Okay. Would everyone please rise for this pledge of allegiance? Pledge allegiance to the flag of the United States of America and to the republic for which it stands. One nation under God, indivisible, with liberty and
justice for all. >> All right, welcome to the uh month of February board of health public meetings for the city of River. Uh my name is Dr. Drew Bunker. With me today is um Kathleen Savage, board member to my left, Vivian Katano, board member to my
right. Um also invitable invited municipal staff Lauren Buck to my left, director of public health, Michael Wells, also to my left, health agent, director of inspectional services, and Paula Sublivvita, board of health clerk. Attendees also are Bonnie Carroll,
director of six city tobacco initiative and Mark Gotautleb, director of public health advocacy institute at Northeastern University School of Law. First topic today is going to be to review and approve the minutes from the January meeting of 2026. So I'm going to ask the other board members if they
approve those minutes. >> I approve the minutes as written. >> I approve of the minutes. >> Great. Thank you. Next is going to be the public health communicable monthly report with Lauren Buck. >> Thanks Dr. Bunker. So our report for February 2026. Um our communicable
disease month report. Um a couple of highlights here. Our influenza numbers are significantly decreased from the previous few months which is great. Um we are monitoring two EMPOX cases. Um this is a trend that we're seeing throughout the region right now. Our co's case our COVID cases are also
trending uh you know leveling off which is great. Um some state and national public health updates. The US has now reached a 104 measles cases in 2025. Hitting this number in just one point one and a half months represents an extraordinary rate rate extraordinary
rate of acceleration. One we haven't seen in a very long time. Um there's several outbreaks that I'm sure everyone has heard on the news. An outre an outbreak in South Carolina uh Utah and Arizona. Luckily, these are somewhat slowing down. There's an outbreak in Florida which is increasing. There are 78 cases, 57 of which are associated
with the outbreak uh at a single university, a Maria. There are some smaller outbreaks in North Carolina, Washington State, and California, that are continuing to grow. Uh just a reminder, measles is the most contagious virus on Earth. Even small
dips in vaccination coverage can give it an opening to spread. If you're fully vaccinated, you are well protected and most people in the United States receive the MMR, which stands for measles, mumps, and rebella vaccine as children. 96% of all current cases are among unvaccinated people. Our public health
department offers MMR vaccinations through our childhood childhood immunization program in conjunction with River Public Schools. If you have a question about this or any type of or any other of our other vaccination offerings, you can call our office at
781-4858486. Next, um February is American Heart Health Month. As a reminder, heart disease remains the leading cause of death in the United States, a position it has held since 1950. It is the top killer for both men and women and across most ethnic and racial groups. About
half of sorry about half of the United States population lives with at least one major risk factor. Things like high blood pressure, high cholesterol or smoking. Fortunately, nearly 80% of all cardiac events are preventable through lifestyle changes. The National Institute of Health recommends 150
minutes of physical activity per week. Even walking 30 minutes a day can reduce the risk of heart disease significantly. In terms of diet, the American Heart Associ association recommends prioritizing high-fiber foods, focusing on lean protein like fish instead of red meat, and reducing sodium and sugar
intake. So, uh, finally, a couple of updates from the city of River Health and Human Services. In honor of National Black Balloon Day on March 6th, the SUDI office, SUDI stands for substance use disorder and homelessness initiatives um office is offering Narcan training and
free Narcan giveaway on Wednesday, March 4th at 1:23 Shirley A from 10 to 2 p.m. Black Balloon Day is meant to commemorate the lives of those lost to a drug overdose and reduce stigma around substance use. Additionally, the city office is launching its first podcast in
conjunction with Rever TV. Very excited about that. The podcast is called SOS or shame on stigma, a podcast on flipping the script. It's hosted by our SUDI office program manager and clinician and it features peers, clinicians, law enforcement, and community partners. And
it focuses on real talk, real talk regarding addiction, mental health, and harm reduction. It will launch on March 5th, sorry, March 4th on Spotify, YouTube, and Apple podcasts. Finally, the public health department is launching new public health nurse office
hours at Revier Public Library starting Monday, March 9th from 10:00 to 11:00. This new program we're calling Check out Your Health, um is offered once a month and is free and open to the public. It will offer things like blood pressure checks, pulse and oxygen level checks, health related consultations, and free
seasonal health topics. Um and that's it. >> Great. Thank you, Lauren. Next is going to be the inspectional inspectional services monthly report. >> Thanks, Dr. Bunker. Um, inspectional services uh report for the month of
February. On the interior housing division, we performed 69 certificates of fitness, 16 certificate of fitness reinspection, eight interior complaints received, one interior complaint um inspection.
on the uh food inspection division. We performed 31 routine inspections, four reinspections, seven complaint inspections, four pre-opening inspections, 15 temporary food service inspections um or licenses. on the exterior sanitation division. Um,
trash violations issued, 412. One violation for CS outed in improper times, 24 violations for overflowing dumpsters, eight violations for um, junk heaps, dumps, and automobile graveyards, 13 violations for multiple unregistered vehicles on a property, one violation
for unclean, unsanitary land, 228 violations for snow and ice, and one violation for working without permits. Thank you. Great. Thank you. Next, uh we're going to have a educational presentation
onratom. Um this was going to be first by Lauren Buck. Uh I think some people are here today at the meeting to um give their opinion or discuss um what we're talking about in theratom. Um and so I'll just wait till after we're done
with the presentations and you guys whoever's here can come up speak for two minutes um in front of the board. Um but you will have time to speak in front. Um but we'll first start with Lauren and then Mark who will also give his presentation. Uh great. Thank you.
>> Great. Thanks Dr. Bunker. Um so I'm going to direct you to the PowerPoint presentation that you should be seeing now. Great. Um so I'm going to do a very brief presentation. Um this is supplementing just for the viewers at home and everyone here. Um this presentation is supple supplementing some educational materials that the
board has received prior to this. Um we've uh done a lot of research and we've making sure we're just making sure the board is fully aware and getting some good education about what is uh like Dr. Bunker mentioned this this board of health meeting is truly just about education. No decisions will be
made tonight. Um no regulations will be passed tonight. Um this is really just about making sure we're all um getting educated and and learning about what's going on in our city regarding this. So today we're going to talk about Kratom and the public health concerns. So again
a very very brief overview of what isratom and this information is from the department of justice drug enforcement administration. It's drug fact sheet which of which has one very general information. It is native to Southeast Asia. It's a leaf um that has two major
ingredients. Um metroyinine I think I'm saying that right. I hope I'm saying that right. And seven hydroxy metroinine which are both psychoactive. Um the leaves are crushed and then they can either be smoked, brewed with tea, put into a capsule, put into a selzer, put into juice, uh put into a vape, things
like that. Um and the things that are on the market in the United States are much more concentrated and potent formulations than what are used in the traditional medicine uh in Southeast Southeast Asia. Um the effects that it has on the body, it stimulates the Mu
receptor, which is the same as uh what opioids do. At low doses, it's reported to be a stimulant. So it would increase alertness and energy at high doses. It can be seditive and it can be dict definitely can be addictive at high doses. Other effects of the body are
things like nausea, itching, sweating, tacocardia, vomiting, drowsiness, hpatxicity which is um liver disease, uh seizures and hallucinations. And then finally, what is the legal status currently? It is not regulated by the federal government and it's not
regulated by the state of Massachusetts. You'll see I have a little asterisk there because there are currently um some bills in the legislature um that have not been passed yet, but there are multiple bills talking about a statewide ban in the legislature. Again, that process would play out as it does at the
state level and does not necessarily impede our ability at a city level to regulate. Uh the FDA has not approved for any medical use and the DEA has listed as a drug or chemical of concern at this time. Next slide.
Okay, so here's the landscape in Massachusetts currently. Um, these are the cities and towns who have bans currently. Some of them, they all look a little different. Some of them are very similar. Some of them have age restrictions. Some of them have specific um, product restrictions. LOL and Canton
are both starred as well because we spoke to both of those public health departments. And I have some information about what it looked like in both of those cities. On the next slide, we also have um Drakit, I hope I'm saying that right. Belchuretown, which was the first town to regulate Chelmsford, Marbor, and
Westboro. So that is those are the cities and towns who have banned in their municipalities. Next slide. Okay. So what information did we learn from LOL and Canton? because I want to make sure that the board of health recognizes that any regulations that we
do pass have to be able to be enforced by a public health uh department have to be manageable, have to respect and and be um you know they have to be tailored to what's going on in River. But what happened in LOL and Canton? So in lol the whole push to
ban was actually started by their recovery centers which uh of which they have a couple in in l um they found that most of their products were being marketed to older adults. What they mean by older adults is like not kids not teenagers. Um this is a product that
really is focused on adults. Um they did find that several interest groups um came to their um public hearings. Uh, create them across America was the name that they gave us as the interest group that came in support sorry in support of
not instituting a ban. I want to make sure that that's clear too. Um, they didn't have any residents speak during their public hearings in opposition to banning. They only had the int groups who spoke in opposition to banning in LOL. Their regulation happens
through their tobacco control officer. Want to make sure you guys are super under like clear about what that would mean here in River. Our tobacco control officer is Bonnie Carol who you guys all know. Bonnie Carroll is part of the six city tobacco initiative. So she doesn't only regulate tobacco in River, she
regulates it in Somerville, Chelsea, Lynn, I'm probably not getting all the six cities correctly. She's very busy and her scope um according to the six city tobacco initiative is just the tobacco regulations. So Bonnie wouldn't actually be able to regulate in rever or enforce
this ban. It's kind of like outside of her scope. So the burden of enforcement um would be on Mike and inspectional services. So I want to make sure you're clear about the process that it would take here. And I can talk more about that in my next slide. Uh so again in
LOL they found that three stores um so since they enacted the ban three stores have kind of violated the ban. So three stores have been fined. They instituted the same fine structure that we have implemented for our sale of tobacco to a minor fine where you all are familiar
with this. It's a th00and for the first violation, 2,000 for the second, 3,000 for the third. Quick note here, we've heard from the state and those that are much more experts in this field that as a city, we are actually not allowed to
fine as a board of health more than $1,000. So, we wouldn't be implementing a fine structure like this because we actually can't. our fine structure would be capped at $1,000 if we did decide to move forward with a ban. >> Uh let's just keep going through the
presentation. Okay. Uh so in Canton, what did we learn from Canton? Their um initi um the impetus to banatom actually came from their school nurses. Um they had six locations selling at the time of
instituting the ban. And in um Canton, very similar to what would have to happen in River is the health inspector does the enforcements. Um the consequences of violating the regulation is losing their tobacco license. So if they ever found someone who was illegally selling, they would lose their
tobacco license. Um in their public hearing um process, they found two spoke against the ban, but both of those people they noted were buying online. After the ban was enacted, all convenience stores and grocery stores were handd delivered the regulation.
They have not had any infractions so far. Um, and this is just a quick note that they they enforce other banned substances, things like vape and zin at the same time as they're inspecting forratom products. So, that was super valuable information that we learned
from both Long and Canton, who I think are the two most similar to in all the towns that have decided to do this. Um, and now let's talk about what's going on in River because that's really what's most important here. From the time that we decided to put
this on the agenda, we have done a lot of work surveying businesses. We've surveyed approximately 40 businesses. This is either via phone call or in-person visits. Of those 40 businesses that we surveyed, we found that only three businesses were found to be selling products. of those businesses,
the type of products that they were selling was a varied degree. It was um this on on the right hand side you'll see in the seltzer. So like these um they they look like energy drinks kind of thing that um that's kind of how you would you know they're in the same you
know container as energy drinks and stuff like that. A vape form and then all the way on the lefth hand side you'll see pills. So there is this powder uh type of form that can be put into a pill or just be in a powder something like that. So those were the main types of products that we saw here
in River. And again only three businesses out of the 40 that we surveys. I just want to be super transparent that is not a comprehensive survey. It's as much as we could get to in the last month with all the snow and all the craziness. Um we so but but 40 businesses I think does give you a good
snapshot of what these are. mostly convenience stores, uh, bodeas, um, um, gas station store, that type of stuff, things with people that have tobacco licenses, but and on and food licenses as well. Um, so very different varying
type of businesses, but a good snapshot of what's going on here. We also asked the poison the Massachusetts poison control line for some statistics and we found in the bottom right hand corner on the square you'll see uh in the last two years
they've had zero calls regarding in the city the zip code that is river so then we asked about Massachusetts as a whole in the last two years the entire state of Massachusetts has had 48 calls uh regarding um whoever is calling in is
reporting they're calling because of so those are that says, "Does anyone have any questions about that statistic?" It's it someone who would be calling the poison control line usually has to say what they're calling for. What is a substance that they're worried about? So, who is ever on the other line can help figure out what's going on, can help give guidance. So, they track data
based on what the substance of the caller is calling about and that's what we specifically asked for. Hope that makes sense. Okay, next slide. So, what would a ban in Revier entail? First the considerations and then the
process of how you would actually go about doing this. Considerations like I mentioned we only our our scope our uh survey although not comprehensive but a very good picture we only found about three stores currently selling. Many stores had no idea what this product
was. I will say anecdotally too. One store that did um was selling after we talked to them decided to take it off their shelves. So, so that you know it doesn't seem the problem doesn't seem in super entrenched in Revier at this time.
I mentioned this already. Ravier's tobacco control officer Bonnie who you are all very familiar with does not have the scope or bandwidth to enforce the regulation. So enforcement would have to come from the river inspectional department health inspectors which Mike could talk about later if you have any questions for him. Um the board of
health would have to decide would have to decide a fine structure and would have to be okay with us enforcing it. This would be very similar to when Bonnie brings um people who have violated selling tobacco and we have to enforce the the fines that we have enacted through the board. So it would look like that where they would be able
to come before the board but they would you know be subject to the fine. Then I just also want to make sure as a board of health you have a lot of power and we always need to be cognizant of the unintended consequences of any regulations that we're implementing. Um I put here two things. People using it
for pain control. Obviously, anecdotally, I think we've all heard kind of these stories. Is it less harmful than other Sorry, that was a typo. Harmful. Sorry about that typo. Than other controlled substances. This brings me to the um the letters that are in yourformational packet that I gave
you today. We have received throughout the the week um some letters speaking in defense, speaking about personal relationships, speaking about their own experiences, which I definitely would encourage you to read each one of them and you know um take it into
consideration again just always be cognizant of the fact that every regulation has some type of unintended consequence or you know um yeah unintended consequence. Okay. Finally, and then I'll pass it over to Mark who has a lot more expertise than I do. what would the process look like for the
board? Because we have passed regulations before. If you all remember, we passed the chickenkeeping regulation. Um, we've revised some existing regulations, but this would be the first time that we're kind of doing this from the from the ground up. Um, so today's
meeting is educational. Um, if you decide to move forward with promagating regulations, um, we need a policy, we need the policy writer for the city and the solicitor who I have talked to. I've talked to the solicitor already to help draft regulations. Then we'd have a public hearing. We'd probably not be able to do this in March. We'd probably
need to get it. We'd probably need until April to finalize this process. Um we'd have to announce a public hearing um with 21 days notice. That's probably another reason why we probably would need to do this in April. Um at the public hearing, anyone could come speak. Pros, cons, you know, we'd be there
would be a discussion about it. You would also be seeing the regulations. You would be able to make amendments. you would be able to meet make edits to the regulations or you would be able to say these are not the regulations we want. We're going to throw them out at that time. Any changes made after the public hearing may require another public hearing and then you would be
voting after all of that to enact them or not. And then we would be moving forward with inspections, annual inspections, fines, appeals on a regular basis, very similar again to the um tobacco regulations that we have already existing. Any questions for me
specifically before we pass it over to Mark or Mike? I guess. >> Yeah, Lauren, I do have a question. Um, I believe you mentioned that in Canton consequences of violating the regulation is losing a tobacco license. Um, so I
know you mentioned the fines and low. Is that something we could do in Rebear? >> That is a great question. I think it's something we could consider and if that was a the way that we wanted to move forward, we would definitely have to bring it to the city solicitor to make
sure that that type of regulation would be legal, but I I I do think that's an option we could take. Yes. >> And thank you so much for bringing um the letters that you received to our attention. Um I will be sure to read all of these before our next meeting, but I
see that none of these are signed like their own state address. So, I would love to know if these are actually REI folks or just folks from outside of Re because it makes a big difference. >> Yeah, very good point. These are all received via email. So, you're exactly
right that it's um you have to obviously weigh that when you're reading letters like this of you you are here to enact and enforce regulations for the city of Rivier and that should be really what you're thinking about. So, I don't have a great way to tell where these people
are coming from. So, I definitely think you should keep that in mind when you're reading them. I can't speak for >> Do we have capacity to email them back and ask them for their address? >> Sure. I could I could work on that. Yeah, >> Lauren, I have a I have a question also.
Guys, guys, >> I have a question from all the >> Okay, we'll try again. Um, from reading different articles for research that I've done, it sounds like the CR there were two different types of it.
>> Sorry, we have to maintain quiet. >> Thank you >> for both, please. >> Okay, Mr. Cantino, you please, we ask you. >> Just like you. >> Can we take a recess, please? >> Yeah, we'll take we're going to take a
recess from the meeting. >> I'm not going to do this. We can resume. >> Okay. We started. Okay. I had started to ask a question. It seems like what we're looking at basically are two different drugs. Is it going to be possible to
regulate one side the the higher dose versus the higher dose and the lower dose? I see it as two separate completely separate issues. >> That's a great question. I think for enforcement it would probably be difficult to do that. I can look
specifically um at other um cities to see if any of them have taken that tact. Mhm. >> Uh so I don't know if the I don't know of the answer right now, but I can definitely look into it. >> Yeah. >> Okay. Thank Thank you.
>> Any other questions for me? Uh or we can move over to Mark's present. Okay. No, I think we're good. Yeah. Just get Mark if we you don't mind going ahead and and starting your presentation. Thank you. >> Not at all. I'm Mark Gotautle and um I I just want to say Lauren, you did a
fantastic job and I uh I've been uh editing my my slide deck a little bit so that I'm not going to cover some of the same points you are. Let me see if I'm able to. Ah, sharing is not turned on. All right. Well, there we go. Hang on a second. Um
so, yeah, I think we can skip the what is slide. I'm Markle. I'm executive director of the public health advocacy institute at Northeastern University School of Law where I'm a professor teaching public health advocacy to law students. Um, thank you for having me.
I'll try to be quick. I know we had a little delay uh a moment ago and I think we can go to the next slide here. Um so and this really goes to the the the uh the question that was just asked which
is about the two types of of ofratom and one is this natural leafratum um which uh contains approximately a 2% concentration of the psychoactive
alkyoids of seven hydroxy metrogenine um known as 70oh H and uh and nitrogenine and and those provide with its opioid like effects. Um they work on opioid receptors in the brain and target
the same receptors as for example morphine. So while pure leafratom has only as I say 2% of these alcohol 2% concentration of these alkyoids the synthetic pro products that are available have concentrations up to 98%.
So that's what a 4,900% increase in potency. Um so these are very different um uh drugs if you will. For the most part, it's the high potency synthetic cratom that's associated with
addiction and implicated in sometimes fatal overdoses um as uh depicted in in this slide um uh with a headline from the Tampa Bay Times finding hundreds of uh deaths in Florida. Um and this really
creates a question for for regulators and policy makers and boards of health. Um should we only regulate synthetic cratum where most of the harmful effects are are um are attributed or do we have a acrosstheboard
um restriction on the sales or access toratum products? Um and I will go to um a a few slides up if you could. Um, next another
one more because I think we covered this and no back back and the question is does doesratom uh pose a threat to to um to to minors and I think the key this is a key question right doesratom pose risk
to children and adolescence I think overall particularly syntheticum with syntheticum the answer is yes um um we've seen an increase in usage overall. It's very accessible. Um and maybe not so much in Revier because there are only
three um uh retail outlets. Um but this is not an age restricted drug. It is um one that uh any um kid can conceivably purchase in in a retail location. Um and
it's becoming more highly associated with uh marijuana and uh and tobacco use. Uh youth who reported uh past month tobacco or marijuana use were about two and a half times more
likely to um report uh use as well. Um and it has is both a stimulant and an analesic. So at lower doses it has a stimulant effect. higher doses and an analesic effect. Um and so as a
stimulant it has an effect kind of similar to aderall and students have been um uh using and and sometimes abusing aderall um particularly in college as a way to increase their
attentiveness and studying. Um and um and we've also seen, believe it or not, uh and um and we were talking about um uh Lauren, the the poison control centers. And fortunately, you haven't had any issues coming up in River uh
thus far, but we've seen accidentalratom use in newborns and infants because of a lack of knowledge of effects on uh pregnant and breastfeeding mothers. Um some pregnant women have used um
synthetic to manage pain. Um and um research by the center for injury research and policy at the central Ohio poison center uh at Nationwide Children's Hospital found that cratom use um while pregnant and breastfeeding
can result in symptoms of withdrawal in infants. And this has been something that's been noted. Um so this does can pose a risk to kids. And if you go to the next slide, um you know, we'll see
that as the um as the um industry grows, we see similarities to the cannabis and tobacco industries um in the way that the products have been creating youth appeal. And you see these these picturedratom taffies, seltzers and
gummies, tonics and vapes, very similar to the types of products you might see in a cannabis cannabis dispensary or a a vape shop. Um, and you know, as we saw with the legalization of cannabis here in the Commonwealth, the uh it we saw a
dramatically increased THC concentrations um in extracts and isolates um that were entering the market. um various canabonoids in addition to THC. Uh so we're seeing those these similar um you
know very concentrated high potency products in the syn in the synthetic catratom formulations that are that are sold u today. Um one important difference though is thatratom products are as I mentioned largely unregulated.
uh any uh in Massachusetts, a 17-year-old can't purchase vapes, can't purchase alcohol, can't purchase cannabis, but they are able to purchase something that looks very similar. Um it has a similar drug effect. In fact, one that's stronger than morphine in
synthetic. Um um moving one one more slide here and I'll try to wrap this up quickly. Uh we have the um if you could move one slide forward. Yes. So we have age restrictions um in
in some states. Um uh we've got um oh and and we've uh uh we've we've jumped to the next slide, but that's fine. So we've got age restrictions in some states. We have um some complete bans. Uh we have um uh some states that have
uh banned it to sales to persons under 18. Some have ba banned sales to per people under 21. Uh some that have required child safe packaging such as Utah and West Virginia. So there's been been um a lot of that. Um and um I'll
just say that um you know the um there are despite whatever kinds of restrictions are are done at the for retail there is an abundance of uh the internet options for obtaining products that are almost uh all synthetic
products. Internationally we find that the US is one of the few western countries whereatratom is is largely unregulated. Um, Australia and New Zealand banned more than 10 years ago and deemed it a narcotic. In Europe, um,
several countries consider a controlled or banned substance. Denmark, Finland, France, Germany, Ireland, the UK, Romania, Sweden. Um, in Canada, selling or importing u with the intention of ingestion is prohibited. So, we're a bit
of an outlier in that regard here in the States. Um uh we want to go forward another slide here. Um the DEA um lists as a drug and chemical of concern. Uh it
was uh it it had proposed um including as a schedule one drug like cocaine or heroin. Um but uh they the um that um uh proposal was withdrawn due to some
public and congressional opposition some years ago. Um the FDA has not approved for any medical use. So it can't be marketed legally as a drug, a dietary supplement or a food additive. It's basically been silent onratom.
Um and um you know there was a uh congressional bill filed a few years ago called theratom consumer protection act um that was um uh supported by the American association the trade association for the industry uh which
would have required congressional hearings and uh but also put brakes on any FDA action on uh onratom uh but it's not pending in the current congress. Um, moving ahead one more slide here and
I'll try to wrap this up in uh in 2 minutes or less. Um, right now we've gotratom as a controlled substance in seven states. Um, we have a variety of states that have uh different types of
approaches toratom. Some age restrict the product entirely. Some only um restrict sales of cratom products with um uh concentrations of um 70oh or
hydroxy metrogenine um greater than 2% which is what it would be in natural leafratom. So that's another approach right. So, if you're going to just try to ban the super concentrated synthetic
products, um this is going to require testing um and probably third-party um laboratory testing and certificates of analysis. So, this is become becomes a a a bit of a an administrative burden
to do that. Um and um moving ahead um we've got uh enforcement. Oh, local cratom bands. Yeah, we've got lots of uh uh cratom bands. I believe we've uh um this has been discussed already. So, we
can move past that. Um uh we have Yeah, let me just update you a little bit on um the uh um statewide uh legislation. um a couple of weeks ago or less than that on the 19th
of February um the um S4394 and H2454 which requires ingredient labeling um and directions on products um contaminate prohibits prohibit a prohibition on
contamination with nonratom substances limits to that 2% concentration of the alkyoids and an age restriction that advanced from the judiciary committee to the Ways and Means Committee. So that actually
has some momentum at the state level and this would essentially eliminate the high potency um synthetic products. So that leaves us with the question of what we want to do or what could be done
locally. And you can just skip to the last slide if you will because my voice is going. Pardon me. So, you know, it's it's a popular um product. It's been um touted
as a a hugely important um uh analesic for folks who don't want to uh use um um opioid analesics or pain medications. Some people have found it to be very
helpful in mitigating the um um you know the complications of withdrawal from opioids as a harm reduction product. But um the synthetic pratum at very high concentrations of these alkyoids um is
is actually a fairly dangerous product. And I think it's very difficult at the local level to try to distinguish between um concentrations ofratom. You could go through a a type of process similar to what we have with flavored
tobacco where you need um uh retailers get you know certification and a letter from the manufacturers indicating that um these products do not exceed 2%. That's a little bit hard to do I think at the local level and if you're going
to go in that direction you need to really consider what would be involved in enforcement. I think it's kind of cleaner and neater at the local level for just a blanket ban on allum products. Um and perhaps if the state
legislation does move forward um and that includes laboratory testing and something like that, then perhaps um you could take another look at what you would want to do locally. So that's that's my presentation. Thank you very much for your attention.
If you have any questions, I can try to answer them. >> Thank you so much, Mark. Presentation, >> can I can I can you talk again just about the uh concentration? I just want to make sure I understood that. So, the
synthetic cratom products has 98% of how do you pronounce this? Hydro midagene. >> Yeah, that's 70 is uh is is is the easy way to to to put it. Yeah. So when people were using this and it's a leaf
and it was grounded, it's only 2%. >> Yes. And those products are available on the market um you know natural leafratom. And I think there are very passionate and articulate advocates for natural leafratom products who feel like
it's going to be very unfair because to them to have a a total ban. Um but I think it's also very difficult at the local level particularly to um to distinguish among the uh different kinds of products because there are many
products that are out there. Um so it it it I think puts boards of health um and municipalities in a difficult position in Massachusetts without any kind of statewide regulatory framework. >> Mark, I also have another uh question
for you. It caught my attention that Lowel started regulating this from Lauren's presentation um because advocacy from recovery centers. I also spoke to somebody who spoke um who works at a recovery center. She couldn't be
here today, but she mentioned that this is also a big issue uh of concern among her patients. Um do you have any more data regarding that? Well, I it's you know I think has um one
of the the appeals of this product is that it can be used for harm reduction um in um folks who are um suffering from opioid use disorder. Um however at the higher concentrations of syn with
synthetic um it actually is stimulating the opioid receptors in almost the exact same way um that morphine does or heroin does. Um and and you know it for folks who have
become addicted to that in synthetic um people have been have required um um medicationass assisted treatment um to uh to help them with that addiction. So again, you know, it's you can kind it is
about two different drugs, but they're both calledratom. Um and um and I think there is probably some really good um harm reduction potential for this product in, you know, in in the face of a fentanyl and an opioid situation that
um can be absolutely deadly. Um but we do have you know I guess maybe o thousands of incidents of of overdose whereratom was part of the drug mix. It's rarely um uh creates a fatal
overdose in and of itself but um has been found you know um in autopsies of overdose victims usually um with other um substances as well. and almost always the synthetic version.
>> I have a question for you. Um, >> in in the packaging, >> does it specify which type if it's leaves or if it's synthetic? >> Yeah, the packaging is not regulated. >> So, um um that's one of the areas of
potential regulation is is on the packaging. Hard to do at the local level. Um but that is you know that it's very difficult for and that is what the state in fact the state legislation that is now pending at ways and means would
address that >> and same thing with the some of the stuff that's found locally in reair if somebody is purchasing some of these things that Lauren showed in her presentation the drinks the powder what else was there uh the vape do they know what
concentration they're getting does it attempt to even put it on the package. Are people >> I think that varies from product to product. >> Yeah, that that would vary from product to product. So there's no there there's no
consistency there since there is no regulatory requirement um addressing this. >> Great. Any other questions from the board? >> I just ask a question. >> We're gonna um Can we wait to have you
come up um and speak? >> Um I think he's going to be Mark, are you going to stay with us for the um >> I'm happy to stay for the uh >> Do you mind when you come up asking? I'm sorry to Yeah. >> Um All right.
Thank you. I think Bonnie Carol was going to speak today, but unfortunately she's not able to make this meeting. Um, so now we're just going to open the um basically the floor up for for people who come here and want would like to speak um about their feelings about this
possible legislation or this possible um regulation that's could be coming before the board. Um please limit to two minutes. I am going to be timing. I'm sorry. We're just trying to move things along, but um so please if anyone would like to come up and speak
and just say um your name and then um address >> Wayne Rose Street. Um so I've been doing some research into this. Um that's why I called the board of health to bring it to their attention
over a month ago. It's finally come up and I'm glad that it has. Um, this stuff's dangerous. Dangerous for the children. Anybody can get it. Any There's no regulations. So, what are they selling in these packages?
Do any of you know? >> I think we don't we don't know. >> You don't know. So, I mean, there's got to be some regulation, especially when it comes to children. Uh people are overdosing from this. They're they are getting it's highly addictive. My friend
was addicted to it and he bought this stuff at a liquor store in Re. So I I I don't agree with everything your uh presentation guys said, but I mean
there's no regulation. You can't check it. We don't know what's in these in this stuff and we're selling it to kids. We're immorals here. This is you guys at the bord of hope. You guys are like the last stop for us. Please help us. Please
help the children of rea, will you? >> Thank you. >> Did you did you have a specific question for Mark? >> My my question. Well, you answered it because it's not it's not regulated. Okay. Yeah. >> And we don't know what's in the packages. Yep. >> And that was one of my uh questions. So,
>> okay. Thank you so much. >> Thank you. Yep. Yeah, great. >> Hi, my name is Mike Fischer. I'm a community member. Um, not actually from SUS. I live just over in uh not from Re. I live just over in SUS. Um, I came to
talk about the differences between extracts, synthetics, and natural leaf cratom. I have a onepage handout here if I could give to you. It's from the uh global credratom coalition organization based out of Washington DC. Just wanted to state that there is a
huge difference between naturalratom and synthetics and extracts. Um with the synthetics and the extracts, I definitely agree that they should be be banned 100%. They're extremely dangerous. When you're talking about the concentrations of 4 to 5,000 parts per
million, that's extremely high harmful to the body. It affects the respiratory system can cause your breathing to shut down. When it comes to the natural whole leaf cratom, the parts per million in a single dose, like you said, a less than
2%, that's less than 100 parts per million. It's less than 05%. It's a very small number. Um, the FDA, they do have case studies on this. Their recommendation of parts per million of a safe product is less than 400. Natural
Leaf has less than 100. Like I just previously said, um there have been zero cases reported of any sort of severe harm from this product, hospitalization or anything like that. Just wanted to bring that to the attention as well. Um
you can basically as a comparison a cup of coffee has 100 milligrams of caffeine. I feel safe drinking a cup of coffee. I would not take a 5,000 milligram capsule of caffeine. They're night and day in totally different different totally different beings. Once
you do these extracts and these um synthetic processes that they perform on the whole leafratom it's no longer it's a totally different product. These 70 products are dangerous and that should be banned 100%. Now when it comes to the whole leaf cratom I do agree it's not
intended for the use of children. It's for adult use and there should be regulations. There should be age restrictions. Um there's plenty of other examples of the regulations that can be put on it to make it safe for the community, but in the product itself, it is a safe product. It's been used for
thousands of years and traditional wellness. And like I said, there's been zero case zero harm effects from it. And on that flyer that I just gave you, there's a QR code which links directly to the FDA's website on 70 products. And there's some studies on there if you
wanted to look further into it. That's a great resource that you can look at. And um there are steps that you can take to distinguish between whole leafratom and these synthetics. Responsible packaging restrictions, labeling restrictions, um
21 and over adult use. So there are ways that this can be regulated and has been regulated in many successful situations and I think Re should consider these uh these situations where regulation can be successful on a whole leaf freedom which does have a lot of helpfulness to it as
opposed to harm. >> Thank you. Thank you so much. Any uh any questions from any board members? >> Does anybody have any questions for me? Any any questions from I don't think I have any questions. I
appreciate the information and we'll I I didn't realize that the uh FDA had come up with this uh QR code. This will be quite helpful. Um so I appreciate it. Okay. >> Yeah. So um we will keep this discussion
going. I think in the next the next meeting we will discuss further. Um I think from the the board perspective I think it's going to be a challenging decision but I I see both sides of the argument of banning it completely
because we don't know what concentration is in these products versus having strict regulations. But that strict regul regulations, I'd have to see how other communities have really done the strict regulations and the strict packaging. Um
>> just a just a note on process. Um you're absolutely right, Dr. Bunker. You have information in front of you that's new tonight. So again, today is just educational. We can put an um agenda item on the March board of health meeting to have like further discussions and at that time you can determine as a
board if you'd like us to move forward with writing regulations. if not um any specific things that you'd like to see at that time. So, yeah, we can we can put that on the board meeting in March. >> Okay. I know I'm not going to be at the board meeting. Um
one question I would like to see is if that regulation, the bill that they're trying to pass, if that goes through, what changes is that going to make for us? And should we also be acting proactively? >> Is Mark still on? Mark. U Mark, do you want to take a shot at that one?
>> I'm I'm sorry. Could you repeat that? I that was having a little audio issue. >> Sorry. Um the bill that you talked about. >> Yeah. >> Uh if that does pass, how is that going to change what we're talking about basically?
>> Right. It will it it will um uh reduce the um maximum um concentration of 70 to 2% which is the same as natural leaf cratom. It would require um um warnings
uh and information on packaging um and um age restrict the product to 21 and over >> which is sorry which is kind of like well we're one of our options. Thank you for explaining that. >> And and as I was mentioning, my only
concern really is that it's just I I I think enforcement might be difficult um for uh doing it community by community if you're distinguishing among the different kinds of products. It just that's my that's my only concern. and
and the gentleman who um who who's who who gave that very eloquent comment um and and very informative comment I think is is absolutely correct that you know the natural leaf cratom poses um um minimal if any um public health threat
and and may in fact be something that could benefit public health um in in terms of its mild analesic um energizing and uh and and impact on on harm reduction from opioids. So, um I it's
not easy for me to say, well, you should just ban all products, but um it it is a difficult uh call and I know you're going to give it some deliberation as you move forward. >> Mark, can I ask you a question? Where is the state process? Because sometimes um
state process can take years. Uh, and my concern is that we might see that we may have three stores may be selling these products that people have no idea what they're getting into. Um, and then while the state acts, we just might see a
peripheration of the products, an increase in number of things available. Where's the state at with um their process? >> Well, the the bill was filed um a little over a year ago. It was assigned to the
judiciary committee. The judiciary committee held a hearing um and ultimately issued its recommendation to um uh um um to not approve the bill but to um approve it out of the committee to
the next committee which is the ways and means committee which is the next step in the legislative process. And that just happened um a week and a half ago. Uh so there will likely be a Ways and Means Committee hearing at the legislature. Um uh and it'll probably be
a joint hearing. Uh and perhaps it'll make it to the floor before the end of the legislative session um at the end of this year. >> But there's no guarantee that the state is going to regulate it this year, right? >> Absolutely no guarantee. Um, it's it
it's it's no one really knows what uh what legislation is ultimately going to make it to the floor. It's an interesting process here in the Commonwealth. >> I have a question that I just thought of. Um, the non-synthetic, the leaf version, is
it is it addictive? It's less >> um the the the the leaf version um would I think be considered very mildly addictive um in the same way that you know caffeine is addictive but it
doesn't um pose a uh you don't have a much you know much caffeine use disorder as a clinical problem. Um, so it's it's it's sort of like that >> there have been FDA studies that prove that sorry not proof that state that
natural leaf creatum is less addictive than tobacco and alcohol. >> Thank you to both of you. >> Yeah, I just have a a question. Sorry. Um, do we know what products are being
sold in Revier at the these stores? Are they synthetic? Are they leaf products? I I don't even know what what is actually out there on the on the shelves. I know what I I see the different types of products, but what is actually these being sold? Because if
the the question is if only synthetics are being sold and that's easy. We just ban it because there's only synthetics being sold. >> Uh sorry, Dr. Bonger, that's a great question. I think it speaks to Mark's point that it actually is
I'll be completely honest. We did a a survey of products based on things like other presentations, Google searches, looking at pictures, making like comparing pictures to see if they look like the same type of packaging, that type of thing. So, we weren't really
looking for the the ingredients. We were looking for the actual products, the products that that are listed. I mean, I have to only assume that they are the syn synthetic type. Um, but maybe Mark has more knowledge about that, but I
think this also speaks to the very tricky nature. You'd have to become almost like an expert in the type of products. Mark, you can jump in here too if you're you probably know a lot more than I do >> yet. I don't know what's on the store shelves in in rever and I I don't think
any more than than you do since I don't generally shop for for great but um but yeah I I think it is um u most of what we see um you know at at liquor stores and gas stations are the synthetic uh
highly concentrated um uh versions of of so um and and that's that's That's that's where I think a a big chunk of the market is unfortunately. So a lot of what's out there on the in the in the retail sector and sold on the internet
is in fact the much more um uh dangerous uh formulation of of there really should be different names for them because they are completely different um types of products. It's like, you know, um a cup
of tea versus a uh freebasing cocaine. you know, they're both they're both stimulants, but um in a completely different uh category in terms of the uh the risk to health and addiction. >> I just want to say as far as knowing what types of products on that are on
the shelves with the regulations requiring labeling with the percentages, like you said, less than 2% which is recommended by the FDA would be a step on how you would know what type of product it was. So if a product wasn't labeled and didn't have the proper percentages and warnings on it, then
that in itself should be banned. But if it does follow the regulations set forward by the board as well as recommendations by the FDA, then that's your answer where how you would know which products would be approved and which products wouldn't through one form would be through package labeling which
would give you the details on what's actually in the package. The only issue is that they people could claim like these companies could claim that there's a certain percentage and without it being a monitored medication by the FDA, we don't actually
know. So you could claim to have some sort of percentage. I know I hear what you're saying. Um but yeah, thank you for that. >> People could claim like these companies could >> All right. I think. Yeah, just one more question
and then I think we're going to have to move on to the next. >> My question is just >> I'm Wayne Ross Review Street again. I'm just wondering if we could bring the uh state reps up here to find out what's going on in Boston with their bills.
Bring them forward. Let's hear what they have to say. This is this is dangerous. I think that there should be something passed at least for children. age restrictions that that should be first and foremost. >> No, absolutely. And I hopefully I we
don't know, but I hope this is something that's very much on the top of what their agenda is and what they need to be doing because I agree with you. This is lives we're talking about >> affected for the Yeah. >> This is blowing up in Florida. >> Yeah. >> Florida. You want to you want to take a lesson,
>> look at this stuff coming out of Florida. >> Okay. Yeah. Thank you. >> Thank you. >> All right. I think the we will discuss more at our next next meeting um for now and talk about what
what our plan is for regulation because I do believe there needs to be regulation whether it's banning it completely or having some sort of um regulatory uh age restriction late package packaging whatnot. Um thank you um
Mark for being here. I will let you go. I appreciate it. >> Dr. the bunker. I think Bonnie Carol's trying to >> Oh, sorry. Is Bonnie trying to get in? >> Trying to get in via Zoom. >> Okay. Bonnie's here. >> Okay. >> All right. Bonnie, did you have um
something you wanted to say? >> Hi. Yes. I'm so sorry. My deepest apologies for >> Okay. No problem. >> Please go ahead. Bonnie, just a to reminder, you're on the agenda for talking about the ch changes to the FDA
marketing granted orders that what we talked about. >> I Yes, thank you. >> I do think you're going to have to give a bit of a um explanation to the board. I don't you know, they weren't on our email thread. >> Okay. Um I did just want to say though,
too, I don't know what that Bonnie, can you hear us? >> Yes. Um, I'm here. I'm sorry that I'm There's an awful lot of feedback. I'm not sure what's wrong, but um, can you hear me? Okay. >> Yes, we can. >> Okay. I first of all, my deepest
apologies for being late. It's a whole story that I won't get into. Um however just in uh just one thing to add >> Bonnie Viviana made a great suggestion. How about we um move this agenda item to March? Is that okay? And you'd be able
to come potentially in March in person? >> Yes, absolutely. Um, I did want to just add one thing, Lauren, to the previous conversation. Since I inspect the stores in Rever, I wanted to say that 90% of what I find in the stores is synthetic
>> crater. >> Oh, that's amazing. Thank you, Bonnie, for adding that insight. And we'll add your agenda item about the FDA marketing granted orders to March. >> Sounds good. Great. Thank you, Bonnie. So, that's going to conclude the the
credum discussion for today. Um, next is the So, thank you everyone who's here for discuss. We're going to move on to some other um board of health topics. So, next is going to be the Thank you. the the body body art licensing. Um, I
believe Lauren, you can take it from there. >> Just one today. Um we did the majority of our body art licenses back in January, but we did have one additional um that we inspected yesterday, I believe. Yes. Uh so this is a uh application for an individual
practitioner for Piedad Nikira Quinto Garcia. Um she will be practicing under Sarah Espino. So this is just an individual practitioner license. Her inspection was on the 25th. She did pass and so I recommend uh that the board
vote to approve her license. >> Yes, I approve the license. >> I approve also. >> I approve as well. >> Great. Thank you. And that's it. Great. All right. That will conclude this month's meeting. Thank you very much.