O W N O F Y A R M O U T H
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
Telephone (508) 398-2231, ext. 1241
Fax (508) 760-3472
Board of Health - Health Division
2
All in favor
6. Plastic Product Waiver - Review
In preparation for review of the Disposable Plastic Reduction Regulation at Town Meeting, the Health
Department has been working on a Plastic Product Waiver. Format edits will be made to the waiver. The
waiver will be for plastics number one (1), two (2), and five (5) only. All other plastics excluding number
six (6) will require a variance, which is a separate application available on the Town of Yarmouth website.
The Board reviewed a video on the Yarmouth plastic reduction and would like to see other content that
focuses on how the new regulation is more cohesive and achievable than the original bylaw. The Board
noted the importance of providing guidance on how to follow the new plastic reduction regulation.
On November 17th, the item of rescinding the current plastic reduction bylaw will be on the special Town
Meeting Warrant.
7. Review & Approve of Minutes
Motion: Laurance Venezia moved to approve the minutes from October 6, 2025, with one edit. Second: Eric Weston
All in favor 8. New/Old Business
Barry noted that there were fifty-one (51) participants at the October Flu Clinic at the Yarmouth Senior
Center, the event went smoothly, and the department saw a larger turnout than the previous year.
As November is Diabetes Awareness Month the Health Department is hosting a free A1C screening event
on November 14th from 1:30 p.m. to 3:00 p.m. in partnership with the Barnstable County Public Health
Nursing Division. The event is at the Yarmouth Town Hall, 1146 Route 28, South Yarmouth, MA 02664.
Hillard noted that A1C testing is a great way to assess average blood glucose over about three (3) months.
The Barnstable County Health & Environment Division will host Buried in Treasures workshops starting
November 18th. This is a sixteen (16) week commitment open to all who may need resources for
decluttering, hoarding, or supporting others with compulsive acquiring. For more information, the public
can call 774-330-3001.
Barnstable County has a food assistance information page on their website, capecod.gov with several
helpful resources on locating food pantries, information on SNAP/HIP, transportation, and educational
materials available in English, Spanish, and Portuguese.
Cape Cod Community Food Pantry:
Tuesdays & Thursdays 5:30-6:30 p.m.
2nd Friday of the month 3:00-4:00 p.m.
3rd Saturday of the month 10:00-11:00 a.m.
4th Friday of the month 10:00-11:00 a.m.
Senior Hours: 2nd & 4th Wednesdays 10:00-12:00 p.m.
3
Eric shared that the Family Table Collaborative provides heathy prepared meals to the community, offers
cooking classes and other resources to assist families struggling with food insecurity. The Family Table
Collaborative can be contacted at 508-348-9777.
Barry shared a message from Roby Whitehouse, Assistant Public Works Director stating that the Town of
Yarmouth has two (2) licensed pesticide applicators and ensured only licensed applicators can apply on
town property.
The Board discussed the new Town of Bourne health regulation banning the sale of Kratom. Hillard
described Kratom in low doses as a stimulant and when used in high doses can act similar to an opioid with
the addictive nature. Barry wanted to bring this to the Board’s attention as the Health Department received
a call from a concerned parent that her son was struggling with addiction to Kratom products. The Board
expressed concern for public health and would like to discuss further options at the next meeting.
Hillard shared a recent announcement that was made by the Health and Human Services Secretary claiming
a connection between circumcision and autism. Hillard stated the medical community is not aware of any
scientific research to support this connection and encouraged parents and future parents who may have
concerns for their children to speak with their medical providers. Hillard also advised any parents who have
concerns regarding a previous announcement from the government regarding a link between Tylenol usage
during pregnancy and autism to also speak with their medical providers.
Next Meeting: December 1, 2025 9. Adjournment 6:15 P.M.
Motion: Laurance Venezia Second: Eric Weston All in favor
1
BOARD OF HEALTH MEETING MINUTES 1146 Route 28, South Yarmouth December 18, 2023 Board Members Present: Hillard Boskey, M.D., Charles T. Holway, Mary Craig, Laurance Venezia DVM, Eric
Weston Others Present: Jay Gardiner, Health Director 1. Call to Order
The meeting was called to order at 5:00 p.m. 2. Declaration of a Quorum
Quorum Present
3. Public Comment
None
4. 3-Month Update – Migrant Family Relocation
Hillard noted that there is a fact sheet on the web-site available to the public with information relative to
this topic.
Dr. Mark Smith, Superintendent of DY Reginal School District 28 students into the system. Living
Harborside suites, fully integrated into the system. Created an additional bus stop on route 28. Since all
are living in one location – it was not as big of an issue as logistically. Set up to support language need.
.
Next Meeting:
5. Adjournment 6:15 P.M.
Motion: Laurance Venezia Second: Eric Weston All in favor
T O W N O F Y A R M O U T H
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
Telephone (508) 398-2231, ext. 1241
Fax (508) 760-3472
Board of Health - Health Division
Town of Yarmouth Health Department
Blood Drive – January
In recognition of National Blood Donor Month, the Yarmouth Health Department invites
community members to help save lives by donating blood!
January is a critical month for blood donations. Holiday schedules, winter weather, and the cold
and flu season often lead to a drop in donations—creating a higher risk for blood shortages. Your
contribution this month can make a meaningful difference for patients in need.
Community Blood Drive Details
Date: Friday, January 23, 2026
Time: 10:30 a.m. – 3:00 p.m.
Location: Lorusso Lodge at Flax Pond
31 Dupont Avenue, South Yarmouth
Hosted in partnership with the American Red Cross
Donation Options
Whole Blood Donation
The most common and flexible type of donation. About one pint of blood is collected, and the
process generally takes about one hour.
Power Red Donation
This procedure collects a concentrated dose of red blood cells while returning most plasma and
platelets to the donor. Specific eligibility requirements apply; donors must have Type A Negative,
B Negative, or O blood.
How to Schedule an Appointment
Visit the American Red Cross website:
https://www.redcrossbloyod.org/give.html/drive-results?zipSponsor=YARMOUTHREC
Or go to “Find a Drive” and enter the sponsor code YARMOUTHREC
Walk-ins are welcome, but we encourage appointments to help minimize wait times.
Juice, water, and small snacks will be provided for all donors.