The Kratom Controversy

Officer Ashley EllerApopka (FL) Police Department

6/11/2021

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KRATOMWhat is it and why we should be

concerned

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What is Kratom?

Kratom is a tree. The leaves are used as a recreational

drug and as medicine. Kratom is banned by some

states in the U.S. due to safety concerns.

What is Kratom?

People use kratom for withdrawal from heroin, morphine, and other opioid drugs, as well

as cough, depression, anxiety, and many other conditions, but there is

no good scientific evidence to support these uses.

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Who is using Kratom?

• The results of a 2016 online survey found that kratom users in the United States tend to be middle-aged, middle-income people living with pain.

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Who is using Kratom?

• By some scientists’ count, there are between 10 million and 15 million kratom users in the US alone.

• They are using the drug for everything from chronic pain relief to replacement for their morning coffee.

How does Kratom work?

Kratom contains a chemical called

mitragynine which works like opioid drugs such as codeine and morphine to

relieve pain.

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What are Kratoms uses & effectiveness(There is insufficient evidence to prove)

Anxiety

Cough

Depression

Diabetes

Diarrhea

High blood pressure

Pain

Withdrawal from heroin, morphine, and other opioid drugs

Side Effects and Safety • Kratom is POSSIBLY UNSAFE for most

people.

• Kratom can cause many side effects, including tongue numbness, nausea, vomiting, dry mouth, need to urinate, constipation, aggression, hallucinations, delusions, and thyroid problems.

• Kratom in large doses may cause trouble breathing, brain swelling, seizures, liver damage, and death.

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Side Effects and Safety

Alcoholism• People with alcohol dependence who

use kratom appear to have anincreased risk of suicide comparedto those who use kratom but are notdependent on alcohol.

Mental Illness• In theory, kratom might worsen

existing mental disorders. Also,people with mental disorders whouse kratom appear to have anincreased risk of suicide comparedto those who use kratom but donot have a mental disorder.

Kratom DosingThe appropriate dose of kratomdepends on several factors such asthe user's age, health, and severalother conditions. Currently there isnot enough scientific informationto determine an appropriate rangeof doses for kratom.

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Kratom VeinsRed Vein Elixir is known to have a relaxing effect and is said to ease muscle tension and body aches.

This is the perfect choice for someone looking to relax after a long day at work, after working out, or to ease minor aches and pains in the body.

White Vein Elixir is highly energizing and promotes clear focus.

This vein is great for those who are looking for the energizing effects of coffee, but don’t want to suffer the negative effects that can come with a caffeine crash.

Green Vein Elixir is said to have mood-boosting, euphoric properties accompanied by a slight energy boost.

This is an excellent choice for persons who aren’t sure where to start, as it promotes the release of feel-good endorphins in the body.

What are the Dangers?

The National Poison Data System found that between 2011-2017 there were 11 deaths associated with Kratom exposure. Nine of the 11 deaths reported in this study involved Kratom plus other drugs and medicines, such as diphenhydramine (an antihistamine), alcohol, caffeine, benzodiazepines, fentanyl, and cocaine.

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What’s it like to be high on Kratom?

Stimulant like effects

• Diaphoresis (Excessive Sweating)

• Decreased Appetite

• Elevated Mood or Euphoria

• Increased Concentration or Focus

• Increased Energy and Endurance

• Tingling in the Extremities

• Tremors or Shaking

• Increased Heart Rate and Body Temperature

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Opioid like effects

• Reduced Anxiety and A Sense of Calm

• Reduction in Pain or Discomfort

• Drowsiness or “Nodding Off ”

• Extreme Muscle Relaxation

• Lowered Heart Rate

• Depressed Breathing

• Constipation

• Delayed Orgasm (particularly in men)

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Notable KratomDeath Parents in Chester County, PA are suing

kratom distributor SoCal Herbal Remedies.Their son, Caleb Sturgis, died in a caraccident in 2018. He was 25. The ChesterCounty Coroner ruled the cause of death“acute mitragynine intoxication”.

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Is KratomIllegal?

In 1943, the Thai governmentpassed the Kratom Act 2486 thatmade planting of the tree illegal. In1979, the Thai government enactedthe Narcotics Act B.E. 2522,placing kratom along withmarijuana in Category V of a fivecategory classification of narcotics.

Is Kratom Illegal?With the exception of Sarasota County, it iscurrently legal to purchase and consume kratom inthe state of Florida. Although a few states eitherhave banned or have pending legislation regardingkratom, the herb is legal in most states.

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What are withdrawal symptoms of excessive Kratom consumption?

• Muscle aches

• Aggression

• Emotional changes such as mood swings

• Seizures

• Dilated Pupils

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Florida Drug and Law Enforcement Official Statewide Intelligence

Drug Report

Some Florida countieshave proposed ordinancesrelated to kratom; howeverat this time, Sarasota Countyis the only county known tohave passed an ordinancerelated to the marketing of“designer drugs” amongwhich is kratom.

District 9 Medical Examiner

District 9 (Orlando) reported three (3) deaths where kratomwas present but not the cause of death. One (1) of thesedeaths was found to be natural due to heart disease, thoughMitragynine, caffeine, caffeine metabolite, and alprazolamwere also present. Both of the other District 9 deaths weredetermined to be accidental; one (1) involved acute heroinand cocaine toxicity and the other involved intoxication byacetyl fentanyl.

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(b)- Prima Facie Evidence—Designer Drug. A DesignerDrug is: (1) Any capsule, pill, powder, liquid,vegetative material, product, or other substance,however constituted, including but not limited to anySynthetic Cannabis, Substituted Cathinone, orKratom.

Sec. 62-351. - Regulation of designer drugs and misbranded consumer commodities.

Sarasota County Municipal Code Regarding Kratom:Sec. 62-348. - Specific findings of fact regarding Kratom.(a)- Due to its psychotropic and addictive nature, theU.S. Army and Navy banned use of Kratom, and theDrug Enforcement Agency has placed Kratom on theDEA Watch List.(b)- Kratom has been shown to be addictive, evidencinga clear set of effects and side effects, ranging from drymouth, insomnia, and anorexia to hallucinations,delusion, and confusion, and a consistent withdrawalsyndrome (including symptoms of limb spasticity,hostility, aggression, and emotional lability).(c)-Despite its dangers in use, Kratom is promoted as alegal psychoactive product.(d)-Kratom is not currently scheduled under theControlled Substances Act, but is controlled inThailand, Malaysia, and Myanmar, where it isindigenous.

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Macon Georgia A sworn affidavit from the sheriff's office

said the 21-year-old driver had alcohol, oneempty packet of "high-potency" kratom andanother packet containing 15 capsules ofthe herb. Police said he failed field sobrietytests, his speech was slurred, his eyesbloodshot and he had trouble standing.

Charleston South Carolina:Conflicting views overkratom, drug found in systemof suspect in DUI death of11-year-old

• A toxicology report shows fentanyl andan over-the-counter substance known askratom were found in his body.

• “I got completely physically hooked onit,” said Emily Baumil. She says she wasusing the substance during her recoveryfrom alcohol addiction.

• “In recovery and yet completelyconsumed by kratom, every bit as muchas I was anything else, I had struggledwith. When I didn’t have it, it was theexact same physical sickness as comingoff opiates.”

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Collier County, FloridaWoman holding baby shoved byFlorida man claiming to beaddicted to Kratom

• Jeremy Buchman, 33, was havingbreakfast at his home when the victimasked if he had taken his medication.Buchman is going through addictiontreatment and is prescribed medicine tohelp him, according to an incident reportfrom the Collier County Sheriff ’s Office.

• The victim told deputies that Buchmanhas been addicted to kratom for the pastthree years

As kratom becomes more popular in the U.S., it’s only natural for usersto ask certain questions about its use. Is kratom considered a legalsubstance? Can you get a DUI on kratom? Could you get arrested?

In all states, a DUI offense breaks down into two basic components:

• Is the offender physically operating a vehicle?

• Is the offender under the influence of drugs or alcohol?

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Kratomspot.com

• When discussing kratom and driving, it’s important to remember that kratom is a legal substance in all but six states. If you live in one of these six states, kratom and driving is unquestionably illegal:

• Alabama

• Arkansas

• Indiana

• Rhode Island

• Vermont

• Wisconsin

Phase 1- Vehicle in Motion

• A 34-year-old male was stopped bya law enforcement officer forimproper lane travel and stoppingin the wrong place.

• He was reported to have stopped10 feet before a stop sign for noapparent reason. He then droveforward and stopped again. Thedriver entered the oncoming laneof travel upon turning onto theintersecting highway before quicklymoving into the correct lane.

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Phase 2- Personal Contact

• The driver was observed to appear disoriented and confused.

• He was reported to have slurred speech, bloodshot watery eyes and difficulty dividing his attention.

• A portable breath test was administered with the result of 0.000.

Phase 3- Pre-Arrest Screening

• The officer then conducted standardized field sobriety tests (SFSTs)

• HGN - Two of six clues on the horizontal gaze nystagmus

• WAT - Seven of eight clues on the walk-and-turn

• OLS - Four of four clues on the one-leg stand

• The Romberg balance test was also conducted with the following results: Extreme eyelid tremors, swaying and an inability to stand still

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DRE Drug Influence Evaluation

• Initial observation showed that the individual was pale, had bloodshot watery eyes, a drowsy appearance and fluctuated between being calm and agitated.

Eye Examinations

• Horizontal Gaze Nystagmus - The subject presented two of six clues on the HGN test; however, the test was unable to be completed because the subject repeatedly looked away from the stimulus while the officer checked for sustained and distinct nystagmus at maximum deviation.

• Vertical Gaze Nystagmus was not detected.

• Lack of convergence was found to be present.

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Psychophysical Tests

• Modified Romberg Balance - The subject had a fast internal clock estimating the passage of 30 seconds in 24 seconds. During the test, the subject swayed, and it was noted that he had severe eyelid tremors and upper body muscle tremors.

• Walk and Turn - The subject became agitated during the instructional phase and exhibited six of eight clues including inability to keep balance, stopped while walking, stepped off the line, missed heel to toe, raised his arms for balance and hopped during the turn.

Psychophysical Tests

• One Leg Stand - The subject was observed to sway, use his arms for balance, hop and put his foot down twice prior to the conclusion of the test.

• Finger-to-Nose - The subject used the pad of his finger rather than the tip on several instances and touched his nostrils rather than the tip of his nose multiple times.

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Vital Signs

• Pulse was checked at three separate times over the course of 30 minutes with readings of 90, 106 and 80 beats per minute (BPM). • When compared with the DRE average range of 60–90 BPM, the pulse appears slightly

elevated

• The subject had an elevated systolic blood pressure of 150/82 mmHg• DRE average range is 120–140/70–90

• The subject's body temperature was measured and found to be 98.6°F, which was within the normal DRE average range of 98.6 (± 1.0)

Dark Room

• The DRE then checked the individual's pupil size and reaction to light

• The pupils were found to be dilated in all lighting conditions:

• 7.0 mm in diameter in room light (Normal: 2.5–5 mm)

• 9.0 mm in total darkness (Normal: 5–8.5 mm)

• 7.5 mm in direct light (Normal: 2–4.5 mm)

• Overall reaction to light was noted to be slow

• Raised taste buds and thick white saliva were seen on the tongue

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Muscle Tone and Subjects Statements

• Muscle tone was determined to be normal

• The subject's statements were also recorded. The subject admitted to using:

• Kratom- ‘Energy Powder, Blast Off, Fusion, Fast Forward, Nalt and B-12’

• Prozac- Selective Serotonin Reuptake Inhibitor (SSRI)

• Saphris- Antipsychotic medication used to treat schizophrenia and acute mania for bipolar disorder

• Risperidone- Used to treat schizophrenia and bipolar disorder

• Depakote- Used to treat seizures and bipolar disorder

• Nuvigil- Used to treat sleepiness from narcolepsy and sleep apnea

• Klonopin- Used to treat seizures, panic disorder, and anxiety

Opinion of the Evaluator

• Upon completion of the examination, it was the opinion of the DRE that the subject was under the influence of a Central Nervous System (CNS) stimulant

• Blood was drawn approximately 2 hours after the initial arrest/stop

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Toxicology

• The blood was sent to NMS Labs in Willow Grove, PA to test for bath salts and stimulant designer drugs.

• Analysis was conducted by liquid chromatography–time-of-flight mass spectrometry with the following results: 63 ng/mL α-PVP, 6.1 ng/mL methylone and positive for ethylone.

• These results are consistent with the DRE’s opinion of driving performance being impaired by a CNS stimulant.

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So should we worry about kratom use?

• There are no FDA-approved uses for kratom, and the agency has received concerning reports about the safety of kratom.

• At low doses, kratom has been reported to work like a stimulant. A small dose that produces stimulant effects is just a few grams. The effects usually happen within 10 minutes after ingesting it and can last up to 1 1/2 hours.

• Kratom has been reported as being sedative, producing euphoric effects, and dulling emotions and sensations. A larger dose of between 10 and 25 grams of dried leaves can have a sedative effect, with feelings of calmness and euphoria. This could last for up to six hours.

KAVAWhat is it and why we should be concerned

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What is Kava?

Kava is an herbal remedy that's made from the roots of Piper methysticum -- a type of plant found in the

islands of the Pacific Ocean. Its name literally means “intoxicating pepper.”

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What is Kava?

It contains substances called Kavapyrones. They act much

like alcohol on your brain, making you feel calm, relaxed, and happy.

The plant is also thought to relieve pain, prevent seizures, and

relax muscles.

How is Kava ingested

• In Fiji, the tradition is to wait until everyone has their shell of Kava. Once ready, the person leading the group will clap their hands once and say “BULA”.

• Everyone else responds in turn with “BULA” and the group has their Kava together. Bula means “to long life and good health”, in Fijian.

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What is Kava used for?

• The main use of kava is to help with anxiety

• It has become an increasingly popular natural alternative to benzodiazepines such as Xanax and Ativan

Ground Kava Root

This is the traditional preparation of kava. It includes grinding the kava root, putting it in a muslin cloth, and then steeping it in water. This process can be lengthy, and requires a lot of kneading and straining. Some people prefer this method because they feel it maximizes the effects.

Micronized Kava Micronized kava is a fine powder, and is comparable to an instant version of the root. This process doesn’t require any steeping or kneading; the powder is simply added to a drink of choice.

Kava Concentrate Kava concentrate is a concentrated liquid form of the substance that can be added to another drink of choice. Kava concentrate is a tincture blend that typically comes in an eye-dropper for easy administration.

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Is Kava Safe to use?

Doctors aren’t sure how much kava you can take safely.

The most serious concern stems from reports of liver damage in

a few people who took kava.

Kava can interact with some medications, including:

• Antiretroviral medicines used to treat HIV/AIDS

• Benzodiazepines and barbiturates that treat anxiety

• Medications used to treat Parkinson's disease.

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Kava and DUI• “Napoleon Samuels mumbled barely above a whisper inside his

SUV, propped up on a sidewalk in front of a concrete pillar, the engine revving. He sweated profusely, deputes said. His body swayed like a willow tree whenever he tried to stand, and he alternated between staring up at the sky and falling asleep as he miserably failed one field sobriety test after another.”

• -South Florida Sun Sentinel March 13, 2011

Kava and DUI“A man named Sione Olive was driving on Highway 101 to visit his aunt in Palo Alto. He was driving directly from his church, Shoreline Church in San Mateo, where he had been given kava tea during a religious function. It’s common for Kava Kava to be part of Polynesian rituals.”

THE PEOPLE, Plaintiff and Appellant, v. SIONE OLIVE, Defendant and Respondent.(Superior Court of San Mateo County, No. SM306891, Marta S. Diaz, Judge.)

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Mixing Kratom and KavaIncreased relaxation and more efficient relief from

pain.

Pro’s to using Kava and Kratom Together

• Significant reduction in anxiety

• The intense feeling of well being after being exposed to a stressful environment

• Increase in cognition

• Improves sleep

• Help fight depression

• Enhancement in mood due to stimulation of serotonergic and dopaminergic pathways

• Significant relief from pain

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Con’s of using Kava and Kratom Together

• Risk of interaction with several other medicinal drugs.

• If combined with alcohol, it can cause liver cirrhosis.

• Excessive dosage is responsible for the hepatic and renal failure.

**Mixing the two drugs can have dangerous outcomes that may result in death if the doses of the drugs are too high. So using the mixture of Kava and Kratom is highly concerning.**

Marketing of Kava and Kratom

How are Kava and Kratom being sold

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The BreakdownKava• A natural muscle relaxer, kava gives

you a natural buzz without affecting your cognitive or motor skills. When ingested, it can cause a slight numbing or tingling sensation to your tongue and mouth.

Elixir (Kratom)• Elixir is a tea leaf from Southeast

Asia (Malaysia, Indonesia, Thailand, etc.) from a plant in the coffee family, and has deep roots in Chinese and South Asian medicines.

Elixir?• An elixir is a sweet liquid used for

medical purposes, to be taken orally and intended to cure one's illness.

• When used as a pharmaceutical preparation, an elixir contains at least one active ingredient designed to be taken orally.

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SUNDAY-THURSDAY 10 AM TO 12 AM

FRIDAY-SATURDAY 10 AM TO 2 AM

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