Regional Industry & News

MINOT — Many in the political sphere have been dismissive of Gov. Kelly Armstrong's call for a special session to address kratom in both its botanical and synthetic varieties.

Armstrong's argument, which he made recently on the Plain Talk podcast, is that we're facing a crisis that has flown under our radar.

It certainly flew under my radar. I had no idea what kratom was until I learned about it last week while reporting about the special session.

But Armstrong isn't just blowing smoke. In talking to people in law enforcement, the public health sphere and retailers, what I've quickly learned is that, up until Armstrong's emergency order banning lawful sales, a lot of kratom product was getting moved in North Dakota, and people who are cut off from it are going to have a problem.

"I'm comfortable overreacting," Armstrong told us during the Plain Talk interview. It's become clear, very quickly, that this is far from an overreaction.

"People are just going to be miserable," Dr. Dan Cramer, chief clinical officer for behavioral health at the state hospital in Jamestown, told me when I contacted him. "It's going to feel awful."

Right now we're having a debate about whether Armstrong should have called a special session over kratom, with politicians like Democratic state Sen. Tim Mathern pooh-poohing the move. That debate is going to be over quickly. The facts about kratom that are quickly emerging have buttressed the governor's argument that this is a nascent public health crisis.

When lawmakers convene in Bismarck in early September, they'll commence a debate about what to do about kratom. Given what I'm quickly learning about the substance, I side with the governor's position. Let's ban it all. Later, we can have a debate about whether we want to allow any form of the substance to be sold legally, while also imposing regulations about packaging transparency, dosage and what age you should be to lawfully purchase it.

But there's a third debate we need to have, which is how we handle what may be an epidemic of kratom withdrawal. That this is a very real problem illustrates the need for the special session, and also the need for lawmakers to ensure our state is prepared for it.

"We identified that we are seeing an increase in kratom use among people seeking behavior health services. We're seeing an increase in usage and struggles that go along with that," Cramer told me.

Part of what caused the sale of kratom to soar, he believes, is that there wasn't the sort of stigma attached to it as there is to other drugs like opioids or methamphetamine. "It was legal, so the perception was it wasn't harmful, and you couldn't be addicted. I think that's not what we found," he said. "People are in fact addicted, and go through withdrawal. Shakes. Nausea. Vomiting. Inability to sleep. Just being miserable."

Cramer said we don't have a lot of good information available about how widespread kratom use is, but there are anecdotes in the public record suggesting it's a lot. At a recent meeting of the Dunn County Commission in western North Dakota, Cassandra Altringer, a family nurse practitioner from the Coal Country Community Health Center’s clinic in Killdeer, addressed the commissioners about the impacts of kratom on the local community.

"She emphasized that a majority of her patients in her addiction medicine program during the past eight months were there due to kratom usage," the Dickinson Press reported.

“A lot of the people that are using, they are community members in Dunn County,” Altringer told the county leaders. “If they do not live in Dunn County, they are people that are employed here.”

“When people come to see me, they are usually at a point that they cannot pay their bills, they are struggling feeding their children, they cannot function at work,” she continued. “That’s when people come to me because they are at a point where they have run out of stops — they can’t buy the substance anymore.”

That's very rural Dunn County we're talking about, which has a population of roughly 4,000.

Those who are saying this isn't a crisis worthy of a special session are being foolish.

"There are medical-assisted treatments that are available," Cramer told me when I asked what people who are struggling with kratom should do. "It's a healthcare need. Go in and talk to your doctor. Primary care can help. There are resources available. There are drop-in clinics available in these regions 24 hours a day."

As further evidence of how big this problem is, he indicated that one public health region is considering opening a Saturday clinic to help people in the wake of the ban. He also said North Dakota's Parents Lead website has a lot of good resources, and people could also seek help by calling or texting 988, the Suicide and Crisis Lifeline, or 211, the community information and referral helpline.

Cramer wanted to emphasize that help is out there. "We don't want people to suffer unnecessarily."