States enact emergency orders on kratom while awaiting federal rules

States are moving faster and further than federal regulators to get kratom off store shelves, with some banning the herb outright while a pending federal rule targets only one of its chemicals.

Massachusetts acted Thursday. Its public health commissioner, Dr. Robbie Goldstein, issued a temporary emergency order placing all forms of kratom into Schedule I under state law. Schedule I substances are subject to the most stringent controls.

The order also gives local health boards more authority to take action against stores that keep selling the products—sometimes referred to as “gas station heroin.”

North Dakota went farther on Aug. 5, when Gov. Kelly Armstrong declared a public health emergency and banned the sale, use and possession of all kratom products statewide.

Kratom is a tropical tree native to Southeast Asia and related to the coffee plant. At low doses, it acts like a stimulant. At higher doses, it acts like an opioid.

A separate emergency rule from the North Dakota Board of Pharmacy classified the kratom chemical 7-hydroxymitragynine, known as 7-OH, as a Schedule I substance for 180 days.

Armstrong has called lawmakers into a special session Sept. 2 to write the restrictions into state law.

Florida moved earlier. In June, its attorney general, James Uthmeier, signed an emergency rule that placed concentrated 7-OH and six related compounds in Schedule I.

Products sold in Florida may now contain no more than 1 milligram of those chemicals per gram or per milliliter.

Federal action is narrower. The U.S. Drug Enforcement Administration (DEA) announced July 1 that it intends to temporarily place 7-OH and three related substances in Schedule I, according to the Congressional Research Service.

The kratom plant itself would not be covered, as long as its 7-OH content stays below set limits.

The leaves contain only trace amounts of 7-OH, but the compound can be made in a lab and packed into gummies, tablets, powders and dissolvable strips that are widely sold at gas stations, smoke shops and online.

Health officials link the products to seizures, hallucinations, dependence and withdrawal symptoms.

Since 2013, Florida medical examiners have tied at least 587 overdose deaths to these compounds, the attorney general’s office said.

“We are seeing this affect Floridians of all ages, from infants to the elderly, which speaks directly to how aggressively and irresponsibly this drug is marketed,” said Dr. Cory Howard, an emergency physician and medical toxicologist at Tampa General Hospital.

Dr. Thomas Nappe, an addiction medicine specialist at the same Florida hospital, said 7-OH causes severe dependence and withdrawal, “requiring intense support to foster recovery.”

Goldstein, the Massachusetts health commissioner, said many users do not understand the danger.

“Our goal is to protect the public while getting those who need treatment or support the care they deserve,” he said.

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