FRESNO COUNTY – Citing health concerns and a lack of regulation, Fresno County took the first steps toward banning the sale of kratom, a substance typically used as a supplement to boost energy or manage pain.
After an hour of discussion and debate at the Fresno County Board of Supervisors meeting on Nov. 18, board members unanimously voted in favor of an ordinance that would prohibit the sale of certain kratom products in unincorporated areas of the county. District 5 Supervisor Nathan Magsig spearheaded the move and said he had spent the last few months working with the public health department to craft the ordinance.
Magsig said he had never heard of kratom until a few months ago, when Interim Health Officer Dr. Rais Vohra appeared on a local TV station warning about its dangers. When he started doing research on the substance, he reached out to the health department and learned that kratom is not regulated and has addictive characteristics.
“A lot of people are using it, and children can even have access to it, because there’s nothing that limits the ability of kids or anyone from being able to buy this particular drug,” Magsig said.
What is kratom?
Kratom is a tropical tree leaf indigenous to Southeast Asia. According to the National Institutes of Health, kratom can produce opioid- and stimulant-like effects. The U.S. Food and Drug Administration has not approved any uses of kratom, but kratom leaves and products derived from the leaves are sold and marketed as herbal supplements.
According to the NIH, the best-known chemical compounds that are present in kratom include mitragynine and 7-hydroxymitragynine, called 7-OH. While the natural kratom leaf has been chewed, smoked or used in tea for centuries in Southeast Asia, it is synthetic products with unnaturally high concentrations of 7-OH that have particularly raised concerns about kratom.
In his introduction of the ordinance, Vohra said kratom is a substance well-known to medical toxicologists like himself. He said that unlike fentanyl or heroin, kratom is not just an opioid, but an opioid and a stimulant that also hits other neurological receptors, meaning it can cause a “really complicated picture.”
“In a nutshell, it’s unregulated, unpredictable and under-appreciated as a true cause of harm,” Vohra said.
People can develop a dependence on kratom and also experience withdrawal syndromes, Vohra said. Further, he said the purified forms of kratom, including the compound 7-OH, which is being sold in pill and capsule form, is “basically kratom on steroids.”
Overuse of kratom can be fatal, and Vohra said that from a public health standpoint, it can also cause seizure disorders, liver failure and addiction.
Another issue is that there is limited research on kratom use and no guidelines for how much of the product someone can use before it becomes harmful.
Approaches to regulation
With the first version of the ordinance, Magsig initially sought to ban the sale and distribution of all kratom products; however, public feedback prompted the board to move away from a blanket ban.
The updated ordinance only fully bans synthetic kratom products with a 7-OH concentration of 2% or higher. Anything with a concentration of less than 2% or natural leaf kratom will not be banned; however, the county will require sellers to store it behind the counter with tobacco products and its sale will be restricted to individuals 21 and over.
Many county residents, and some non-residents, spoke during public comment on the item, with most opposing the outright ban of kratom sales.
All members of the public who spoke agreed that the highly-concentrated synthetic versions of kratom are dangerous and not recommended for use. When it comes to the kratom leaf, however, residents shared about their experiences using it with the board. Some said kratom helped them kick their energy drink habits, making them feel alert but not jittery.
Resident Rosie Kritzer said her son died from a kratom overdose despite researching it and using it as a tea for several years. Yet, she also knows people who use kratom for pain management who have said they wouldn’t survive without it, so its use is something that has to be weighed. Kritzer said she believes the real harm is in the concentrated forms.
“I think public awareness — and I commend Fresno County for bringing this up — is needed some more,” Kritzer said. “Other young people need to know that it can be deadly.”
Kritzer, along with other public commenters, also noted that people would still be able to possess and use kratom and buy it online, just not in stores around the county. Supervisor Brian Pacheco said he thought a full ban on the sale of the product would be like “throwing the baby out with the bath water.”
An even earlier version of the ordinance, which was edited just a few days before the board meeting, did not ban kratom outright, instead placing an age restriction on its purchase. Pacheco said when that was the case, it made sense to him as a way to protect county youth.
“Now we’re kind of telling adults what they can and can’t use,” Pacheco said. “I’ve heard discussion, listened to the items, and to me it seems clear that there’s two types, there’s a leaf and then there’s a concentrated kind. … So I’m a little bit conflicted on this, because we’re really not doing anything other than banning it from being sold in the county.”
Continued back-and-forth between supervisors and county officials brought the ordinance to a version that was eventually approved.
The ordinance will go before the board for a second reading on Dec. 9. Although ordinances passed unanimously on the first reading typically end up on the consent calendar, Mendes said he wants this to come before the board as a regular item again to ensure the edits were done properly.
If passed on the second reading, the ordinance will take effect 30 days later.