WEBVTT

METADATA
Video-Count: 1
Video-1: youtube.com/watch?v=SnhuyNBIero

NOTE
MEETING SECTIONS:

Part 1 (Video ID: SnhuyNBIero):
- 00:01:59: Meeting Start, Pledge of Allegiance, Introductions of Members
- 00:04:34: Public Health Communicable Disease Monthly Report (Lauren Buck)
- 00:09:09: Inspectional Services Monthly Report (Michael Wells)
- 00:11:04: Presentation: Status-Neutral HIV Care in Suffolk County Jails
- 00:23:28: Comments and Discussion of Presentation on HIV Care
- 00:27:20: Introduction: Restricting the Sale of Kratom Products
- 00:28:27: Kratom Regulation Summary and Background Information
- 00:30:39: Further Details on Kratom Regulations by Claire Enzarello
- 00:36:25: Opening the Floor to Proponents of Kratom Ban
- 00:37:25: Public Comment: Allison Smith, Global Kratom Coalition Opposes Ban
- 00:40:45: Reading of Public Comments Received by Paula Sepulveda
- 00:41:24: Board of Health Discussion Regarding Kratom Regulations


Part: 1

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Mhm. >> Hello. Welcome to the May 2026 Board of Health meeting for the city of Revere. Can everyone please stand for the Pledge of Allegiance? >> I pledge allegiance to the flag of the United States of America, and to the

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republic for which it stands, one nation under God, indivisible, with liberty and justice for all. >> Thank you. So, welcome. My name is Dr. Drew Bunker, chair of Board of Health. To my left is Kathleen Savage, also board member. And

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to my right is Viviana Catano, board member as well. Invited staff are today are Lauren Buck, Director of Public Health, Michael Wells, Health Agent, Director of Inspectional Services, Paula Sepulveda, Board of Health Clerk, and Claire Enzirello,

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policy writer and analyst. First, we're going to review and approve the minutes from April. So, I just ask the other board members if they approve those minutes. >> I approve the minutes. >> I approve the minutes. >> Excellent, thank you. And then next is the Public Health Communicable Disease

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monthly report with Lauren Buck. >> Thanks, Dr. Bunker. Uh for May 2026, uh we had actually a relatively low um threshold of communicable diseases. We had 13 influenza cases, only one Lyme disease uh case, and several COVID

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cases. Um so, that's great news. Uh from state and national public health updates, I wanted to give an update about Ebola and hantavirus. So, first I'll talk about Ebola. There is currently an Ebola outbreak in Central Africa that continues to spread. The latest figures of more than 160

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deaths and 1,000 suspected cases in the Dominican um sorry, the Democratic Republic of Congo are almost uh certainly an undercount, and the trajectory means deeply concerning. For those of us in the United States, the personal risk remains low, but the toll on the region is severe. All signs

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are pointing towards widespread and undetected community transmission, and compared to previous outbreaks, the spread of infection is very fast, and there are multiple epicenters, including in the DCR in Uganda. What does this mean for you? If you have travel plans to this region, it's time to cancel

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them. This is a high-risk situation that's currently happening in Central Africa, and the CDC has released a level four travel advisory. There is also a great uncertainty if and when the administration would let you back in if you did travel to that area. But for the general public in the US,

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your risk remains very very low right now. Uh hantavirus update, as of yesterday, Wednesday the 27th, there were 11 confirmed cases and two probable cases of the Andes strain hantavirus. There have been three glo- uh deaths globally. In the United States, all 18 quarantined

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individuals continue to test negative. More cases may continue to show up given that the time from last exposure to first sign of infection for hantavirus is actually quite long. It's about 45 days. Just as a review, hantavirus is a family of viruses that cause pulmonary symptoms and hemorrhagic fever. The strain

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currently being monitored is the only one known to spread person-to-person, but people initially contract it from rodents. The spread is usually limited to people who have close contact with an ill person. Currently, the 18 American travelers, like I mentioned, um from the initially uninfected cruise are

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quarantine quarantining in a specialized facility in Nebraska. So, to summarize in good news, your risk from this cruise ship hantavirus outbreak is extremely low at this point. Um updates from the city of Revere Health and Human Services. With summer rapidly approaching, it's time to think

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about water and swimming safety. Remember to never swim alone and only swim at beaches and bodies of water that are supervised by a lifeguard. Learn about rip current safety, which is making sure you stay calm, don't fight the current, float on your back, and swim parallel to the shore. Never dive

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headfirst into unknown or shallow waters. Play clo- Sorry, pay close attention to beach warning flags and signs. Weekly water testing has started at Revere's public beaches, and if any of Revere the Revere beaches are going to be closed for high bacteria levels, you will see signage posted at the

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lifeguard stands, and there will be a red alert banner on the city's webpage, the main webpage. So, it's a good idea to get in the habit of checking the website before heading to the beach for the day. Finally, if you have a home pool, remember to abide by all state and local federal federal regulation state, local,

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and federal regulations about fencing, gates, covers, and safety gear. Next up, FIFA. So, the FIFA World Cup tournament begins in about 2 weeks. Revere is expecting an increase in tourists and overnight guests through mid-June to July. The Public Health Department, Mayor's Office, Public Safety, and Field of Play Committee are

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working closely with the state and each other to ensure safety and security is maintained throughout the course of the tournament. And you need to budget for increased car and foot traffic in your travels throughout this time. Next up, mosquitoes. So, mosquito season is here. As a reminder, residents can request weekly mosquito spraying for their

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property from Northeast Mosquito Northeast Massachusetts Mosquito Control and Wetlands Management District by visiting the City of Revere Public Health Department website. There's a link there where you can request weekly spraying. You have to request it weekly. Every The cutoff is every Sunday every

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Wednesday Wednesday for the week. And if there is bad weather, they will not come to do the spraying for that week, but you must request it every week. Finally, the Public Health Department is hosting its first-ever community baby shower in late June, and we are asking for donations of diapers of any size and

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baby wipes. Drop-off Drop-off locations include City Hall and the Revere Public Library. We are collecting these items until June 15th, and any help would be most much appreciated and would be benefiting the most vulnerable members in our community. That's it. >> Great. Thank you, Lauren. Next is the

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Inspectional Services monthly report with Michael Wells. >> Thanks, Dr. Bunker. The Inspectional Services monthly report for May is on the interior housing division. We performed 30 certificate certificate of fitness inspections. We conducted 40 certificate of fitness

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reinspections. 16 interior complaints were received and in process. Four interior complaint inspections. Three interior complaint reinspections. 16 pool and spa inspections, um five spa reinspections,

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and one safe housing task force um inspection. On the food inspection division, we performed 47 uh routine inspections, six reinspections, nine complaint inspections, one pre-opening inspection, and five temporary food service

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inspections. On the exterior sanitation division, um we issued 504 violations for uh trash accumulation um of trash and debris, 53 violations for overflowing dumpsters,

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one violation for improper signage in public property, 20 violations for uh junk heap dumpsters and automobile graveyards, eight violations for uh properties with multiple unregistered vehicles, 50 violations for unclean unsanitary land, which is overgrowth, um and that

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concludes the report. Um as we speak about overgrowth, I know we were just talking feels like last month about snow and ice, but we're now on to um luckily with that's all done and over with, and we're on to overgrowth. So, um please residential properties and commercial properties, please make sure

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that we're maintaining our properties um free of overgrowth, um and maintaining the grass in um on your properties. Thank you. >> Great. Thank you, Michael. Next is going to be a presentation by the the BMC research group, although it's

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involving a lot of research or a lot of institutions um in their with their work on HIV and incarceration. So, I have Dr. Alice Warshall. Hope I said that right. Thank you. >> doctor at the um post office building in

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Revere um during residency at MGH. So, I was over there between 2008 and 2011. So it's really nice to come back to Revere and spend some time with you. I am an infectious diseases doctor and an addiction doctor internal medicine doctor at Boston Medical Center and I've

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been providing health care in the jails across Massachusetts for about 15 years. Currently working as one of the doctors at the Suffolk County Jail which there's two Suffolk County Jail South Bay which is in the south side and the

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Nashua Street. So I'm going to talk to you a little bit and I'm here with Sarah Fieldman who's project coordinator with us. I'm going to talk about stat something called status neutral HIV care in Suffolk County Jails. Next slide please. I do receive support from Gilead which

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makes medications that prevent HIV. Thank you. Okay, so there's been tons of HIV outbreaks in Massachusetts. You may have heard of Lowell and Lawrence as being the two sites of HIV outbreaks that occurred in the past. Boston also has several

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outbreaks. There's consistently people who get HIV through sex but what we're seeing especially as substance use disorder is impacting our community is HIV being shared through people who use needles or inject drugs and so this is just a report of just how

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many cases we have. This is through 2023 and you can see in the middle there's like a spike and then after there's a spike of HIV there usually is the Department of Public Health comes in and starts testing and putting people on treatment and then it goes down but we're continuing to see lots of HIV and

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I do believe even right now we might be in the middle of a spike of HIV. Next slide. These are some of the numbers from 2024 and you just see Boston, Chelsea and Revere. You can see Revere is at the lower side in terms of the diagnosis

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rate but what I want you to see on the right side is something called viral suppression. So someone with HIV should be on medicines to suppress their HIV virus. They will live just as long as someone without HIV. Things have really changed and improved. But the goal is to get their virus suppressed. These numbers I think are a

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little bit on the low side. And it looks like Revere is actually better than Boston and Chelsea. But the goal is that everyone with HIV is suppressed. If you're suppressed, you cannot transmit the virus. Next slide. This is a breakdown of all of the new

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cases of HIV in Revere in 2024. What you can see is 56% of them were attributable to male with male sex. But there's also a group of people male with male sex and injection drug use and also a group of injection drug use. There's also no identified risk which may in

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fact be injection drug use or other things that people just don't feel comfortable sharing with us. And so this is the breakdown of Revere which is pretty similar honestly as it looks at the rest of Suffolk County. Next slide, please. So I wanted to talk to you about PrEP. If you haven't heard about PrEP back in 2012 or so, it was this really

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paradigm-shifting medicine. It's a medicine that originally with Truvada or Descovy, you would take every day to prevent HIV. And a prevention for HIV was unheard of until that time. What we have now is something called cabotegravir which is

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long-acting injectable medicines. You get an injection every 2 months and it prevents HIV. And about 2 or 3 months ago maybe this this new this new one was approved that's every 6 months. So an injection every 6 months prevents HIV. So it's really revolutionary and we really want to get people who are at

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risk on these medicines. Next slide. So I work in the jails and I help create these CDC recommendations for the correctional and detention centers. And if you push forward, you'll see there are specific guidelines for jails. And that jail jails should be checking for lots of different things to keep our entire community safe. One of the things

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that I'd like to talk to you about is how jails and prisons are different. Jails are at the county level and the average length of stay in a jail is actually quite short. So someone comes into jail and they're usually released within 7 to days to 30 days. That's because they're pre-trial, they haven't been found guilty of crime, or bail is

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set, other things. So, this is different than prisons. Prisons are extended periods of time. Um and so, when you come into jail, you're supposed to be offered an HIV test, you're supposed to be offered lots of tests and lots of vaccines. But, sometimes that's really hard to happen. You can imagine the person coming into

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jail at that moment in time might not be in their best moment in their life. They may not be interested in talking, they may be withdrawing, although we're doing a lot to support them from not withdrawing recently. Um so, HIV testing at intake is important. Next slide. Um so, there's something called

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status-neutral care, um and it's what the Massachusetts and Boston um sort of AIDS coalition has come up with and taken from New York City. So, status-neutral care means you get an HIV test, and I'm going to care for you if it's positive or negative. If it's positive, I'm going to put you on meds

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to suppress your viral load and have you live a really long time. If it's negative, we're going to have a discussion about you going on meds to prevent HIV. So, that's status-neutral. Either way, I'm going to talk to you about hep C, I'm going to talk to you about syphilis, I'm going to talk to you about lots of different things, give you vaccinations. So, status-neutral. I'm

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going to care for you whether you don't have HIV or whether you do have HIV. That's a shift from historically where if someone has an HIV negative, we're sort of like pat pat on the back, you know, congrats, um which really misses an opportunity to prevent HIV moving forward. Next slide.

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Okay, but very few people in Massachusetts get PrEP, the medicine, especially in the jails. HIV testing is supposed to be the first step to make sure someone does not have a testing, but there's lots of reasons why testing does not happen in jails. For example, the process of getting

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blood from people who use drugs can be really challenging, and rapid testing is not routinely used in jails. Most care is provided by nurses in jails, and many nurses do not feel comfortable doing HIV testing or discussing HIV test results. You can also imagine that someone who

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might be at risk for HIV does not want to get tested in jail. I have told people that they have HIV while they're in jail. It is not a comfortable experience being away from your loved ones. Um there's potentially a lot of risk if you disclose to other people for bullying. So there's a lot of things that can go wrong with happening for

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testing in jail. So there's a lot of reasons why in our mind maybe this is the perfect thing, but in actual actuality it's not really happening. Next slide, please. Okay, so we created this study. You can go forward. Hopefully, yeah. And so we're one of we at the ID Touch study um

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are one of eight sites nationally um that got funding through NIDA. As you know, the NIH um has a lot of barriers to pushing out funds right now. So it's sort of a victory that we've been funded. Um and all of our sites are looking to support HIV um treatment and

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prevention in jails and prisons. And one of the qualifications for applying for this is you have to be in an end uh at at a county at risk for HIV outbreaks. Suffolk is deemed by the government uh by the CDC as at risk for HIV governments I mean for HIV outbreaks.

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And so you also have to focus on three towns and we're focusing on Boston, Revere, and Chelsea. Next slide. This is our team. Um I'm MPI. My name's Alisa Worcell. Liz Evans is at University of Massachusetts. We're at Tufts. We're at MGH. We're at UMass, BMC, Boston College, Cornell. And more than anything

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what I'd like to highlight is Shatira Thomas who's a person with lived experience and expertise of being incarcerated who serves on uh who's a key component of our team and makes sure we're not missing the mark um because you we really there's a phrase nothing about us without us. Um and that's

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really what I like to bring power to action and that's where Shatira is helping us out. Next slide. So we're focusing in the Massachusetts Suffolk County Sheriff's Department. Like I said, Nashua Street is on the north side. It's sort of a shorter terms jail. Usually you get um sort of processed there and then you'll

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eventually move to South Bay which is kind of down the way on the south side. and those are our two jails that we're focusing on. Next slide. So, if you're in the community and then you come into jail, and then I said you'll leave in the community, if you could go forward, our research question is how can we increase HIV testing and prep during and post

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incarceration with our program. Next slide, please. So, what we did is we increased HIV testing and prep discussions. We increased the touch points. Um we wanted to optimize conversations about HIV testing, and we're moving towards diversifying testing modalities.

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So, for example, in January 2025, we added to the intake process. Everyone who comes into jail needs to go through this intake process. Something we recommend checking for HIV, hep C, and syphilis, which are all treatable as part of your health care here. We test for these with a blood test unless you do not want it. Do you have any

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questions or concerns? Opt out. This is sort of a modified opt out, but opt out is like one of the best ways of offering and normalizing this type of health care. Um and so that's what we did. So, if everyone's like, "Okay, what did you do?" That's what we did in January 2025. Next slide.

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Oh, you can keep on going probably through that. So, I just wanted to show you all some of our results. So, after implementing that prompt into the our electronic health record, we saw an increase of HIV tests occur. Um we're still tracking this as time goes on. It It looks honestly uh like the trajectory

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was increasing anyway if you were to look at it with statistical eyes anyway, and so there were tons of people um for example, Ken Eek Salonen, uh who if you don't know is a wonderful force who's out there testing for HIV in the community. Um is the is the ID person at this jail. So, there's tons of champions

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in the jail, so it's not just us that was was working on it. But that's a kind of a nice idea that maybe we made an influence, and I can say we're we are finding more cases of HIV, which is one of the things we're looking for. Next slide. About 1/3 of people in jail do not

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remember HIV being tested offering to them. That's a key component. So, even though we're asking everyone who comes in through the jail doors, "Do you want HIV testing?" We talked to about 60 people and we said, "Have you been offered HIV testing?" And about one of them 1/3 of them said, "I never remember

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being asked about HIV testing." I think that's because that intake process is so busy and scary and there's so much stuff going on in that moment and like the 40th concern in that mind is HIV at that moment in time. You know, who's taking you know, there's so many other things

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going on. Um and so that was the main finding that I wanted to show and if you go to the next slide, most people know about PrEP but few people are on it. So, we looked again at these 58 people and we said, "Have you ever heard about PrEP before?" These are all people who are incarcerated and all people who use

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drugs. And 1/5 of them had never heard about PrEP before. Um I think it's interesting to show that only 15% had ever been on PrEP and have you ever been like of the 53 and of the people who had been on PrEP, are you currently on PrEP? Eight. It's also really interesting that

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five of them are women. We're finding women pick up PrEP a lot more to prevent themselves because of exchange sex and other things that they're at risk for, not necessarily the drug use but other risk factors. Um and so we're seeing more and more women ask for PrEP to prevent themselves against HIV. It's a

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harder sell for men and I have lots of kind of thoughts on that. Um yeah, you can next slide. So, we still have work to do on our intervention. If you could advance a few, we want to We did those two already but we're hoping to bring rapid testing into people into the jails. So, rapid testing isn't typically supported as

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much because the DPH offers one blood test that has hep C, syphilis and HIV all on it. Um and then we want to hope to support people to link them to testing following release and I think this might be my last slide. So, questions for you is what is your current availability of PrEP in Revere?

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Um where do people go to get it? Can people get PrEP and medications for opioid use disorder like methadone or Suboxone at the same place? And what are some opportunities to collaborate with you in supporting people released from jail on status neutral HIV care? And I don't necessarily think we all have to answer these questions now. It can

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always be in a follow-up email, but those are some of my ideas and hopes for us to discuss. I think that's my last slide. Yep. >> Thank you. >> [laughter] >> Thank you so much, Dr. Warshel. Um I'll just say that to answer some of

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your questions, you know, I'm I work at as you know MGH Revere on Broadway and um from my understanding all the primary care doctors offer PrEP there or most if not all offer PrEP. So, it is offered in primary care. I can't

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speak for Cambridge Health Alliance um which also has a sizable primary care population in Revere. Um but it is a possibility. I think that that there's a needs to be a frame shift in terms of offering it more to people

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who use drugs. I think at least in my training it was men who have sex with men, yes, you need to have that discussion, but the discussion of people who use drugs I was not trained to do that. So, I've I've had to kind of reframe how I think about it um and have offered it to patients. It's

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just again, a lot of people who use substances have very chaotic lives um are on the run, you know, for whatever reason or homeless. And so, it's hard to get them to buy in or consistently take it. So, then you worry about adherence and you worry about yeah, all things like that, but um yeah,

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I'm happy to hear from other people. >> Yeah, I'll just Hi, thank you so much for your presentation. That was great. Um I we do have a substance use and homelessness initiatives office within the public health department who I think it would be great for you to talk to you and I'll definitely connect you after the meeting. They work with Dr. Bunker on a weekly basis to do street medicine

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and outreach and all that good stuff. Um syringe exchange and all all that thing all those things and probably have the best our average workers probably have the best knowledge about like what's kind of happening and what where do people get this and what are people talking about. So I'll definitely connect you guys.

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In terms of MAT, I mean I think MAT at this point is like very very widespread in Revere and like most people who want access to it can get it. Do you agree Dr. Bunker? >> Yeah, I think from the from the work that we do with the homeless substance use team we are trying to get people into the methadone

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clinics. We're trying to get you know, I offer MAT to everyone I see if they're willing to try. Um but uh yeah, so I think that is there. I think we're missing a a portion of people who are not homeless who are still using um that are kind of

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falling through the cracks. So you know, I've always thought about those people who yeah, how to get to them. >> And I will say too Revere has a syringe service provider. It's um health innovations. But I definitely think we can um expand and like make that more like more

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of a robust program for sure. And so I think that would definitely be something that we can talk to the the SUDI we call it the SUDI office the substance use disorder and homelessness initiatives office. Um so I think we could definitely talk about that. >> And that's run by Mary Wheeler, right? Okay, so I'm emailing with her all the time emailing with her all the time.

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Yeah, they're great. >> Yep. >> Yeah, I I think one of the hard things when you meet people who use drugs especially in jail and you offer prep they say you know, I'm done with that. Like I'm done with that part of my life. >> And sometimes as a doctor when you're seeing someone at a moment in which they're reachable to discuss prep you

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feel like just to your point like you feel like offering prep they sometimes take offering prep as a that you're not convinced that they're done using drugs. And so it comes against it the the sexual part like most people will go on and have sex. And so like whether or not the the drugs continue the sex part and

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that I actually think that's what's happening with the women who may um you know, see themself at risk through sex. And so, I don't know if there's some way to disentangle, you know, my belief in your sobriety with, you know, sort of sex-positive kind of

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feeling. So, thank you so. >> Thank you so much. All right. If no one has any further questions or comments, then we can move on to the next um topic, which is the the review of the draft regulations

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restricting the sale of kratom products. Yep. And so, I'm going to go ahead and read a little bit about what what we're going to be talking about. So, we will now review the draft regulations restricting the sale of kratom products and then commence the public hearing on these

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regulations. First, Lauren Buck, Director of Public Health, will introduce and summarize the draft regulations. Then, Claire Enzarello, Revere's policy writer and analyst, will review the regulatory comments of the draft components of the draft. After this is completed, we will hear the

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proponents and opponents of the draft regulations. Please limit comments to a maximum of 2 minutes and remember to state your name and address for the record before any remarks. Next, Paula Sepulveda, the clerk of the Board of Health, will read into the record comments received via phone call or

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email. Finally, the Board of Health will discuss and if necessary, recommend revisions to the current draft language. The final vote on this set of regulations will take place at June's Board of Health meeting. So, Lauren, please introduce and summarize the draft regulations for the board, audience members, and the public

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watching at home. >> Thanks, Dr. Bunker. Um, first, a quick review of kratom. Kratom is a plant-based substance that can have different effects on the body depending on the dosage and formulation. Some people use it to boost energy or focus, others use it to relax, or for pain

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management. But, it has risks. It can cause nausea, dizziness, dependence, and withdrawal, specifically because kratom acts on the same receptors in the brain as opioids do. When mixed with other substances or in high amounts, it can be dangerous. And importantly, kratom sits in a regulatory

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and medicinal gray area. It's not FDA approved, the research is spotty, and packaging is not standardized or reliable. Next, as a reminder to how we ended up here. The city received a complaint from a concerned resident that was funneled to the Board of Health. The Public Health

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Department conducted research on the state of kratom sales in Revere, and the landscape of kratom regulation statewide. We reviewed other municipalities' regulations and current legislation in front of the state legisla- legislator. We informally surveyed Revere businesses to determine

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the scope of kratom sales in Revere, and we talked about it at this at a previous meeting. Not a comprehensive survey, but we got a a pretty good picture of what was going on. We spoke with two municipalities, Canton and Lowell, about their experiences regulating. We reviewed presentations from MAHP and CDC. And we hosted two

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previous Board of Health meetings. One was an educational meeting with a subject matter expert, um, Mark Gottlieb, the director of the Public Health Advocacy Institute at Northeastern University School of Law. And, uh, a discussion with the Board of Health members. So, that's how we got to this meeting. >> [snorts] >> Finally, um, to summarize the

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regulations before you, they establish a blanket ban on the sale of kratom within the city of Revere. The board can decide when the ban will be put into effect, and we will be giving, if if we move forward with the the regulations, retailers will get a notification prior to the, uh, the ban being put into

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effect. And it does establish a fine structure in place of any violations. That's it. >> Great. Thank you, Lauren. Next, Claire will come to the podium to provide more details. >> Hi, everyone. I'm Claire. I think this

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is my first time before Miss Savage and Miss Katana. So, I'm in the solicitor's office uh, with the attorneys who work for the city and when the Board of Health calls on me, I come and I try to help in any way I can. So, you won't hear any medical opinion from

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me. I'm not a scientist. I'm not a medical professional. So, I can't speak to the danger or health benefits of kratom, but I wanted to give you a little context for the language you have before you. So, kratom, as Lauren said, it is not regulated by the FDA, the CDC, the

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public health department here in Massachusetts. It's basically just in a gray area, as she said. And so, this board has three options available to it. It can do nothing, which right now we've done nothing. And it can continue on being sold, being used, however.

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You can ban it, which is before you tonight in a proposal. And that ban, nothing is ever permanent. If something were to change in the future, it can always be changed, as we saw with marijuana. It was not approved, then it was approved, then it wasn't approved again. So, things can always change.

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It's not like a forever ban for the rest of our lives. It can be, but it doesn't have to be. And your third option, some towns and cities in Massachusetts have chosen to regulate it through kind of a half and half approach. So, allowing just the natural leaf to be

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sold and banning only the synthetic version. Um I can tell you that from my research, the municipalities and towns that have done that are much smaller than Revere and might not have the same population size that we have to safeguard here in Revere. And they don't

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have as many um liquor stores, convenience stores, and places where it can be sold. So, it might be more manageable in those areas, but I will say I looked at Amherst, um the town of Amherst where they have kind of this 50/50 regulation going on. And at their most recent Board of Health

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meeting, printed the minutes just to give you an idea so that you know what each type of our options look like. In Amherst, they have natural leaf is allowed, synthetic is not allowed, and they were speaking on the challenges in being able to

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discern from a health inspector standpoint, from a city health department standpoint, um the quality of the product, the correct dosage, if something is natural, if something is synthetic, uh without the state telling us how to do that. A lot of cities and towns are kind of left

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on their own. Like I don't expect Michael Wells to go in with a microscope and put some of these products under that. So, just keeping that in mind if you wanted to go with that hybrid approach for regulation, it will take a bit more time in figuring out how to do

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that. The ban is more of an immediate um proposal, and then doing nothing keeps us where we are right now. Um I was asked by our health department to talk about quickly what is going on at the state level. So, the federal level is a whole other

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beast. You have the CDC, you have the FDA, you have the DEA, you have all these big federal agencies kind of uh sending letters to each other, sending recommendations to each other. Not really too much going on, but at the state level, we do have a lot of action happening at our Massachusetts state

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legislature. So, there are three bills pending right now. We have House Bill 5127, which is kind of that 50/50 regulation. So, they are going to be they are proposing clear labeling on packages, no

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synthetic sales whatsoever, age restriction 21 plus, and the Massachusetts Department of Public Health would have some sort of enforcement of um standards for testing to get into 2% uh maximum alkaloid content

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of the 7-OH, which is that really kind of bad portion of um that product. We also have House Bill 1680, which is kind of a harsher one. That classifies kratom as a class A controlled substance, which would make possession and distribution of kratom a

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criminal offense equal to heroin possession and distribution. And then we have Senate Bill 1558, which would add to our existing Massachusetts General Laws, where we keep all of our electronic nicotine regulations and our flavored tobacco

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regulations. That one asks to put kratom inside that section of our law and ban its sale. Um so, similar to what you guys are considering tonight. So, I just wanted you to know what's happening at the state level. Your kind of three options:

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sit on it and leave it as is, ban it as a whole, or approach some type of hybrid regulation. All of them are possible. Um from my perspective in a policy standpoint, they're all doable. Um you have option two before you tonight, but I'm happy to talk about any

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different options you guys might have in mind, but for now, if you were to move forward with a blanket ban, like Lauren said, there'd be a grace period. It's not like Michael could go tomorrow and ticket all of these unsuspecting um businesses, but we would put in a grace

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period to allow people time to to readjust. Although, I don't think this is a huge business model um for these stores that do carry it, but I'm happy to answer any questions on how the regulation would interact with any type of state regulation or federal regulation. Um

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if the state does act on it, we will have to act in accordance with what the state does. But again, they're very uh flexible working with us, and we're flexible working with them. So, happy to answer any questions. >> Thank you, Claire. No, I don't have any questions. That was very clear.

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Great. Uh next we will open up the the board or the this meeting to people who um are proponents of the draft in front of us tonight. And that draft being the um ban of sale of kratom in Revere.

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Please remember remember to state your name, your full name, address for the record, and please keep any comments to 2 minutes or less. The board will address any questions during the discussion after all comments have been spoken. Thank you. There was no one who spoke. Uh,

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next we will hear any opponents. Please remember to state your full name and address for the record, and keep your comments to 2 minutes or less. Again, the Board of Health will address any questions during the discussion after all comments have spoken have been spoken. >> About to drop some sick beats up in here. No, I'm kidding. I'm sorry.

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Hi, my name is Allison Smith. I live at 620 3rd Street, uh, Northeast, Washington, D.C. Um, however, I'm in Boston enough that I feel like I should file for a second residence. Um, I love coming here. Um, so my name's Allison Smith. I'm the Director of Government Affairs for the Global Kratom Coalition. We are a nonprofit

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organization that works at the federal, state, and local level to implement regulations on kratom and ban synthetic substances and drugs. Um, I lead our local policy, um, and I spend a lot of time in Massachusetts because you guys are very active in this. Um,

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first I want to take a second to just say, one, sorry for spilling water on your carpet. Uh, two, this is a serious issue, and I really do appreciate you guys taking the time to research this, to learn more about it, and to take this seriously as far as

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access to these unregulated high-potency synthetic substances. They are a danger, and they need to be addressed and they need to be regulated. And I just clicked edit my notes. So, I just want to start by saying that there are there's a website called the Kratom Index that has over a thousand

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different research studies that have been conducted on the safety, efficacy, and use of natural kratom. Notice I didn't say 17, I didn't say a hundred thousands. And I'm happy to send that to you via email. And then adverse events regarding natural kratom are rare, extremely rare.

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When these do happen, they are overwhelmingly tied to polysubstance use or they have a pre-existing medical condition. We don't ban energy drinks when an adverse happen adverse event happens as unfortunate as it is. We don't we limit sales. We prohibit attractive packaging to children and we

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age gate. Natural kratom is a botanical product from Southeast Asia. It came over here in the 70s from veterans of the Vietnam War and today approximately 23 million Americans use natural kratom safely. It's in contrast the products that are making headlines for addiction,

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overdoses, and your quote-unquote gas station heroin. This is your concentrated synthetic 7-OH product. These products are chemically manipulated, extremely potent, and openly marketed with an opioid style branding. I mean, you can go to a gas station or a convenience store and find them and it will say like 7-oxy to mimic OxyContin. So, it's very

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it's very clear what they are trying to do with these these substances. The federal government is moving to distinguish between these products. Last summer, the FDA, HHS, DEA announced a coordinated effort to add concentrated synthetic 7-OH to the schedule. They made it clear during the press

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conference and repeatedly since then that this does not apply to natural kratom. And living in Washington D.C., I can tell you that federal scheduling of this is imminent. Is my time up? >> Yes. >> Okay. >> just give some closing thoughts? >> Um >> I'm sorry. >> No, no, no, you're fine. I am happy to be a resource for you guys. My

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background is in policy. I specialize in localities. I would love to help find a way to to this bill a regulatory bill. I understand that there are some concerns with it. However, Boston is looking at a regulatory bill. Council member Fitzgerald has encouraged localities to reach out to him and given the proximity of Revere to Boston, I feel like it's

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pertinent that you guys work together rather than passing separate ordinances. So, again, happy to be a resource, answer any questions, and thank you for your time. >> Thank you so much for speaking. All right. Well, finally Paula is going to

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um read any public comments that we received. >> So, we actually received one email in support and 14 emails in opposition of the proposed regulations. We're waving the the reading and they're

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part of tonight's record. >> Thank you. At this point, the public hearing has concluded and now that the Board of Health will discuss and offer Now, the Board of Health will discuss and offer any amendments or edits they see fit. So, I know we've had multiple meetings about this um

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and talked about this and I was actually at the um Massachusetts Association of Board of Health um conference and we this came up um because a lot of municipalities are dealing with it um and we had a really good speaker who

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um was a lawyer and whose son used to be on opiates and now takes kratom. And she said you know given the you know, she someone who's always been in support of kratom but at this point in time

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what's going out what's out there right now, we don't know how to know the level of the 7-OH alkaloid. The label can claim it but we have no way of actually knowing. Um

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it's not FDA regulated. It's made in FDA approved sites, but it's not FDA regulated. Um I had a family friend who last month passed away from a um a kratom overdose. So, I'm not sure what what it was. I assume it was a

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synthetic. Um And so, you know, this is uh as a physician, this is something that kind of is very important and and I recognize that we need to do something we need to act because lives are at stake. Um

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And we've heard a lot from people outside of Revere. It's interesting, none of the comments, none of the people who have come to any of these meetings have been from Revere. And so, it makes me think Our job is not Our job is to protect Revere, right?

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And if this has been on everywhere through Revere and no one in Revere has been against it, if anything, we've got proponents. This was brought to the meeting by Revere resident. I mean, to me, this is our job is Revere. Protect the public health of

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Revere. I can't in good conscience allow kratom to be sold in Revere. And I can only speak for Revere. I can't speak to Boston. I can't speak to any other municipality in the entire country. But that's just my thoughts. I'm happy

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to hear it from the board members. >> I guess I'll go next. Um I agree with what you're saying in Revere. The priority for us is what's going on in Revere. And agree with you know, what what she said is as rules change, we will have the

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option of changing and revising what where the restrictions are adjusting it. Um I know it was brought up in the past about Yes, using the synthetic versus the natural. It's

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I don't know how in city of size and with people in the public in the inspectional department, how they would be able to assess and evaluate. So, I agree definitely agree with what you're saying. >> Yeah, I am I'm in agreement with you

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both. I definitely see that there's potential for medicinal uses for the natural plant, but it's going to be it's going to be very difficult for inspectional services to go out and distinguish. So, I think it makes the most sense to protect our residents, our community

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here in Revere. That's our mission, the Revere community. Um so, and and again, I I like the flexibility that we can revisit this. But for now, it just it makes sense that these products should not be sold in the city of Revere. >> All right. So, we'll be voting next um

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meeting in June. But thank you guys. I think that concludes this this month's meeting. Thank you for all that were here and spoke.