Board of Supervisors Committee - Regular Meeting

All right, so good morning. Let's call the meeting to order for the Board of Supervisors Health Committee on July 27th, 2026. Clerk, want to take the roll?

Supervisor Tam? Present. Supervisor Miley?

Present.

We have a call.

OK, thank you. All right, the first item is Healthy Schools and Communities Update.

There we go. Now you can hear me. Good morning, Supervisor Miley and Supervisor Tam. Good to see you. Thanks for having me this morning. I'm just going to provide a brief update on what's been happening with Healthy Schools and Communities over the last couple of years. We have the slides up. Thanks. first slide that you can see, that's actually a photo of all of our staff that we took at the REACH Ashland Youth Center this past year. You can see our outfits are color coordinated. I don't know how we manage that. But I'll just, I'll jump in. Our North Star, like what we're really trying to envision with Healthy Schools and Communities is that youth embody self-determination and that they graduate from high school equipped with options and they're ready for college and career. And our work is really around integrating education and health and making sure that we're looking at the whole child and all aspects of youth in their communities. Next slide, please. And these are the strategies that we work on, kind of the three big buckets. The first one is around systems building. We work a lot with our school districts and community-based organizations, increasing their capacity, just making the health and wellness systems work better. One example of this is our coordination of service teams. We've been working on this for several years in Alameda County. with community-based organizations and school districts. Probably our biggest bucket of work is the youth wellness and leadership. And I'll go into more detail on all of our programs, but examples are our Reach Ashland Youth Center. We don't operate, we fund 28 health centers throughout Alameda County. We have our Youth Family Opportunity Initiative, our Caminos program, just to name a few of our strategies. And we also do family engagement and support. So we fund school-linked and school-based family resource centers. We work with our family liaisons at school districts. And we also have some community health workers that work within school districts to help families navigate public systems and connect them to resources. Next slide, please. And the first strategy I'm gonna talk about, or actually I think it goes to the map next. The next slide, yeah, here we go. This just shows that we really are focused on, all of our work is focused through an equity lens. And we make sure that all of our programs and services are in the neighborhoods furthest from opportunity and where, our children and families are experiencing the greatest health disparities. And you can see all the different programs that we have kind of mapped out throughout the county, some of our youth and family opportunity hubs, our school health centers, and then the REACH Ashland Youth Center, which is right there in the center of the county in Ashland-Cherryland neighborhood. Next slide, please. And just a little bit about REACH. These are some updates and some of the priority areas that we're working on right now. We've been working a lot around coordination in the unincorporated area, focusing on staff and our partner agencies. We have three, just as some examples, we have three REACH members right now who have voting seats on the Eden Area Community Collaborative. We're also right now involved in the Eden Promise Neighborhood Applications. We're partnering with Cal State East Bay and the Eden Area partners around that application. So that's a really exciting opportunity. We're also working on healing centered engagement and some of our staff have been certified in this model. It's Dr. Shawn Ginwright's model around healing centered engagement and it builds on the trauma informed approach that REACH has done throughout since it began. And we also continue to work on youth and adult power sharing. And we're in our third year with this work. And then lastly, we continue to work on our coordination of services and we're expanding our clinical team to make sure that we're working really closely with the school district and all the CBOs in the neighborhood around our coordination of services. I think this is a picture at... At our summer camp, we always take the kids to one of the beaches in the area at our summer camp. I believe this one was Angel Island, I want to say. This was recent. And then the next slide, it's a video of our arts and creativity program. It's a promotional video clip we thought we'd show for you today. And this is all produced in-house outreach. Hopefully you can get it to work. You can try the, there's the link or you can just click on the video.

The arts consists of mainly two spaces in addition to some.

Thank you.

Thanks.

Record your own music in. In the works, we paint. And we also do a bit of sculpting and other arts. You can also sign up for cooking classes. All that and we post it on social media just like you're seeing now.

We also have special offerings like a class taught by a Pixar animator and real world artists.

On top of that, all the youth facilitators teaching here are also real world artists. So you can come to the arts Monday through Friday and don't be afraid to ask.

If we can't get it to work, you can I think it's in the deck that you have, so you can just watch it on your own time. Thanks. And then the next slide is around some of our service numbers at REACH. But I should just mention that, Our numbers are back to pre-pandemic levels. So we've been serving. We've continued to grow our membership. And we're back to where we were before the pandemic, which is great news. We're also really working more with our clinic, the Fuente Clinic, which is on-site at REACH, to make sure that those numbers can remain.

Don't be afraid to ask about special sign-ups and summer camp.

And drop in every Friday for Open Lab. Couldn't get the plane. Now it's hard to go back to the deck. I'll just mention that our clinic, the Fuente Clinic has been experiencing a little bit of a drop in service numbers. They think due to everything that's been happening with HR1, so we're trying to just really work as much as we can with that clinic in partnership to increase their services and service for our children and youth in the neighborhood. Let's see, here we go. And the photo here is our Color of Youth event, which we do annually. And this is a chance for them to showcase, the youth to showcase their creative, all of their creative endeavors over the course of the year. And they also do like a break dancing contest with Destiny Arts at this event. And then there now you can see the numbers. So we're gradually going up since the pandemic. And we're also, like I said, over to the right working on the cost. We're trying to increase those numbers as well as one of our priorities. All right, next slide. And now moving on to school health centers. As I mentioned, we have 28 school health centers in the county. Healthy Schools and Communities provides a base allocation for our partner agencies to operate these centers and they're throughout the county. You can kind of see a map throughout the county here in how many different school districts? Oh, 10 lead agencies and in five, let's see, five different school districts, I believe. Next slide, please. And these are just some of the highlights. We've been partnering with UCSF for many years to evaluate our school health centers, which has been great because they've also been able to access in recent years, the electronic health record, which helps us understand, just better understand how our school health centers are doing and how they're serving our clients. We've served approximately 15,000 clients with almost 60,000 visits. And we have strong client retention with 60% that returned for follow-up visits. And we have 206 youth that participated in our youth leadership programming. And we also learned that school health center users are more likely than non-users to report receiving needed help with sexual health and counseling services. And 98% of students agree that the school health center helped them have somewhere to go when they needed help or support. And these are just some of our priorities that we're working on right now. We're really working on sustaining our school health centers. They've been experiencing some challenges over the last few years due to rising costs, also possibly because of HR1. So we're really leaning into sustainability work and partnering and talking about how to increase funding for our school health centers for the base allocation. just to help them operate. It's not a particularly profitable endeavor, and it's just gotten more difficult over the years to operate these clinics. We also continue to host our learning community, which has been even more important because of the sustainability issues where we share best practices and we develop our cross-agency support for the clinics. And we continue to just build more partnerships with our stakeholders to address and approach all of our challenges and ensure that the school health centers remain safe spaces for young people, especially during this current climate. And one area that we've been leaning into even more is better partnerships, stronger partnerships with AC Health, with our entire agency, especially around Medi-Cal outreach. AC Health has been working really hard right now to make sure that we're doing a lot of Medi-Cal outreach given all of the changes with our federal policy changes. So we've been really leaning in around that as well as around immunization and dental health. Next slide, please. And then this is just a little bit about our youth and family opportunity initiative. Let's see here, we fund, we have programs across 10 cities and five different supervisor districts. And we fund 10 CBOs and five school district partners. And this has enabled us through these partners to serve approximately 15,000 individuals Almost 4,000 families received health coverage, application assistance. And most of our children and youth and families are very pleased with our services. They're connected to us. They have better access to healthy food and healthcare as a result. And the youth are feeling like they have an adult who cares about them as a result of participating in our programs. Next slide. And over this next year, we hope to again leverage our family resource centers to really help assist families with Medi-Cal and CalFresh changes at the federal level, making sure they understand the policy changes and helping families continue to enroll and keep their coverage. And we will want to continue to explore opportunities for more client voice in our programming. And we'll do this in partnership with REACH. We've learned a lot about our youth adult power sharing at REACH. And we want to spread that throughout the county, that knowledge and those best practices. And this is a photo I think at REACH. And then this is, it just says here about a Dublin student that launched a podcast to address mental health. And this was with one of our YFO partner organizations. Next slide, please. And then a little bit about our Communos program. Our Communos program offers case management and capacity building for school districts and educators to support unaccompanied immigrant youth children of migrant families and caregivers using a culturally relevant lens. And these were some of the things that we did over this past year. We had a provider retreat, which was an end of the year gathering to celebrate over 10 years of work in our Communos program. And this was a really important time to do this work, to offer our providers self-care and resilience building, in response to all the increased stress that's been happening due to the changing immigration policies. We also served over almost 3,000 newcomer students throughout Alameda County. And we offered quite a few consultation sessions with our schools and districts and offered trainings. And we trained nearly 100 providers around family emergency preparedness with Inc's East Bay Sanctuary Covenant. to help families prepare for potential separation due to the threats of detention. And then lastly, we co-hosted the first Tri-Valley Immigration Resource Fair, and we offered legal immigration resources, as well as connections to community resources and Know Your Rights workshops. Next slide, please. And these are just some of the things we're going to be working on this fiscal year. We'll be publishing our Caminando Juntos resource guide, which is a resource guide helping our community-based organizations and school districts better serve our newcomer populations. And we're going to be continuing to partner with school districts to make sure that they're remaining welcoming and safe spaces during this time. And we're gonna continue to sustain our Camino's learning community where we share all of our best practices and expand our partnerships to address all of the emerging needs, including the Medi-Cal outreach, legal services and basic needs. Next slide, please. And we also do a lot of school-based behavioral health. And our school-based behavioral health initiative expands universal access to behavioral health supports. And it builds on the capacity of schools and districts to promote mental health wellness and social emotional development. I think what's important to, to kind of emphasize here with our behavioral health work is that it serves kids that don't necessarily, they don't have to have Medi-Cal to get served. It really focuses on serving all the kids with very little barrier to being served. And so we have some clinical case managers that are providing direct service within schools. And we've served through those clinicians around 150 students. And of those students, eight out of 10 of them reported they learned new ways to help them feel better, manage stress and anxiety. And they felt they had an adult at school who cared about them. We also do a lot of coordination of services teamwork. So we help support school districts with how to do this cost system. And we also fund school districts to do this work. And so we have these supports in 284 schools and approximately 20,300 students were referred through the coordination of service teams. And we do a lot of behavioral health consultation to help our staff. be prepared for serving their students. And then lastly, we executed over $2.5 million worth of contracts to 14 school districts and four CBOs to provide those direct behavioral health services. And these are just some of the priorities that we will continue to work on over this fiscal year. coordination of services teams. We're also doing a lot of behavioral health consultation around crisis protocols and serving priority populations like LGBTQI populations. We're also offering clinical consultation groups for our providers working in schools to really support their work around best practices and support. And we're doing a lot of training. So cost training, youth mental health first aid, and cannabis opioids 101. And lastly, peer leadership has been something we've been working on for the last few years. So peer mentor programs are something that we support and train around throughout the county. Next slide. I think this is our last program slide. This is a little bit around the family engagement and support work that we do. We support a lot of work. Again, it's working with our school districts and CBOs to help their family engagement specialists. We have a family liaison community network and we've launched a new, we've been working on parent cafes. So this is kind of a new model that we've been trying over the last couple of years. And we're offering this parent cafe trainings in English and Spanish throughout the county. um and let's see we've been working with training and coaching for family liaisons and the eden unincorporated area in partnership with eden united church of christ and we do a consultation group with the san lorenzo school community liaisons we also have three community health workers that focus on west oakland tri-valley and south county connecting those families to resources. And we've served about 247 families, connecting them to healthcare through that work. And lastly, this is our systems change work, our systems building. As I mentioned before, and as you can see throughout the presentation, what we've been talking about is that we support We work in partnership with school districts and our community organizations and public agencies to build health and wellness systems. And some of this work is internal to Alameda County Health. We facilitate a youth, a children, youth and families work group. So all of our programs across Alameda County Health that serve children, youth and families come together. We talk about what we're doing. We coordinate efforts and we align our work. We're also leading an internal Alameda County Health Measure C implementation work group. We just finished our theory of change. And again, we're working on coordinating that work, learning from each other and aligning the work. And we also facilitate seven learning communities, which I just talked a bit about. Our Camino's learning community is an example, our school health centers. And we lead the school health steering committee in partnership with the Alameda Coffee County Office of Education. Some of that work we're doing, we have a behavioral health sustainability work group as part of that steering committee, where we're looking at trying to come up with strategies to learn about our funding for behavioral health, expand the funding within our school districts. And lastly, we're coordinating partnerships and services in the urban and incorporated area of Alameda County. And an example of that is that the Promise Neighborhood application that we're working on right now, and hopefully we get funding for. I think that was the last slide, thanks.

All right, thanks, Supervisor Tan.

Thank you for that presentation. There seems to be a lot of underlying themes about the need for funding and sustainability. So along those lines, do you happen to know the status of the school-based health center at Alameda High that was run by Alameda Family Services? Because I think back in April, there was a concern. that because of staffing shortage, because of HR1 and the lack of Medi-Cal coverage that Alameda Family Services could no longer provide support and La Familia and Roots wasn't able to provide some corresponding support?

We are still looking for a medical provider for that site because Native had to pull out. So we're still in the process of trying to find a provider for that site. So it's a challenge.

In terms of funding, because I know the Ashland Youth Center, Supervisor Miley's office has been basically trying to fill the gap for a long time. And we're looking at trying to get Measure W funding. And similarly, the Wilma Chan Family Resource Center at Hayward Acres, which provides funding family support, including referrals and legal consultation for immigrant support as well. How, I mean, we're looking at trying to provide some Measure W funding to close the gap, but then we're seeing, as you said, in Ashland, a decline in usage. So how are we reconciling? Reach, I know, is definitely a county, but Is there some way in which the schools can partner more closely in the school-based ones?

Yeah, for sure. So we haven't seen a decline in the REACH services and membership. It's just the clinic there. Yeah, the Fuente Clinic, they've experienced a little bit of a decline that we're really trying to carefully monitor. And yes, we're trying to increase our partnerships to make sure that We have we do a lot of like newcomer support across all of our school districts so one example is we have a clinician that specializes in that and she works with a lot of newcomer youth at some of the schools throughout Oakland. And so one focus will be to have, she's going to kind of help us bring those youth to Fuente. and kind of have sort of like a warm handoff to that clinic. So that's just one example of a strategy, but we're also continuing to partner really closely with the San Lorenzo school district. We have really strong relationships there to basically help the clinic ensure that, you know, those students are getting served and are in there, you know, the, the numbers stay high. But yeah, I think the same kind of work could happen in Hayward. And we also have staff that work within the Hayward Unified School District. So I would love to talk with you offline, too, to kind of explore more ideas around that Family Resource Center.

Yeah, I think that would be helpful if perhaps you can offer a presentation at, like, the Alameda Youth and Families Collaborative with Supervisor Chan started 30 years ago, right? And because there's changes that have happened. And similarly, there was an effort to do something similar with Oakland Thrives, which involves multiple jurisdictions and trying to get an update and see how we can best leverage some of these multiple challenges and resources. Yeah, we would be happy to do that. Okay.

Supervisor, could I add something real quick? Yeah, I was just going to say, in terms of the school-based health centers in general, the way that the county supports those models is that we provide through the center some base funding. And historically, that's been Measure A funding. It's a small amount of money, but it supports those learning communities, like a consistent model, etc., and the clinics, the medical providers who actually provide the services bill for those services. So what we're seeing is that, you know, with the Medi-Cal HR1 changes that are coming down the pike, clinics are having to make some choices about where they want to put their resources, right? And there's just an overall decline in Medi-Cal. I think that's also one of the issues that we see in Alameda is that it's a lower percentage of students who are on Medi-Cal compared to some of our other areas. So we have had some conversations both with the Alameda County Office of Education and talked with the superintendent about like how do we bring this to Oakland Thrives perhaps as a way to think about some different models. And then we've also talked with the clinic consortium because most of the providers are FQHCs to see Can we do something different in a way that makes sure that we're providing those services in the schools?

Yeah, I think that's important. In terms of looking at alternatives, I'm trying to get a better sense of whether or not the family resource center can become a more encompassing if some of these other school-based programs, because it's dealing with the whole unit rather than just the children or the kids at schools. And I know the FQs have a role in providing a lot of that support. And perhaps the challenge that we're facing with is obviously also on the behavioral health front, right? And how to provide some adequate support on the behavioral health front, especially right now. I know that my office has been trying to get a career teen center, the QTAC center up and running at Alameda, this unified school district. And so we're hoping maybe we can, lean into some of that support from your organization?

Yeah, definitely. Okay. Yeah.

Thank you. Thanks. Well, thanks for the report. Appreciate it. I definitely feel we need to have an annual update from the healthy schools and communities. So how many staff do you have? Oh, that's a good question off the top of my head.

I want to say like 40. 40? Yeah, but I should tell, I'll get back to you on the exact number.

Okay, just curious. Then in the opening slide, it says, we envision a county where all youth embody self-determination and graduate from high school healthy and equipped with options for college and career. Do we have any metrics that indicate from whence we... were and started to where we are presently?

Good question. That's kind of our North Star population outcome. I love it. I'm just trying to get a sense.

Do we know we're making progress? I'm just trying to get a sense of that.

I'm just going to be honest. Not really. Our program is small. What we try to do is we try to like pilot best practices and kind of that like sort of practice to policy work. But I do think that that would be a good thing to try to measure because as we try to spread some of these, you know, services that we've basically designed and spread, like cost would be an example. It would be a good kind of like study to look at to see how we have impacted that North Star, but it's a tough, I think it would be a tough thing to measure given our like small kind of footprint. for the whole county. But I feel like if we did some place-based efforts, we could probably do that. That's why I'm excited about the Eden Promise neighborhood because that will allow us to really lean in around all of our coordination and to kind of take everything that we know and try to pilot it in that one community and then maybe we could actually look at some of those outcomes. Yeah.

I don't want to jump ahead of myself because we'll hit the different slides, but it just kind of seems to me you know, I'm challenging you and your boss, because it just seems to me that with the systems change piece, bringing all the systems looking at all this, you could try to create some type of metrics to kind of see if we're making any progress, or we're just spinning our wheels, or, you know, we're doing good stuff, but are we going anywhere?

I mean, I'll just say what I hope to happen is to have more of that coordination across Alameda County Health with children and youth. So beyond healthy schools and communities. And that's why we've started that work group. I think Measure C is a big opportunity. So I think that's where we might be able to see some of really meeting that North Star is if we do it across all of our programs. Yes. Okay. So that would be great. That would be my hope.

I wouldn't put it just on the Office of Healthy Schools and Neighborhoods or the Center for Healthy Schools and Neighborhoods. I think you need to bring in, you know, others in the agency and, you know, external partners, et cetera, to try to create that system and that vision.

Yeah. That was, I believe, kind of the vision of ICPC back in the day too, wasn't it? To kind of the interagency children's policy, to kind of do that collective impact across the county and look at goals and outcomes and be able to measure. I mean, that would be, I think, in a perfect world, how we would be able to measure and reach that North Star.

Let's see here. So do a lot of good stuff with REACH. It's great. With REACH, with the fact that the number of students, youth at REACH increasing, do we know... the demographics of the youth, not necessarily their race, but their age, what school district they're associated with, et cetera.

Yeah, I don't have it in front of me, but we do have all that information that we could share with you.

I'd be curious to kind of get a sense of where that is today.

Mostly San Lorenzo School District, but I think some come from South Hayward as well, and also some from Oakland.

Right, right. So we can give you the exact numbers. That's been my understanding. I was just thinking, if we're going to have this report annually, you could just bring it in a future update. You don't have to give it to me before then, but if you choose to, that'd be great too. Then let's see. And then my office has been keeping me abreast of the Promise Neighborhood proposal and application. So that's really great. Hopefully we'll be successful in receiving that grant. And I did want to make a notation. With the 28 healthy school health centers, What's our relationship with all of the federally qualified clinics? Are we working with all of them? Are they part of that working group for systems change or what's going on there?

Yeah, we have, we work with Tabersio, La Clinica, Native, I might be forgetting one. I don't know that they're all the FQHCs. I don't think we have relationships with all of them, but we do have relationships with a handful of them and they are involved in that learning community. And as Anika said, we're trying to kind of meet even more with our leadership to try to understand the costs, some of the challenges that they're having with the rising costs and just kind of making these clinics work. So we've been working and partnering with the FQHCs even more so in the recent couple of years.

Okay. There was a slide you put up, school health centers highlights. Was that the nearly 15,000 clinics with almost 59,000 visits? Was that since the inception or was that over one year? One year. Okay.

Yeah. Okay. And we have a lot of data around school health centers because we partner, as I mentioned, with UCSF. They actually use our data to publish reports and all kinds of journals. And yeah, so it's a very extensive evaluation. And I'm happy to share more on the evaluation if you're interested.

Yeah, because I'd be interested, maybe the committee would be interested in knowing what the demographic breakdown, because all of the, are you just working with high school students? Are you working with junior high and elementary school?

Wow. There we go. It's back. Not so much with elementary, but mostly high school and some middle school. Yeah. But people, you know, the way it works is that youth from all over the schools can go to those, you know, clinics from other schools. So trying to kind of refer students from all over to those schools. clinics.

And I think supervisor to your question about just sort of how we're connecting the different systems together. You know, there's a lot of great opportunity, for example, through some of the measure C work, the children's pediatric measure C work, we've explicitly sought to improve connections across the center for healthy schools and communities with the public health department and the work that they're doing and kind of thinking about how to leverage those school-based services. And then depending on what happens with HR1 and how it affects, again, that FQHC billing component, there might be new things that we can look at where you're kind of seeing those physical locations in these schools as a place for community members to come in, right? So it's not necessarily just limited to the students there. And so those are some of the things that we wanna explore. Because it's been a long, steady investment that we've had. Some of the schools have done a lot of capital improvements on those clinics. it's both real estate and an infrastructure that we have that we can be leveraging. Sure.

Yeah, because I'm trying to recall, because this isn't a new territory, out in Sobrani Park, is it Madison? Exactly. And is that clinic open to the whole community? Because I thought, if I recall correctly, it's just not youth, it's adults too.

They have a community entrance. Right. It's not all community entrances are created equally, I would say. They still have to walk through. So it's a little not super accessible. I think the true community entrance where you would get kind of more revenue and more clients would be if it was like maybe kind of not they wouldn't have to walk through the school campus we just met about native just about this the other day and they were saying that it's it's kind of tough to get people to come in um because it's so embedded within the school even though it has that even though it does serve the community but is that the kind of thing you're looking to maybe ponder because of the possible changes yes so what we're trying to do right now is um keep you know kind of keep things whole for the next couple of years or even year while we explore those those questions because those questions it takes a while right because it's like facility planning and working with school districts and it's it's not those aren't easy questions to kind of figure out but that's exactly what we're trying to like dig into now. model.

I've got confidence in you, Lisa and Anika and the rest of our executive team and everybody who works with you. I've got confidence. You're going to figure this out. My job, our job is to keep you on your toes. Keep you thinking. Let's not get, you know, let's not get comfortable. Yeah. So good. That sounds good. And then back on the health centers at the schools and the federally qualified clinics. You know, I serve on, and it's not part of Alameda Health. It's part of the Community Development Agency, the lead abatement authority. And we've been, and even in the unincorporated area, there's been a strong push for wanting to get all school-aged kids tested for lead. And I'm actually going to ask my staff working with Anika to schedule a presentation or information presentation on that with all of our stakeholders, including Center for Health Schools and Neighborhoods, Office of Education, et cetera. Because I do think if either we can pilot something or establish something throughout Alameda County and this isn't just for children in you know one school district or in one geographic area it would be county-wide they'd all get tested for lead upon entering let's say the third grade whatever it might be whatever we would figure out would be the best thing Have you had any conversations with the Joint Powers Authority staff on lead around this, as well as the Office of Education? Because I know I've talked to both about this.

Yeah, so we've met with the Office of Education around it. Dr. Moss, I believe, was in that meeting with Kimmy. And we met with ACOE. So we did have a partner meeting with ACOE, Public Health Department, and us to talk about this question. I think it was mainly focused around OUSD, around Oakland. But I think, yeah, I think what you're proposing would be good to sit down and really have a planning discussion around how that would work. It's complex, as you know. But we haven't talked, I don't know if you've talked to the JPA around it.

No, I've not had those conversations. And I think, you know, to the extent that we've talked about them internally with public health in the center, some of it, it's sort of really wanting to think through like the next steps. So if we did offer testing, what does that mean? And, you know, does that, what can families do and wanting to pair it with appropriate education and resources?

Mm-hmm.

So look forward to connecting with you more on that.

Yeah. PFAS, but that's what I think about PFAS and the need for testing there eventually, but at least lead, we know lead is out there and it's causing problems. We have the JPA and at some point we might be able to expand the JPA and expand its funding stream, but I know that's not gonna happen anytime soon. Although that's something I've been trying to achieve for at least a decade or so. But so I wanted to bring up that lead testing piece with the youth.

Make a little picture on the lead too, that something I work, and I used to work at First Five way back when, and we actually worked on a lead program With CDA, I think it was many years ago with family child care providers and just want to just kind of plug that, that I think that would be a good population to partner with first five around because. the kids are in these, you know, like housing stock that's really old and they're kind of like crawling around on the floors and it's anyway. So I just wanted to say that's an advocate for the little ones as well.

Yeah. And I don't want to prolong this, but I know through the JPA, Joint Powers Authority for Lead Abatement, they're looking at trying to do a pilot in a couple of schools, I think, in Hayward and Oakland, potentially. So the point is, I just think we need to move this agenda along, do a pilot, and then... see if we can bring it to scale so that all kids are being tested. And I just think going through the schools, although I'm not opposed to the childcare development centers and childcare facilities, I just think the school would be probably the most expeditious way of monitoring it and gathering the data. But I'll wait. But I'm going to get a report here in the future on that. So let's see. A couple other questions here. One of the slides you mentioned, it said including HSC. What's HSC stand for?

Healthy Schools and Communities.

Oh. And with Youth Uprising, is the only thing you're doing with Youth Uprising is the clinic out there?

Yeah, we have the Castlemont Clinic, which is right there on campus. And we also have the contract with Youth Uprising, as you know.

Yeah. Are we... Because I know there was a lot talked about with REACH, but Youth Uprising is our other youth center that, you know, the county doesn't run it, but we own the facility. We provide a significant amount of funding for Youth Uprising. It's a nonprofit that... runs it to reach its county operated youth uprising is nonprofit. So what are we doing with that?

So that's a good question. When I started healthy schools and communities, we had a very like kind of hands off approach to youth uprising. We were managing the contract, but we weren't doing a lot of like real like partnership with them. But now that's changed. So over the last few years. We meet with them regularly. We've been offering, like we've been including them in trainings with REACH around all kinds of topics like mental health first aid and evaluation and working with partners, like partnerships with CBOs, that kind of thing. And right now we're actually working with them around helping with their behavioral health work because... They had MHSA PEI funding and that was cut. So we're trying to kind of help them access Medi-Cal to see if they can build Medi-Cal because I believe they did in the past. So that's just an example of the kind of work that we're doing with Youth Uprising. And we also really work really closely with the school district. So also helping with that school partnership. But Youth Uprising is amazing. Kiana is amazing. We're really lucky to have her as a CEO and great leadership there now.

Well, I just thought it was, because we would know the center.

We could probably put that in the presentation, actually.

Obviously, I'm on the Youth Uprising Board, so I know kind of what's going on. And quite frankly, I've probably been the Youth Uprising more than I've been to reach in the last year or two. I just don't want us to forget youth uprising, even though it's run by a nonprofit. In the past, we've had to provide additional resources many years ago, a million dollars to help bail out youth uprising, et cetera. And that model, I still think, is very important. And I think youth uprising is very important to have. Because I think if it's not successful and we're not working with him and collaborating with him as well as we could, I think it'll be a disservice to the youth in Oakland who primarily go to youth uprising and will go to youth uprising.

Yeah.

Great. Yeah. And let's see here if there's anything else. Okay. I think I'm now over to Over to systems building. Yeah, I think I'm really interested in having this committee have a presentation on what's going on with Alameda County Office of Education around the behavioral health piece, Medi-Cal piece, mental health piece, et cetera. Yeah, that's a great idea. Because I know you're talking with the superintendent.

Yeah, we've actually been working with ACOE. So when I started HSC in 2020, before 2020, we didn't partner as much with ACOE. And that was one actually positive thing that came out of the pandemic. We became very close partners. And over the last six years, we've been working really closely together around that Children and Youth Behavioral Health Initiative. um supporting that work sustaining that work uh and like i mentioned we have the school health steering committee now that we run together in partnership and yeah we're just working side by side to try to align our work and be as efficient as we can with our resources to make sure that as many kids as possible are served with behavioral health services in the schools But yeah, I think it would be great to have them come and talk about that work.

Yeah, because I get bits and pieces sometimes from the director and sometimes from the superintendent. But I think it'd be good for the committee to kind of get a real good informational update because it just seems like things are kind of making progress. But I'd be curious to see what progress we've made and where we need to go and what are the impediments to us getting there.

As I mentioned, that school health steering committee. And that's the question that you just posed is exactly what we're grappling with in that work group. And so maybe as we progress through that work group, we can bring some of those findings around what are the gaps and what do we need to do as a county to try to fill that behavioral health gap within schools. So, yeah.

The thing that I would add, Supervisor, is so in addition to the work that Healthy Schools and Communities does directly with ACOE, I believe the board recently received a communication from the superintendent sort of providing an update on the work around foster youth specifically. So with the ICC, I always forget the acronyms, but the Interagency Children's Council. So there's some stuff that we're required to do per state law for that. So there is a leadership steering committee that includes me, the social services agency director, Dr. Tribble, Chief Ford, and recently we've had first five, sorry, the regional center added to the mix, and the superintendent. And so I think there's multiple layers of the work that's happening. And We just had a meeting last week where we were talking specifically about what are the things that we want to collectively measure together. So happy to reach out to the superintendent and we can bring something back for you in the fall, maybe.

Okay. Do you have anything else before we have public speakers?

Do you have a sense of the proportion of kids in our schools that are under Medicaid or Medi-Cal?

Good question. Do you have that data, Anika?

I think we have it off the top of my head, but we can look into that.

The reason I'm asking is because I know this is back in the day when I was working at the Water District when we were trying to provide means the tests were led in the schools, school buildings. And I know recently the Center for Disease Control through the federal government that received some significant grant funding to tests were led in drinking water. But I know it was a requirement back then for kids that are like around two or three years old to get tested for lead. So that was a requirement under Medicaid covered children.

Yeah, I think we have a good sense by district and school and neighborhood. a decent sense of Medi-Cal rates. I don't have it off the top of my head, but there's actually also kind of a map that we have through our school health center state alliance that looks at Medi-Cal rates too that we can just share that with you.

That would be good because the testing is covered by Medicaid for that.

Great.

Yeah, and it looks like about a quarter of our total Medi-Cal population in the county is youth under the age of 18. So that's well over or close to 100,000 kids.

Do we have any public speakers on this item?

I have no speakers for item one.

All right. So thanks, and we look forward to ongoing updates. And... Thank you. All right, so our next item is an action item that I'm really pleased that it's here before us. A proposed ordinance prohibiting the sale of noxious oxides in Alameda County. So this is going to be good.

Okay, thank you. Good morning, supervisors. This is Paul Cummings, Director of Alameda County Public Health Department's Tobacco Control Program, and my name is Rachel Gratz-Lazarus, Senior Program Specialist with Alameda County's Tobacco Control Program. We'd like to walk you through the public health concerns surrounding nitrous oxide for recreational use. discuss the regulations intended to limit retail access to nitrous oxide, especially among teens and young adults, and provide an overview of the proposed ordinance prohibiting the sale of nitrous oxide and nitrous oxide devices within unincorporated Alameda County. Next slide, please. So Alameda County Tobacco Control Program conducts observations in tobacco retailer establishments to assess the prevalence of tobacco products. And our program has increasingly noticed the sale of nitrous oxide in these stores, particularly in smoke shops and vape shops throughout Alameda County. We have observed nitrous oxide for sale or advertised on the websites and social media accounts of smoke shops in Alameda County in unincorporated areas, including the smoke shop pictured here. Our program is committed to ensuring that tobacco retailers do not replace tobacco with other harmful and addictive products. So nitrous oxide is an odorless, colorless gas that, when inhaled, gives a rapid and short-lived euphoric high. It is often referred to as laughing gas, NOx, whippets, or galaxy gas. Nitrous oxide does have a number of legitimate legal uses. It is used in medical, dental, and pharmaceutical settings as a sedative and pain reliever. It is used for culinary purposes as a food propellant, such as in whipped cream containers, and it is used for automotive purposes to boost engine horsepower. Inhaling for recreational purposes is not a legitimate legal use. Nitrous oxide products are commonly sold in smoke shops and at gas stations, and given their low cost and availability, they can be dangerously misused for recreational purposes. Nitrous oxide is a growing public health concern. When abused as an intoxicating inhalant, nitrous oxide displaces oxygen in the lungs and can cause irreversible neurologic, cardiovascular, and psychiatric damage, including asphyxiation, paralysis, and death. Nitrous oxide products are marketed with sweet flavors and bright colorful packaging that entice youth and young adults. Social media trends glamorize, normalize, and rebrand nitrous to appear as fun and harmless. For example, news reports have highlighted a viral social media trend involving Galaxy Gas, where users, influencers, and teens post short clips on platforms like TikTok and Instagram, inhaling the gas for a fast euphoric high. Because nitrous oxide products are accessible in the retail environment, young users may underestimate their danger. Emergency room visits due to nitrous oxide misuse are on the rise, as well as significant increases in nitrous oxide related mortalities. According to the CDC, there were 23 cases of nitrous oxide related deaths in 2010, compared to 156 cases in 2023. data consistently shows that recreational abuse is highest among teens and young adults ages 16 through 30 years of age, with a notable over-representation among males and a disproportionate impact on socioeconomically disadvantaged populations. Driving under the influence of nitrous oxide is also extremely dangerous and jurisdictions in California have been experiencing a rise in nitrous oxide DUIs. For example, in San Francisco, a young woman was left paralyzed after riding in a car with her boyfriend who crashed at roughly 100 miles per hour after inhaling nitrous oxide. And in Albany recently, a driver was arrested for driving under the influence of drugs and unlawful possession of 85 large canisters of nitrous oxide. The FDA advises consumers not to misuse or inhale nitrous oxide products from any size canisters, tanks, or chargers due to the potential for severe adverse health effects, including death. In California, nitrous oxide can legally be sold for legitimate purposes, but it is illegal to sell or give nitrous oxide to a miner or to knowingly sell or possess nitrous oxide for the purpose of intoxication. California law also requires retailers to maintain on-site documentation of nitrous oxide sales. There are some proposed California bills which could potentially regulate nitrous oxide sales. None of these bills are comprehensive, and it is unclear whether they will continue moving through the legislative process. Local laws allow for jurisdictions to set standards around nitrous oxide sales to protect public health in communities. And given these public health concerns, a growing number of California jurisdictions have already prohibited the sale and distribution of nitrous oxide for recreational use amid an uptick in youth misuse and public safety incidents. The city of Alameda was the first jurisdiction in Alameda County to prohibit the sale of nitrous oxide for recreational use a few months back in April. San Francisco and Los Angeles are currently considering regulations prohibiting nitrous oxide sales as well. And I'm going to pass it on to Paul.

Okay, thank you. So as Rachel described, the idea of this is to protect the public health by eliminating retail access to nitrous oxide for recreational use. So this would prohibit the sale of nitrous oxide and devices within the unincorporated areas. It prohibits property owners from knowingly allowing the sale on their premises and holds retailers accountable to comply with documentation. Next slide. the products themselves as well as the devices would be prohibited. And just looking at those products, they don't look like the things that you're going to use in automotive shops. Next slide. So there are exceptions for legal uses, and these include contained in a food product for use as a propellant. It's sold in a wholesale capacity. It's designed, marketed, and safety labeled for industrial use exclusively for automotive purposes, providing medical or dental care or sold by a pharmacist or pharmacy. And then if there are other exceptions that come up later, there is an exception created for those as well. So the penalties for sale of these products, first violation is 250, and then 500, and then 1,000 for each additional violation. And violations are... counted during any 60-month or five-year time span. And each day that a product is for sale can count as an additional violation. And finally, the products that are for sale can be seized. So community development agency would do enforcement through their inspections at retail establishments and retailers alleged to have violated the ordinance may request an appeals hearing before a hearing officer. So essentially this creates a very clear enforcement penalties structure for the sale, for prohibiting the sale of nitrous oxide for recreational use. Thank you.

Okay, thank you. Supervisor Cham.

Thank you, Chamali. I support development of this ordinance. I just have a few questions because we as a board, especially in our planning meetings, we often get appeals, especially from tobacco retail smoke shops that are in the unincorporated area that have violated a number of terms related to sale to minors of flavored tobacco products. So I'm just trying to understand, like, from an enforcement standpoint, you know, these violations, the 250, the 503 and more, 1,000, is that, like, on top of, like, their violations of tobacco products? And then the next item that we're going to be talking about is the Kratom products, and that's an added layer. So I'm just... trying to understand, like, if you're enforcing for... Because, I mean, sale to minors is just not appropriate. How come it wasn't, like, included in a blanket license for tobacco retail, for example?

So, I guess that... The short answer, I don't know if it's short, but would be that because the tobacco retail licensing ordinance has appeals that goes to the board of zoning adjustment, And it was determined that this ordinance really didn't have a particular zoning interest. Therefore, it was deemed that this should sit as a separate ordinance. But I do hear that people could be fined for sales of nitrous products as well as for sales of say flavored tobacco products or selling to underage youth and you know and ideally we're going to do some education so that retailers aren't doing any of those things and that would be preferable to finding them okay I mean I think it's just

encompassing as things like we're chasing every new addictive product as they come online. And so like if a cannabis dispensary or tobacco retailer sells things that are not appropriate for minors, they should just be banned, right? So the only question I had on that front was, Who determines the penalties? I mean, is it the sheriff department or the code enforcement or how do we make sure this gets enforced appropriately?

Code enforcement is the one that would do the inspections, yes. And so, you know, if someone violated the ordinance, they would cite them and depending on how many citations they had, then the penalty would be appropriate to that.

Okay, so you can be cited without closing your facility, right?

Yeah.

Thank you.

Thanks for those questions, because those are some of my questions, too. It just seems like we're constantly chasing, you know, one product after another to ensure the public health and safety of young people. And there's no way of, and we can't connect this with, like, having the BZA have authority over it.

Yeah, Raymond Leon, Deputy County Council. Good morning. Yeah, the determination by our office has been that the nitrous oxide, it's a separate product from tobacco products, and there isn't a nexus. There isn't a sufficient land user zoning nexus, whereas with the tobacco retailer licensing permit, there was a permit in place, and that's why that was permissible to go through the BCA.

Okay, because for this, you don't have to get a permit to sell this?

That's correct. Under this draft ordinance, that's correct.

And is this, so the same type of gas that goes into like party balloons and stuff like that? So would the ordinance prohibit the sale of this for that purpose?

I think for party balloons, it would be helium, right?

Yeah.

Yeah. So I think that wouldn't be regulated because it's a different chemical. Yeah, I got a little confused as to what substance was what until we dug into this.

Right. And the product, has this product always been around? Because it just seems like it's being marketed very colorfully and attractive and this and the other. Has it always been around? Have I just missed it? It's just puzzling. It's baffling to me.

I would say that you probably aren't the main target audience. No offense.

Are you going back 20, 30 years ago? Even 40 years ago? Yeah.

I think that this is something that has really ticked up in the last few years. I mean, just looking at the number of deaths and how they've been increasing over the last 10 years, I think that this is something that... use has been increasing and the harms associated with it are increasing. I would also say that right now the numbers are still relatively low and that this is potentially a good time to address it before it gets to be like an epidemic.

So this goes to a hearing officer.

Yes.

who pays for the hearing officer? Does the cost of the hearing officer come out of the violation? Who covers that cost?

I expect the county to cover that cost. I think that that is a process that still needs to be discussed with CDA and how they plan to obtain the hearing officer.

Okay. And then, because I know we use hearing officers for different reasons, and three or more violations would be $1,000. So if a person has like a fourth violation to three violations, they could get $1,000. Then if they violate again, would they get another $1,000? So it's cumulative. Okay.

Sorry, that is correct. It's third or subsequent violation that triggers the $1,000. So if there's a fourth or fifth, it'll be $1,000 a piece.

$1,000. Because we want to make sure that this is... you know, the violations are sufficient enough to prohibit that type of behavior. If we find out that it isn't, then obviously we're going to ask this come back. I'm assuming the board's going to adopt this ordinance, but they come back. If we find it in the future, that this isn't enough to stop this type of activity that we increased the fines. Yeah. Because I don't know how much these retailers make on selling this product and maybe the cost of violating the ordinance is worth it based on the sale. I don't know. Do we have a sense of what kind of money they make on this?

We don't know.

Okay. I do think this is good that we're doing this in the unincorporated area and Hopefully other jurisdictions will pick up on it. Alameda has done it in this county. So hopefully other cities will consider doing it in this county as well. We'll chase it out of the county and we'll chase it out of the region. Because once again, we're not banning the product for lawful purposes. It's just for recreational uses and to be sold to minors. OK. Do we have any speakers on this item? Let's have the speakers.

caller you're on the line we're on item two you have two minutes liz wonderful thank you good morning supervisors i'm liz williams and i'm speaking as a vice chair of the alameda county tobacco control coalition i want to express our coalition's support for this proposal to end the sale of nitrous oxide products for recreational use this is a reasonable restriction of a product that is too often sold in deceptive ways and too often used in a harmful manner Just like our communities have been taking great local action to create a healthier retail environment that reduces the availability of tobacco and nicotine products, our coalition likewise supports local action to address the harmful recreational use of nitrous oxide products. Many of these nitrous products are sold in bright, enticing packaging with fun names and appealing flavors. I've seen ones called vanilla cupcake and bomb pop and rainbow candy, just like the vapes and other tobacco products that we thankfully now regulate. These nitrous manufacturers are thinking about how to sell more of their product, not about the negative health consequences of improper use. And that's the role of our local governments. And our coalition wants a healthier, safer retail environment where our young people are not targeted by misleading packaging or have easy access to harmful products in our local retailers. So as explained, the proposal would prohibit the sale of these products for recreational use designed for the purpose of intoxication. But the exceptions would still allow their sale to adults for the various legitimate purposes. We know it's used in restaurants. food service and pharmaceutical settings and medical and dental services, but selling candy flavored nitrous to young people, especially in spaces like tobacco and vape shops, it's creating a real health concern. And as you heard, that's only increased over the last few years. So we thank you for your ongoing leadership in public health and for your consideration of this proposal.

Caller, you're on the line. We're on item two. You have two minutes. Douglas.

Hello? Hello?

Yes.

Yeah. Good evening, members of the Alameda County Health Commission. My name is Douglas Perez. I am a student at Chabot College and an Alameda County resident. I'm here to share serious concerns regarding the sale of nitrous oxide at local tobacco retailers. I want to bring attention to the substance increasingly known as gas station drugs, which carries real health risks and is being sold with little oversight at smoke shops, convenience stores, and tobacco retailers throughout Alameda County. Nitrous oxide is often sold in flavored, brightly packaged canisters marketed under names like Galaxy Gas that appeal directly to young people. Despite being sold recreationally, it is not a harmless product. Heavy or repeated use can cause serious nerve and neurological damage, and misuse has been linked to injuries and deaths, often from asphyxiation. As someone who lives and studies here in Alameda County, this hits close to home. When these products are so easily available and packaged to look fun, it makes it way too easy for young people to get their hands on them, and it honestly undermines a lot of the work the county has already put into public health. I've talked to classmates and people in my neighborhood about this, and it's something a lot of us have noticed and cared about. Overall, what I've observed suggests that nitrous oxide is far too accessible to use, which raises real concerns about the potential health impacts and what that means for community well-being. I encourage the Commission to consider setting a precedent by reducing access to nitrous oxide at tobacco retailers, starting a growing number of communities that have already moved to restricted sale. I appreciate the work the Commission is doing and encourage continued attention to protecting youth and community health moving forward. Thank you again for your time and consideration.

We have no additional speakers on item two.

No more speakers. Do you have anything, Supervisor Tam?

I can move the action item to move the draft ordinance prohibiting the sale of nitrous oxide and nitrous oxide devices to the full board.

I'll second that.

And I want to just take the role. Supervisor Tam? Aye. Supervisor Miley? Aye.

Yeah. You know, it's just, because I'm compelled to say this, it's just disturbing that we have folks who would try to take advantage of young people by selling products like this, putting them in attractive containers, this, that, and the other. It's just very disturbing. So I'm really gonna be interested to see maybe after a year or more of the implementation of this ordinance, you know, what kind of impact it's had, because it's just very, very disturbing. I mean, you know, the staff report about the young person who was injured as a boyfriend was under the effects of this. Yeah, it's just horrible. Because I know, you know, when I had my wisdom teeth pulled, they gave me gas. And, you know, I kind of at a point, you would just say, you can do anything you want to do. You know, you don't have any any conscious sense of right wrong pain anything so to sell this product for recreational purposes to young people it's just i mean it's just revolting quite frankly it's just revolting i think it's the abuse that's the issue here and i know supervisor miley and i are past our youth but um

It just seems like in terms of the nexus, if you're marketing flavored tobacco with colorful signs and Hello Kitty to kids, you're kind of doing the same thing with nitrous oxide devices. So what's the difference there?

Yeah, because to me, it's like, I don't mind legal products being sold legally to adults and for appropriate purposes. But when they're being misused and sold by proprietors, I just, I mean, I just want to put them out of business. You know, you don't even need to be in business, at least in my jurisdiction. Go somewhere else. Yeah. So I don't know if you have any response, but we're kind of just venting here. Okay, so this will come to the full board. Do we anticipate this coming to the full board next week on August 4th or will it be after the recess?

My recommendation would be after the recess given the CEO timelines. Okay.

You know, that's September 15th after the recess. Okay. Hopefully nothing happens between now and then. And then it requires two readings. Okay. All right. Okay. Thanks. Okay. Let's go to item number three. This is an action item as well. Draft ordinance prohibiting the sale of craton and seven hydro cement. Well, whatever, how you pronounce that.

We call it 70H.

Okay, 70H, good, okay, products.

All right, well, for this next presentation, we'd like to walk you through the public health concerns surrounding Kratom, discuss the regulations intended to limit access to Kratom, and provide an overview of the proposed ordinance prohibiting the sale of Kratom and 70H products within unincorporated Alameda County. Alameda County Tobacco Control Program, as mentioned earlier, conducts observations in tobacco retail establishments to assess the prevalence of tobacco products, and we have increasingly noticed the substance kratom for sale in these stores, particularly in smoke shops and vape shops throughout Alameda County. We've observed kratom for sale or advertised on the websites and social media accounts of smoke shops in unincorporated Alameda County, including the smoke shop pictured here. Great. So what is kratom? Kratom is a substance among a group of unregulated products referred to as gas station heroin, which are linked to significant health risks and the potential for dependency. Kratom is an opioid product derived from the kratom tree, which is native to Southeast Asia. And 7-OH, formerly known as 7-hydroxymetragynine, is a powerful and psychoactive compound found in kratom leaves. 70H products are synthetically concentrated kratom derivatives, which bind to the same receptors in the brain as opioid drugs. The impact of kratom can depend on the amount consumed. At lower doses, kratom acts as a stimulant or an energy booster. While at higher doses, it acts like a sedative and produces dangerous opioid-like effects. Because the FDA does not regulate Kratom products, there are no manufacturing standards to ensure their safety, purity, or consistent strength. So Kratom products vary widely in potency, which increases the risk of unexpected effects and contamination. These products are commonly sold at smoke shops and gas stations as gummies, tablets, shots, drinks, powders, and capsules. Kratom is a growing public health concern. The FDA has warned consumers not to use Kratom because of the risk of serious adverse health effects, including liver toxicity, seizures, addiction, and overdose. In some cases, deaths have been associated with Kratom use. When 7-OH products are used in combination with alcohol, medications, or illicit drugs, they can significantly increase the risk of severe life-threatening respiratory depression and slow or stop breathing. Since April 2025, Los Angeles County Department of Public Health reported six fatal overdoses linked to 70H products among previously healthy residents ages 18 through 14. Because Kratom and 70H are widely available and advertised in the retail environment, consumers and retailers may incorrectly assume that such products are legal to sell and manufacture for consumption and that they are safe to consume. The FDA has not approved any Kratom or 70H products as safe or effective for medical use, food additives, or dietary supplements. Both the FDA and State of California consider Kratom and 70H products to be adulterated for the purpose of consumption. As such, the sale of these products for consumption is prohibited under California state law to individuals of any age, and California Department of Public Health Food and Drug Branch routinely embargoes, seizes, and impounds products containing kratom and 7-OH during retailer and wholesaler inspections. The agency has seized over 3,300 illegal kratom and 7-OH products in recent crackdowns. At the federal level, the FDA has issued warnings against companies selling 7-OH and has recommended that 7-OH be classified and regulated as a controlled substance. The FDA exercises its authority to protect consumers from companies selling unapproved Kratom drug products, making false or misleading claims about unproven benefits of Kratom and selling unlawfully marketed Kratom dietary supplements and conventional foods. While there is anecdotal evidence that some people have found natural kratom leaf to be beneficial in supporting pain relief and addiction recovery, neither FDA guidance nor California state law distinguishes between individual kratom products. So natural kratom leaf for the purposes of consumption is considered an adulterated product as are all kratom products for consumption and is therefore prohibited for sale in California and subject to CDPH enforcement. There are no FDA-approved Kratom drug products or over-the-counter drugs containing Kratom that are legally on the market in the US. As noted, California state law regulates both Kratom and 7-OH as adulterated food products. California Health and Safety Code provisions state that it is unlawful for any person to manufacture, sell, deliver, hold, or offer for sale any food that is unadulterated. And given these public health concerns and the high risk of abuse of Kratom and 70H products, a growing number of California jurisdictions have restricted the sale of Kratom products.

Okay.

Thanks, Rachel. So the ordinance is to protect public health and it would... Within Alameda County law, it would prohibit the sale of Kratom and 708 products within the unincorporated areas. So just as a reminder, it's already illegal to sell these products per state law. And this would just clarify that within the county law. And so it would you know, do the same things as the other law to prohibit retailers, require property owners to not allow the products to be sold on their premises. And if there is any allowable sales or documentation requirements, then retailers would need to comply with those.

Next slide, please.

So there are a lot of products out there. Some of them are quite colorful.

We can go on to the next.

So this is very similar to the other ordinance that first violation 250, then going up to 500, 1,000, each subsequent violation would be $1,000. Again, if each day that a product is for sale can count as an additional violation. And the products can be embargoed, seized, and destroyed. Inspections would be done by the community development agency. And retailers alleged to have violated the ordinance may request an appeal hearing before a hearing officer. I, I know that Rachel and I got a bunch of emails, um, since, um, the agenda was announced and we encouraged people to, um, make sure that they submitted their comments directly through the system. Um, a lot of people were making a distinction between Kratom leaf and seven Oh H and, um, without trying to dispute people's experiences, which I believe, state law doesn't make a distinction between Kratom Leaf and 7-OH. And so both of those products are illegal to sell per state law. And this is clarifying that those are illegal to sell within the unincorporated areas, and it's creating a clear penalty process for violations. Thank you.

All right. Public health staff, they're on their JLB, so it's about as damn.

Okay, so... CDA code enforcement is also going to be doing this enforcement mechanism at the local level, even though it's banned by state law. Why can't they do that now since it's banned by state law? Why do we need a separate ordinance to do that? I mean, I'm not disputing the importance of the ordinance. I'm just trying to understand. enforcement mechanism and then the the other issue is you mentioned it's a gas station heroin so is it sold at health food store gas stations and just tobacco shops or how's this going to be enforced uh this is june oh deputy county council uh i can speak with respect to uh the regulatory part because under uh

the current health and safety code with respect to the enforcement of adulterated product, that really occurs at the state level. There's not a independent mechanism for local counties or municipalities to independently enforce products that may be adulterated. It's all done according to through CDPH. So that's why this ordinance will be a little different, provides a clearer regulatory pathway with respect to the unincorporated counties for local enforcement. So that provides a little more context about that aspect. For the other questions, I'll refer to Paul and Rachel.

So, community development agency would, the stores that they inspect, and I mean, I know that that would be the tobacco retailers, the smoke shops, the gas stations that are selling a variety of products. All of those would be part of whom they're inspecting. I'm not sure if they inspect health food stores. What we've mostly been seeing these products showing up have been in gas stations and smoke shops. And I think that's where the concern is arising.

So in the counties that have it, like Orange County and the cities, mostly in Southern California, how long have they had this ordinance in place before? Has it been just within the last year or is it?

It's been within the last year to 18 months.

And what's their experience with enforcement? Has it seen an increase from their code enforcement or?

We haven't gotten that information. We've sort of looked to see who had similar ordinances, but we didn't have data on enforcement results.

Okay. So I know when we had a briefing about this earlier last week, you mentioned that a lot of the associations have with the public health directors and Alameda County Health directors that this is something they recommend that we look at at the local level, even though there is a statewide ban to reinforce that enforcement mechanism. And so that's kind of why I'm asking how other jurisdictions have been doing with the enforcement part.

Yeah, I mean, I think that just like what we've seen in Alameda County around tobacco retail licensing, that enforcement can really vary between jurisdictions. I know that within the unincorporated areas, that enforcement has been really good and that there's been really consistent inspections of retailers and sort of doing clear education with the retailers about what products can and can't be sold and penalizing them if they violate. So I can't speak to what's happening in the other jurisdictions, but just to echo what June said, that despite it being illegal to sell per state law, we didn't have clear regulations at the local level to enforce against it.

I don't want this to become a jurisdictional issue, for example. let's say right at the border between Hayward and the unincorporated area of Cherryland, this is a statewide ban on this issue. It's illegal. So if code enforcement happens to see it across the street, which in another jurisdiction, they don't have the authority to cite that person or they just report it to the city and then have them cite it.

local jurisdiction would not have independent ability to do that. In terms of enforcement fines or even prosecution would need to be coordinated with the state's CDPH in particular about that.

So in that situation, if it was in the unincorporated, they have the tiered fines similar to the ones we have for not just oxide, but if it was, let's say in the city of Hayward, which borders the unincorporated, those fines would not be imposed upon that jurisdiction, right?

It would not. The scope of the ordinance is with respect to the unincorporated county.

Okay. Thank you.

I think like with the other ordinance, hopefully we'll be able to get other jurisdictions in the county to adopt similar ordinances. Our public health staff can share Hopefully this, both what we're doing with Creighton and what we're doing with the oxide, nitrogen oxide, inform other jurisdictions about this and hopefully they'll adopt it as well. We can talk to the mayor's conference, city manager's conference, about these two ordinances and maybe they would pursue it, because I do think it's important that it be pursued and done as comprehensively throughout the county as possible. I understand why, through our public health officer, we just can't impose this like we did with some of our regulations regarding COVID. I do understand the breadth of how that was possible, but this isn't. But I do hope we can inform other jurisdictions in the county so that they can mirror what we've done here. Because this is just, once again, repugnant that we've got retailers out there, gas station heroin, that's just sickening. That's just sickening. And the way in the slide you show the products, they're so colorful and attractive. And it was good. The response to Supervisor Tam that where we've seen the problem is in smoke shops and gas stations. We haven't seen it in other places. Okay. If we see it in other places, then our ordinance would cover it as well. And I also think if food is if If this product is adulterating food, at some point, environmental health should have a role to play when it comes to food in grocery stores or wherever food products are sold. I would think, do we know if that would be the case? Because we're putting all this on code enforcement, and I'm going to ask my staff, if they're listening, to have us talk to... the Community Development Agency about the resources they need for code enforcement. Because once again, we're putting more burden on code enforcement, which I don't mind, but we're already putting a lot of code enforcement. And code enforcement might need more resources to do everything we're asking of code enforcement in the unincorporated area of what Supervisor Tam and I pretty much have responsibility for in the urban unincorporated area. We want to make sure we're just not passing a law that's not going to be able to be enforced because of lack of sufficient resources for personnel. But I know I've said a lot. So back to environmental health.

Yeah, I think with environmental health and the food regulations, there's a few different ways that that comes into play. So in a lot of corner stores, et cetera, there's cottage food regulations, which is pre-packaged food that's sold that actually falls under CDPH guidelines. And so there's some enforcement activity that they can do, but that's limited. In terms of restaurant and food preparation, where people are actually preparing and making the food, as you know, environmental health has extensive responsibility and does quite a bit of enforcement there and permitting. But we would have to look further into this. And, you know, just on the idea of resources and environmental health has that responsibility countywide. And we only have so many people in this particular area. We don't think that there's a role for them. And so that's why we wouldn't have brought them in.

And, you know, we have mentioned that we want to see environmental health get more resources so they can hire more staff to do the work they need to do. But that's another issue. that hopefully the agency's looking into, because I know environmental health is all fee-based, but if they don't have enough fee to have the personnel that they need to do their job. Because if this type of product is adulterated and becomes more of a countywide issue, I would suspect, particularly around food, I don't know if I'm going to then be engaged in it, but I guess we'll wait and see.

I think that would depend on, again, how CDPH pulls it out and sort of where they're monitoring and tracking it. I don't know if Rachel or Paul are aware of instances where it's used in food. I'm not aware of it.

I think it's mostly sort of, you know, prepared substances that are sold, you know, sort of in shops of some sort, right? So mostly what we're seeing is the gas stations and smoke shops.

Okay. Okay. Okay, I do think your response is really important. We really need to get the word out to other local jurisdictions in the county, see if other cities would adopt similar ordinances around Creighton, because yeah, this is Creighton and 708. Yeah. Yeah. Gas station heroin. I mean, that's, that's just my gosh. That's just horrible. The other thing that I was concerned about is I'm a retailer. I want to do the right thing. How do I would I know I have these products like the noxious oxide and noxious oxide and the Creighton? I mean, these are separate products, but I'm consciously aware I have these products, right? Or do I need to have training and more education to know if I'm getting bad products to sell in the community?

I think that would be pretty clear that you were selling it. But our program in the past has worked with local jurisdictions when they have modify their tobacco retail license. And if the, you know, certain products are no longer legal to sell, we try to make sure that there's clear education that goes out to all the retailers. And so, you know, we would certainly work with CDA to make sure that that went out to all of the retailers in the unincorporated areas.

Okay. Yeah, because it's just, I would think it's, yeah, I just don't want retailers to say, we're not aware of the products that we're selling. I just want to make sure that they take on responsibility and we're providing the necessary education and training or whatever it might be. awareness so they know this product is not something appropriate these products are not something appropriate so don't even go there yeah okay um so um oh let's see we have any public comments on this yeah jeffrey laredo and then brandy clark and charles boden

Good morning, members of the committee. My name is Jeffrey Laredo. I'm a retired federal science policy official, having spent 30 years working on addiction and mental health policy. And most of those years were with the US National Institutes of Health. I've lived in Santa Cruz for the past few years, and I've continued that work as a policy consultant. And full disclosure to you today, I am a consultant to the American Kratom Association, which advocates nationwide on behalf of Kratom consumers. Alameda County has a really well-deserved reputation for relying on science and evidence to inform and help craft public policy on a variety of health issues, and I'm urging you today do the same in this instance and reject or amend this proposed ordinance. I've submitted a much longer and detailed statement for the record. I hope you have an opportunity to read that. But today, time is short, so here's my bottom line. Pure natural kratom leaf products and concentrated, synthetically produced and manipulated 7-OH and all of its synthetic derivatives are not the same thing. They're not the same thing. I understand what CDPH has said. They are not the same thing. Even a rudimentary examination of the science related to these products obviously and emphatically reveals this truth. And if you choose to move forward with the ordinance, we hope that you'll remove pure naturally Kratom products from it. The background information you have received from staff, I'm sorry to say is in part inaccurate, incomplete and misleading. And it doesn't give me any joy to say that in public. The backgrounder in the slide set consistently conflates pure natural leaf products with the variety of 7OH products and their synthetic derivatives. It ignores recent federal action that will early next month place 7OH products and their derivatives temporarily into schedule one of the Federal Controlled Substances Act, which will effectively ban those sales across the nation. The information ignores federal statements specifically omitting pure natural kratom leaf products from concern, It ignores, and it also ignores significant FDA and NIH sponsored research pointing to the general safety of pure natural leaf kratom products. Also, I would love to get the citation for the state law that is claimed here today that bans these products. There is no state law. There is CDPH recommendation. It's old. It's based on obsolete information. If I'm mistaken, I would be glad to be corrected in public. please act on scientific evidence. Focus your efforts on preventing the real harm that is caused by the 708 products and all the synthetic derivatives. Thanks so much for the opportunity to speak with you today.

Brandy.

Hello, thank you. I wanted to address the fact that everything that he said, I'm fully backing. There is a distinct difference between natural leaf kratom and 7-OH. And the throwing around the gas station heroin is actually not correct. That is for a substance that's called tantropine. which has not been around for a while. I am in this category. I am in these shops. I've been doing this for four years and I have seen the growth of 70H products and the kratom exponentially. I am behind a natural leaf kratom. This is something that helps me personally with social anxiety. It helps me with nerve pain. It keeps me away from pharmaceuticals and helps me maintain, not cure, but maintain and be able to like conduct my normal daily life. So with natural leaf kratom, I believe that the FDA is already signaled or not the FDA, the DEA is already signaled that they are going to look into this. And And the synthetics are when you take the natural leaf, which is from the coffee plant family, and use the leaf, and you oxidize it. And some companies are using this to oxidize it with everything to like pool chemicals. So without a doubt, the 7-H synthetic is a dangerous drug. I've seen it. I watch it. I've seen it in the stores. It's colorful. It's named as something that's already named after a drug with PERC. And then there are products out there that are just for healthy people making healthy choices. And just to make an example, there is a bottle that you're using. It's a feel-free bottle. That one bottle, if you take one of those pills that's in there, just one pill, that would take 250 bottles of feel-free. Two categories, that one pill that's on there. So we're talking about something from here to over here. extremely different. And in the smoke shops, my job is training. I teach people every day on kratom. I teach them on what it is, what happens, how it works and how it's not okay. And I teach, I talk to them every single day. And so with that, I'm hoping that you guys would make the difference between natural leaf kratom and synthetics because the natural leaf is not the problem here. It's your synthetics.

Thank you, Charles. And then Canberra.

Hey, I'm sorry, I'm not much of a public speaker. I just wanted to say that I have been taking Kratom for the last 10 years to help me manage my chronic pain. I've never taken the 70H1s, just kratom leaf. It would be extremely difficult to overdose on that, not to be graphic, I guess, just like mechanically to consume enough to overdose would be prohibitively difficult. I take Kratom basically to be able to go through my life. When I wake up in severe pain in the morning, Kratom is what helps me get out of bed and go take care of my kid and go about my day. The vendor that I purchased from does do third-party testing where they can give you a breakdown of the active compounds in the substance, any potential, you know, there's salmonella in it or something like that. I'm not buying from like a gas station that has the packaging that I saw on the PowerPoint. I would be strongly in support of age limits on buying kratom, of requiring third party testing and accurate labeling, of banning the enhanced products that have, you know, wildly varying amounts of the active ingredient in them. I just think there is a smarter and more more fine point way of going about this because I'm not the only person I know with with chronic pain and disabilities who relies upon Kratom long term as part of their basically medication regime. If this legislation passes, I will no longer be able to get it from the responsible vendor that I purchased from, and my life is going to get bad really fast. I know that it's a public health concern and I do care about the safety of children. I just wanted to let you know that it is more nuanced maybe than how it's been talked about here. Thank you for your time.

Canberra?

Good morning, my name is Canberra Garrison. I'm a proud Castro Valley resident, a mother of three, a wife, and an OB nurse. Every day I care for pregnant women and I help bring life into this world. My goal sharing my story today is to stress the importance of understanding and recognizing that natural plain leaf kratom and synthetic concentrated 7-OH products are not the same. I respectfully ask you to please oppose a ban on natural plain leaf kratom. I live with an autoimmune disorder that causes severe, debilitating chronic pain. For 12 years, I was a pain management patient and relied on prescription opioids. Over time, like most chronic pain patients, I developed tolerance and dependence. I felt defeated knowing that I depended and needed opioids to function every day. Four years ago, I made the decision to take my life back. After extensive research, I found plain leaf kratom. It helped me through the brutal opioid withdrawals that I faced and has allowed me to manage my chronic pain without returning to prescription opioids. Today, I have been opioid free for four years because of natural plain leaf kratom. I understand that many people who have never experienced these products may assume that natural plain leaf kratom and synthetic concentrated 7-OH products are the same. They are not. In my personal experience, plain leaf kratom does not make me feel high, intoxicated, or impaired. It does not alter who I am. It simply relieves enough of my discomfort that I can live my life to the fullest. If I felt impaired in any way, it would affect my ability to be present for my family, provide care for my patients. I wouldn't get behind the wheel of a car. I wouldn't take it. And I wholeheartedly would not advocate for it. I have never taken 70H products because my goal has never been anything other than pain management while remaining fully functional. Please don't make a decision based on assumptions or misinformation. Make it based on the voices of people who have firsthand experience. Thank you for your time.

Melody, we're on item three. You have two minutes. Thank you so much for your time.

My name is Melody Wolf, and I'm a 12-year daily consumer of Kratom. The FDA HHS asked me to speak at the July 29th, 2025 press conference on Kratom and 70H with the FDA commissioner and HHS Secretary Kennedy. I had to get my comments approved with both agencies so they knew exactly what I was going to say. In fact, they asked me to talk about the benefits and then to help distinguish it from 7-OH, which I 100% would like to see off of the shelves. And I'm so glad that I was able to be a part of helping make that decision to get it off of the shelves. So I've been a pain patient for over 20 years. In about 10 of them, I was bedridden and my kids were in elementary school. Things were pretty dismal in our house. Kids had to have fans out in their room at night so they didn't hear me crying in pain. They had too many responsibilities too soon for kids so young. They never got to be just kids and I didn't get to be just their mom. CPain took me away from my family, away from my community, but Creighton gave me back. In 2022, my daughter was going off maternity leave, and two weeks before, her childcare closed down. And we were still in COVID, so that was a big problem for them. They asked me to move in with them for the year and provide childcare, which I just was 100% all on board with doing, and it's something I enjoyed. The very same zoo where my kids used to push me in a wheelchair, I now chase my granddaughter. A couple of things that I wanted to point out is that the federal government has no appetite for a ban of creatinine of any kind, not even the National Institute of Drug Abuse, Dr. Nora Volkow. She thinks that's part of the solution, not the problem. Regarding the FDA, They do not regulate any supplements for medicinal purposes. They just guarantee what's on the label is what's in the package. And in Orange County, they did not ban kratom either. So I just kind of want to point those two things on my way out of the screen. Thanks so much for your time.

Connie, you're on the line. We're on item three.

Hello. My name is Connie Sanford. I am against banning natural kratom. By necessity from extreme pain, I have taken unadulterated natural leaf kratom under doctor's supervision for 12 years. Other medications and therapies have not helped me, only natural kratom. I was bedridden and now I have several hours a day of productive time. Did you know that the FDA is banning synthetic-made 7-0-H next month? 7-0 is marketed as kratom. You guys even did it in your presentation. You kept calling natural kratom, I mean 7-0 kratom. I've even heard them do it on the news. So the FDA said specifically that they're not going to ban natural leaf kratom. Just this year, the NIH did a... did a study for the FDA and the results, quote, no serious adverse events or deaths were reported. And conclusion, quote, kratom powder was safe and well tolerated at the dose ranges tested with no evidence of meaningful abuse potential or withdrawal, unquote. Please keep kratom legal and accessible. Thank you so much for letting me speak.

Stephen, we're on item three. You have two minutes.

Hello, my name is Stephen McIntosh. I'm a chronic pain patient whose story is a lot like many of the people you've already spoken to. I would echo what Melody said. The Orange County Ordinance does not ban Kratom. It only limits it to adults 21 and older, prohibits products attractive to children, and sets reasonable limits on potency. I'm a support member of the California Narcotics Officers Association who supports the access to adults for botanical Kratom, not 70H. The DEA has signaled that early next month it will federally schedule 70H under Schedule 1. It will have the full power of the Controlled Substances Act behind getting it off your shelves, and I will personally call the FDA for any store I see selling it, so you have no concern there. I would strongly encourage you to also look at the legal nexus between what CDPH is saying and the FDA, including the study by FDA that was just spoken about by the last speaker. CDPH has no particular law against Kratom. It's only saying that based on the FDA's prior statements made years ago, based on an out-of-date web page, that it therefore does not comply with California law. This ignores recent study. It ignores the recent statements made by FDA in July of 2025. It ignores the pending federal scheduling of 70H that explicitly exempts botanical kratom from its definition on purpose because botanical kratom is safe for adults to use reasonably. I went from barely able to get out of bed this morning to be taking my kratom, able to mop my floor and speak intelligently to you right now on matters of law and chemistry. So I strongly encourage you to amend this bill to exempt botanical kratom.

Ethan, you have two minutes.

Thank you. Don't think I can say anything better than what has already been said, but I do wanna point out that the health department used this term of gas station heroin early in their presentation to elicit the exact response that it got from you, Supervisor Miley. It is a shocking idea that gas stations would be selling heroin-like products. And again, the shock and kind of horror that that term elicits is exactly why they use it. But the facts of these products differ from that suggestion. Again, I do support the banning of 7-OH, but the DEA is actively working on that. For the county to do that is, at this point, unnecessary. And again, in the DEA's press release related to this scheduling of 7-0-H, they take the time, which they would not have had to have done, but they did take the time to say that this scheduling action does not – and I'm reading from their website – does not apply to botanical Kratom products that contain naturally occurring 7-OH below the specified threshold. Instead it targets synthesized products and those containing elevated concentrations of 7-OH. I think that is a very important point. The DEA is distinguishing between these products. And if the county deems that it's necessary to pass some ordinance around this, it would not make sense for the county to move in opposition to the DEA's own actions related to these products. I could say more. I'm a retailer of Crotam, not as a gas station or smoke shop owner, but this is something that I've been working with for 15 years and I've seen thousands of people's benefit thousands of individuals benefit from these products over these 15 years. I personally have benefited in numerous ways as well. So I'll cede my time.

Liz? Hello, supervisors. I'm Liz Williams, again speaking as a vice chair of the Alameda County Tobacco Control Coalition. The coalition supports the proposal to end the sale of Kratom and 70H products. These synthetic 70H products are an unregulated, addictive, and pose a particularly dangerous risk when combined with alcohol and medications or other drugs. And as you heard earlier, there are a growing number of overdoses and deaths reported in We all know the dangers that opioid misuse poses in our communities, and we do not need an easy access source of increased opioid risk. Despite these risks, Kratom and 70H products are easy to find at tobacco and vape shops, gas stations, and other retailers in our communities. Our coalition is concerned that these products are readily available and advertised as an innocent pick-me-up. You can buy flavored gummies, energy shots, mint-flavored tablets, and canned drinks like seltzers. Yet there's a risk to public health if people mistakenly think these products are completely safe to use. Our coalition encourages the county to consider the proposed ordinance to ensure that we are protecting our residents from the harmful impacts of these addictive and unregulated products. Thank you for your consideration.

Brittany, you have two minutes. Hi, can you hear me? Yes. Okay.

So, um, I am for banning seven Oh H and keeping Kratom naturally Kratom legal. Um, I wanted to explain that seven Oh H is very addictive and it will ruined people's lives, and it has ruined people's lives. Kratom saves people's lives. I battled a 12-year addiction with prescription opiates, and then I went to three years medication-assisted treatment with methadone. I ended up in jail and did 26 days detox, and on my way home, I stopped and got Kratom with no opiates. Um, so I just beg you to think maybe ready to change their lives. And if you take this vital resource from them, you know, it might not happen when they're ready. Also with the banning of seven Oh H happening, a lot of people are going to be sick. A lot of people in your community are already addicted. Kratom can help those people without turning them back to pharmaceuticals or street drugs. So I would really encourage regulation and to do some extra research here. Everything that these speakers have said is correct. You know, Kratom has not been banned or through the state. Board of Health goes against those. So, yeah. Thanks for having me on today.

Caller, you're on the line. You have two minutes. iPhone user.

Hello, can you hear me?

Yes.

All right.

Sorry, I have to step outside real quick because my son is watching this, Rachel. Thank you for giving us this opportunity to speak. I think everybody has mostly kind of said What you've been hearing over and over again is that 7-0-H is not the same thing as natural kratom. There is not a state law that any legislator passed in California that says kratom is illegal. In fact, there was a regulation law, AB 1088, to regulate kratom, keeping it legal, and banning 7-0-H. It passed the General Assembly unanimously. Unanimously. So... The DEA and the General Assembly of the State of California are all on the same page. 708 needs to be banned. And natural kratom has a lot of benefits. I've taken natural kratom for 15 years. It's been very beneficial to me. It's bizarre to hear anybody calling it gas station heroin because I don't even drink alcohol anymore because I don't like feeling intoxicated anymore. That's why, you know, Kratom works for me as I can continue about my day. But anyway, I wanted to make that clear that, you know, they're saying it's banned statewide. It's never been passed in the General Assembly. The only reason it died in the Senate is because the 7-0-H lobby is very powerful and they were fighting against it and then they muddied the waters and... And it just kind of stalled out, right? But... I'm sorry, I'm not that good of a public speaker, so I kind of lost track of where I was going to go next. But I think everybody else has pretty much hit the nail on the head here. It really is very beneficial to a lot of people, just the natural leaf. It's been used for centuries in Southeast Asia without a single documented death, by the way. In Southeast Asia, it's been used for up to a millennium, actually. I've been using it for 15 years. It's helped me be a productive person. And as somebody else said, 70H is getting banned nationally. And there's a lot of people addicted to that. And they're going to be going into withdrawal. And they can either go to street drugs, maybe Kratom is a way to step up.

Kevin?

Hello?

Yes.

All right. Yeah. I just wanted to add my own thoughts. I didn't know I was going to be speaking today. Kratom has very much helped me with my joint pains and stuff. And it's also helped me when I had gastritis and I went to the emergency room and they had no solutions for me and stuff like that. And, you know, it's such a better alternative than so many other things. And when you think about a crushed leaf, all it is is an herb. But the thing is, I remember, you know, when I walked into a gas station, I saw that bottle of feel good or whatever. And it's like, oh, this is this. Now this is going to be vilified. This is going to return into a party thing and people are going to abuse it like crazy. And it's just not the case with just natural leaf kratom. And I don't I don't like the idea of it. you know that it's its wagon is getting hitched to this super steroid version of this stuff that is yeah very highly addictive and stuff like that where this stuff takes gets people off of being addicted and I don't like to see the idea that how can you vote against something that's being called gas station heroin? Nobody would be able to do that. But this stuff is just a natural powder, and it helps people. It doesn't hurt them. And the alcohol in the back of the gas station kills more people than the six people that just died in a year of this time of being selling this stuff. So yeah, it's a major difference between the two. One is for good and the other is going to ruin the reputation for natural leaf kratom. That is just an herb that's been legal and around for 25 years and it had no problems until these guys synthesized it.

Mac, you're on the line. You have two minutes.

Thank you very much. My name is Matt Caddo, Senior Fellow on Public Policy with the American Kratom Association, and thank you for this opportunity. I speak for the 24 million consumers in America who safely and responsibly use Kratom, including the hundreds of thousands of California residents who do the same. What you have heard today is accurate, that the DEA and the FDA in conjunction with what is known as an eight-factor analysis, have concluded that 7-hydroxymetrogenine is and should be classified as a Schedule I substance. But they specifically say that that does not include natural kratom leaf products. And I think that should be the guiding principle that you, on your board... should consider because access to these products for all of these consumers who commit to responsibly use it for manufacturers who produce products that are within the guidelines that allow for natural products to be consumed by Kratom consumers to do so in the way that it was intended. I think that we would offer, and we have done so in hundreds of communities, to brief your staff on the latest science that relates to kratom. You've heard about the FDA dose finding study that found that kratom is safe at all dose levels and is well tolerated. And now you have the National Institutes of Health who have announced a study as of June 1st that will proceed showing that purified metrogenine, the main kratom alkaloid, will be used to help people and they will study whether it can be used as an alternative for a opioid use disorder treatment. That has been proven in those people that are struggling with addictions today. We urge you to separate the difference between 7-OH and natural leaf kratom products and provide responsible consumers the opportunity to continue to use it. Thank you so much for your time.

Cyrus, you're on the line, you have two minutes. Hello, Cyrus? Hello, yes.

Can you hear me, hello?

Yes.

Good morning, members.

My name is Cyrus Nakar, and I was born and raised in Hayward. I'm a student at De Anza College, one of the top transfer colleges in California for students headed to four-year university. My friends and peers went from Berkeley down to Fremont, and they're the ones who carried me through the ups and downs of getting here, and the reason why I'm speaking today. I'm speaking in support of the proposed ordinances restricting retail sale of nitrous oxide, and specifically kratom, and 70H products in unincorporated Alameda County. I don't have personal experience with either substance, but I've watched high school and college classmates lose ground to nicotine and alcohol. These were capable people with real ambition, and I watched it shrink. Grade slipped, and the goals they used to talk about stopped coming up. The common thread was never curiosity. It was always proximity. Nicotine and alcohol are regulated. They carry age limits, potency standards, and licensed retailers. They still did that damage. Kratom has none of that. It is an opioid product with no potency standard, no testing requirement, and no consistent labeling, most importantly. Kratom may have real value for people managing chronic pain or getting off prescription opioids. That is real. And I'm not here to take that from anyone. But right now, in this county, a minor can walk into a smoke shop and buy an opioid off the shelf. I'm speaking as a youth for other youth. I'd also like to ask you to keep this ordinance whole. There will be pressure to exempt loose leaf kratom, even though independent lab testing has repeatedly found products sold as plain kratom containing concentrated 7-OH levels the plant cannot produce on its own. An exemption for leaf is only as good as the label, and the label is the part that is proven unreliable. On behalf of my peers, both those at risk and those suffering from substance use, I'm asking you to pass this ordinance without a leave exemption and to back it with real enforcement. Thank you again for your time.

Allison. Allison, we're on item three.

Hi, can you hear me?

Yes.

OK, awesome. Hi, my name is Allison Smith. I work with the Global Kratom Coalition to implement regulations on traditional Kratom products while banning synthetic derivatives and other addictive substances. Just a quick couple of notes. Gas station heroin is slang for TNF teen. It has nothing to do with gas with the traditional Kratom. There are 23 million Americans who consume traditional Kratom products, 3 million in California alone. When you say that you're trying to ban all these products for safety, I need you to keep in mind that individuals use these products for a variety of reasons, ranging from energy and focus to minor pain relief. And by blanket banning, you're punishing those who are lawful contributing citizens. They go to work, they go to school, they raise families and contribute to society. The FDA does not approve dietary supplements because they are dietary supplements. Instead, these products are regulated under the Federal Dietary Supplement Health and Education Act, otherwise known as DSHEA. The federal government has made clear the distinction between natural kratom, and on July 6th of this month, they announced their intention to add concentrated 7-OH to Schedule 1, along with other synthetic derivatives, where it will be for about two years while they research it. And in that announcement and the federal register, it made clear that this applies to concentrated 7-OH and their focus is not on traditional products. This provides federal resources for implementing enforcement and federal punishments, such as prison time and fines for individuals who are caught selling these products. But again, make no mistake, traditional kratom is not the same. The state does not have a law banning kratom that has been passed by the state legislature. CDPH made a determination that Kratom is adulterated, but that does not mean these products are banned. There is a question to the lawfulness of this determination. And finally, this recommendation was based on legacy information from the FDA, but the FDA has changed their position in regards to traditional Kratom based on public statements regarding access to regulated traditional Kratom products with the DEA movement. And then final point, I encourage you to follow the lead of Chino, Fountain Valley, Palm Desert, Los Alamitos, Marietta, Ontario, La Quinta, Moreno Valley, Fresno City and County, Riverside County, Buena Park, Orange County, and many others to implement regulation and distinguish between these two products. Thank you for your time.

So we have, I think, five more speakers. Are there any more speakers on this? please raise your hand at this point, because in the next minute or so, we'll cut off any more speakers. And we will, at the moment, Supervisor Tam's left the dais, so we'll take a five-minute recess as well. But we'll be back in five minutes. All right, so we're back from recess. Clerk, want to take the role?

Supervisor Kim, present. Supervisor Miley, present.

So how many were speakers?

Five. Ryan, you're on the line. You have two minutes.

Thank you. My name is Ryan Sherman. I am the Legislative Counsel and State Lobbyist for the California Narcotic Officers Association. We've been actively working on getting this NOH ban throughout the state over the last 10 years. We've also been pushing for local ordinances. At the same time, there was also a ban on various natural and outside products. Dave Kuntz, Common sense regulations for it naturally freedom association doesn't have a position on freedom, however, I will say we've been actively working to ban seven oh H means throughout the state. Dave Kuntz, As of today we've worked with that. three or four dozen cities and counties successfully got these ordinances enacted. We support 100% local effort to ban 7-0-H. As you've heard all the horror stories, we concur with those. We also believe that 7-0-H or the Kratom, naturally Kratom products do not pose the same concern for public safety uh, risks that seven Oh H does. And like I said, some common sense regulations, as far as age gating, you know, 21 and over no marketing, kids, candy flavors, things like that. Um, we've been very supportive of, uh, seven Oh H has clearly been the problem. Whenever you see, uh, you know, references to, yes, there's some heroin is one of the previous speakers alluded to. They are generally talking about, um, the seven Oh H synthetic concentrated products, uh, not the Natural Leaf Kratom. The media's, I think, done a poor job in distinguishing between the two. And so that's been where our focus has been at with 7-0-H and not with Natural Leaf Kratom. Happy to answer any questions. Thank you for your time.

Misty, you're on the line.

Well, now it's what, good afternoon? Good afternoon, ladies and gentlemen. My name is Misty Brown, and I'm a seven-year Kratom consumer advocate and activist. I want to clarify and say that Kratom is not an opioid. Kratom is not 70H, and Kratom is not gas station heroin. I'm going to read you my testimony. From 2008 to 2019, I lived in the grip of FDA-approved pain pills, benzos, and muscle relaxers prescribed for my degenerative disc disease. For 11 years, chronic pain management fueled my addictions. What started as a dependency slowly slid into a destructive cycle of misuse and despair. In April of 2019, I was dismissed from my pain management after failing a required pill count. I was 11 pills short and my usual drug dealers didn't have any of the pink oxytens I needed. Cut off from prescriptions, I turned to the streets in desperation and eventually slipped into cocaine use while searching for another doctor. Then in June of 2019, while suffering through cocaine withdrawal, I stumbled upon the documentary called A Leaf of Faith. That single moment changed the course of my life. The very next day, I began my journey with whole leaf kratom, not synthetic 70H, by walking into a smoke shop. I was carded, the kratom was sitting behind a glass counter, and it was locked up. Kratom quieted the relentless cravings, the constant voice whispering one more pill, one more snort, one more escape. For the first time in over a decade, I felt peace. Kratom gave me the space and clarity to confront the deeper reasons why my addiction started. I have not returned to pain management over seven years. I only consume one teaspoon once a day and I take one to four days off every week. I control Kratom. It does not control me. I'm currently not on Kratom right now. So if Kratom was addictive for me, there's no way I would be able to take daily breaks every single week. Addiction is what people are calling what a brain disease. So it's the person. It is not the substance that they are consuming. I also want to clarify and say that the six people that were addicted. The students saying that they died from 7-OH in their system, as much as I hate 7-OH, those deaths were poly drug use. Thank you for allowing me this opportunity to speak.

Mike. Hello, thank you for allowing me to speak. My name is Michael Pisano. I consume the holy kratom tea powder. It's been very helpful for my chronic insomnia as well as my joint pains. I'm happy, I'm healthy, I'm a productive hard worker. Going down the regulation side, as I said before, the DEA already is differentiating between the semisynthetics and leaf powder. They are banning the 708s, the MGM-15s, all that. They're taking the burden off the states in a locality. So they don't have to have that kind of confusion anymore. But they are not banning whole-leaf powder. Now, I would recommend doing a regulatory approach. First off, get it out of the gas stations. It should not be sold in a gas station, in my opinion. Put it in a 21 and older location. Have a registry system where The only products sold are ones from reputable vendors that can provide a third-party certificate of analysis to ensure purity and that there's no contaminants. You know, this gas station heroin stigma is just really, really brutal. There are people that, you know, have been helpful for their PTSD and for their chronic pain. And I believe this term it is because they can't get access to meds or maybe we're shut off. It should not be taken away from that. I think that there is a alternative approach for the leaf powder where we can regulate it instead of prohibition. And thank you for allowing me the time to speak.

Kevin, you have two minutes.

Hi. I've been taking Kratom now for almost 10 years, and I've never had a problem with it. I was able to get off of it without any withdrawals. I'm currently not on it, but I do take it still time to time. And I would say I've never tried 7-OH, but I do think it needs to be regulated. The whole leaf Is very safe. Thank you very much.

There are no more speakers for this item.

Okay. Thank all the speakers. Yeah, this has been very informative. There's been questions raised about this proposed ordinance. seems like this ordinance goes a little further than Orange County. There have been questions raised about the legal aspects of this action of the DEA and create them as both natural form, synthetic form, as well as the 70H. There have been people that have spoken to the fact that create them at least in its natural form really helps them cope with their pain as opposed to getting addicted to opioids. So I need to understand at this particular moment, if staff has the responses to this, if our, I know Dr. Moss is here, our health officer, So legal, et cetera. Because I think from what I'm hearing, I'm not sure where Supervisor Tam's coming from at the moment. It doesn't seem like we're ready to move this forward to the board. There are a lot of unanswered questions. And all we have here is an ordinance and a PowerPoint. I'd like answers to these questions.

We can have counsel talk a little bit about the legal issues, especially with regard to state regulation. And then I might ask Dr. Moss to talk a little bit about some of the overall health pieces.

Thank you, Supervisors. With respect to at least the references to the County of Orange, their kratom ordinance, it does apply equally to synthetic and natural leaf products, including dried or extracted parts of the kratom leaf. what Orange County does, it includes a threshold. So products that, whether it's naturally derived, extracted, or entirely synthetic, if it contains more than, I believe, 2% of the of the alkali substance, it is banned. So that's how the Orange County Ordinance works. So they have a level and whether it's natural or synthetic, if it's below that, So in the vernacular here, whether it's natural leaf or 7-OH, it will be allowed for sale. And if it's bugged out, it will be banned regardless of its natural extracted or purely synthetic. Which affected the references that there is not a specific state law banning kratom. The law that's in question of why CDPH is enforcing it and has a legal authority to stop the sale of cream for consumption under existing state law is because it's under the adulterated food product section of the health and safety code. That section does not necessarily need to have separate identification of kratom or any other adulterated food product. It just applies generally to any adulterated food product, which in this case includes kratom. And with respect to proposed federal ordinances, proposed federal regulations, regulation of regulating under as a schedule one drug. Again, I haven't seen what the proposal or what it applies, but to the extent that 70H in a synthetic form is regulated does not necessarily mean that the FDA would then consider kratom in its natural leaf form as a unadulterated food product. It's still considered an adulterated food product. And it would not be considered legal for sale for consumption. And I believe it will continue to be that way unless there is some other changes. So that's some of the general overview of the legal issues here.

Also, Dr. Moss, have you had a chance to look at this? Does Kraven help people address their pain? And if it does as a product, is there a way that they could continue to get this product? Or would they have to go back to opioids and other things, other drugs?

As far as I know, there's no... Kratom is not available to be used as a drug, as a pharmaceutical in that way, right? So it's only this, what we've heard about today, this sort of unclearly regulated space where this market and use has grown up. You know, we heard, well, a few things we heard from the callers today, heard a lot of consensus around the potential dangers of these synthetic products. So we'll put that aside. In terms of the natural leaf, People are sharing their experience on the phone. I have no doubt that that is their personal experience, but we don't have that. I've been able to see really wide, large scale clinical trials showing how this would be used. I mean, if it's a drug, it should be regulated as a drug to make sure that it's safe, that we know the dose, that people know what they're getting, that they know what kind of outcomes they might get from it. We're just not in that space. in my experience. I don't see that. I don't see the data. I don't see colleagues using it that way. So we're in another space where people are using a product that they've found that may or may not work for them. There's going to be probably a range of uses out there for it. But I think that's very different from saying, Oh, this is a, this is a tool we use in medicine to treat people's conditions. Just in my experience, not there with this product. And I don't think we have a, we can say that that's a, that that's just the default, right? That all users are, they're using it for a medicinal purpose that's important for them so they can live their lives. That may be true for some, not for others, but we don't know that much about the product and we don't know that much about who's going to be using it out in our communities. So I just, I think there's still a lot of uncertainty in that space that makes me want to be very cautious.

I don't think you introduced yourself.

Oh, I'm sorry. I'm Dr. Nicholas Mawson, the Alameda County Health Officer. And could I just add, I'm reminded also, with medicinal marijuana and medicinal cannabis, right? And the debates and the issues that people raised up there, but also was the space that we were in with very limited data in terms of the therapeutic applications.

Yeah, and I'm glad you brought that up because I was thinking about municipal marijuana, Prop 215. You know, it's one reason why I supported municipal marijuana because all the people who testified, how that helped them. And it's hard for me to want to impose a blanket ban on a product. And I think once again, people, I don't think everybody's lying in terms of how the product is used to help them. I wonder in our ordinance, what if we were to mirror Orange County's ordinance and have thresholds?

If the committee would like us to go back and reconsider options, we can do that. And I think in the cannabis debate, I think just one other thing that comes to mind for me, at least, is that sort of what Dr. Moss is saying is that in terms of the actual regulation of the product itself, medical cannabis was made available, but the strict regulations around pesticide use or other ways that the product was cultivated and developed, that didn't really happen until Prop 64 many years later, right? And so this might be another space where we're kind of working with limited things. And as Supervisor Tam mentioned earlier, that we're trying to catch up to the next new thing, but really wanting to come at it from a space of limiting access to youth more than anything. But if the committee would like us to go back and look at different options, we're happy to do that.

Yeah, let me see what Supervisor Tam would like to do because I kind of jumped out here. And maybe she and I might be on the same page. Maybe we won't be, but Supervisor Tam.

So I appreciate the speakers and definitely Dr. Moss, your expertise. But we're not the right jurisdiction to make the distinction between the synthetic 70H and the natural leaf Creighton. And what we're trying to do right now is develop an enforcement mechanism in Alameda County for what is in state law, albeit it's tied to the health and safety code because of findings that the state public health department has made in terms of what they see nationwide in terms of fatal overdoses associated with kratom synthetic or not and in los angeles county with the department of health so i'm just thinking in terms of a like our ordinance our code enforcements Our short staff, code enforcement staff, is already having enough trouble going to an establishment to figure out whether the item is Creighton, much less whether it's synthetic or natural leaf, much less whether it's under 2% or less, and looking at the ingredient list. So my sense is unless the state makes those changes and distinctions on the safety of the product, all we are doing is basically having a mechanism in Alameda County to basically move forward with the enforcement. So that's kind of where I'm coming from in terms of the practicality of enforcement.

I just wanted to make one other comment about this idea of the levels and, you know, Just for educational purposes, the 7-OH is a metabolite of one of the main chemicals in the natural kratom leaf. So when you take the natural kratom leaf preparation, your body is making 7-OH internally. And it's circulating. So I just wanted to make sure that people knew that we're talking about levels in the product. But things are also happening in the body when people ingest these things that contribute to the effects of what it is they're taking. And so we just... whatever levels we use, if we go down that pathway, we want to make sure we really have a good understanding that, and there is some research about levels and quantities, but when you're talking about a natural, unregulated natural product, you still have, it's not subject to the same kind of testing and scrutiny that a pharmaceutical agent is subject to when it gets to the store shelves. So we're operating in a space where there's going to be limited information for the consumers about the levels. And I just would want us to be on very firm ground if we were to give what seemed to be an endorsement of certain products below a certain level, things like that.

Thank you. Just two points to keep in mind. And so one is that an exception, there is an exemption written into the ordinance, if there are legal uses determined for the product. So that already exists in the ordinance as written. The other is that currently, per state law and how it's enforced, retailers within our Alameda County unincorporated areas, if they're selling these products, whether it's Kratom Leaf or 70H, those products will be embargoed, seized, and destroyed. And if... Alameda County were to pass an ordinance that created a distinction that still when CDPH did inspections in our unincorporated areas, those products would still be embargoed, seized, and destroyed. And so if we make a distinction that's different than what the state distinction is, I think that we put our retailers at risk. Is that consistent?

Again, the ordinance would not have an effect on or legal binding to CDPH. So even if the county sets a percentage threshold, CDPH is not obligated to abide or honor that.

so so very damn um what would you like to do because i'm still thinking so um i'd like to advance this to the full board and then if there's a more robust discussion that needs to happen the full board can have that discussion as well but i'm just trying to think in terms of practicality and the jurisdiction and what we're trying to achieve with this ordinance, which is similar to the nitrous oxide ordinance is similar to what we've done with labor tobacco is they're targeting young people who are most at risk. And there has been data that shows that Creighton had at least the overdose of Creighton has resulted in fatalities in the nation and definitely in the state and in Los Angeles County in particular, as recent as last year. So I would like to advance this to the full board for a discussion.

So if this goes to the full board, once again, it's not gonna get to the board until after the recess in September, and then is this gonna come to a board meeting? or the board planning meeting, which form will this come to, or do you know?

We would look for your direction on that. If you're wanting to have just a conversation in a work session space, we're happy to accommodate that.

Yeah, because I'm not going to, I think we can advance it, but I'm not sure. giving my approval to the ordinance just yet. I'm okay advancing it to the full board so the full board can have the benefit of this.

We can advance it to the board's planning committee since this deals only with the unincorporated area and look at it from the lens of enforcement and the practicalities of enforcement. Because, like I said, I... Yeah. I don't have that knowledge, expertise, or jurisdictional authority to make the distinction between the levels of kratom and whether they're natural or synthetic.

Yeah. Because I do think probably bringing it to a board, just so the public understands, the full board would meet at a board planning meeting. But if it's a board planning meeting, our agendas aren't normally... as a full as it would be for a full board meeting and the board planning meeting usually takes place on a thursday as opposed to a tuesday so i'd like to bring this without a recommendation to the board planning meeting, have CDA, if you can contact state officials so they maybe can provide some testimony. It'll give staff more time to interact with the public around this as well. And if there are any modifications, since it's not being advanced as something we're adopting or advancing to adopt, but advancing to the full board for consideration, it gives you a chance if you want to come back with any modifications or changes or whatever, you'll still be able to do that when it comes to the full board. If you want to come in with options, you can come in with options, but it does buy more time for consideration. consideration around this, because once again, it's just, I don't want to do any harm to folks who are using a product that's helping them out, but nor do I want to condone the use of a product, the synthetic product, if it once again is a public health issue. But then staff is also saying under the state, It doesn't matter. So I'd really like to state if to be available for our meeting, you know, not to be in person, but at least virtually to speak to this as well. So the board and the public, it's the full benefit of all of this before we take an action one way or the other.

Yeah.

So this has been very helpful because I'd never heard of Kratom before, nor 7-0-H. But this has been a very informative meeting this morning slash afternoon. Does that kind of make sense? Like I said, if you feel in the conversations you want to come back with options or questions, Or if you're going to stick to this ordinance, fine. But I want to leave it up to staff to also make some modifications if you think it's worth it. OK. All righty. So I think we've covered everything on our agenda for today. The board planning meeting would probably be, let's see. We do expect this in September. we can work with your your team to figure out which planning meeting it comes to yeah because i think the board planning meeting in september is the 17th i think um but if it um if it doesn't make that agenda then the october meeting okay all right you know and all of our meetings are um uh Brown Act in their notice in the setting up so the public knows about this. OK. All right. So let's see. Do we have any speakers on non-agendized items today? Public speakers on non-agendized items? I have no speakers for public comment. All right. OK. So today, I think, is our last health committee meeting before the recess. So very enlightening meeting. Everyone have a good summer and we'll see you in September.

Thank you.