[MaryAnn O'Connor]: Thank you. Motion passes. And that'll go into effect for this season's market. So thank you. All right. Next I want to dive into a little bit something new. Not that new. It's been on the rising for a while, and it's something that we've been talking about as a region with some of the other health directors, about the increasing amount of products we're seeing out there. Synthetic hemp products as they're being sold, but they're actually THC, synthetic THC products that we're seeing that come out of the Delta 8 and Delta 10 products. So right now, the Mass. Department of Agriculture regulates hemp, and it's deemed that selling and possessing Delta 8 THC products is illegal. It's not a naturally occurring hemp. It's synthetic. And the Farm Bill did remove hemp from the Controlled Substances Act, but it did not impact control or static, um, status of synthetically derived cannabinoids. So that's Delta H Delta eight THC remains a controlled substance. So we do not allow that in Massachusetts. Um, obviously, you know, the mass department of health is the agency that regulates food pursuant to one Oh five CMR 500. And the food requires that all edible products must be from approved food sources. Um, and comply with all regulation and it prohibits the addition of CBD, hemp-derived cannabinoids, in food. It is not an approved food source. Therefore, any edible product that contains hemp-derived delta-8 and or delta-10 cannot be manufactured or sold in Massachusetts. Same with all flavored vaping products, including hemp-derived THC vaping products with delta-8 and delta-10 are prohibited. So, I sent you, and the other product we're seeing kind of grow exponentially around here is called Kratom. Kratom's from a tropical tree native to Southeast Asia, but its leaves contain compounds that have psychotropic effects. It can be addictive. It can be the source of overdose. We see it. Again, coming in pill form, liquid form, as an additive. And again, it's not approved food source. It's not approved by the FDA. It's been banned in several countries due to its addiction potential. Withdrawal symptoms can include nausea, vomiting, insomnia, diarrhea, body aches. Most recently, we heard of an overdose, unfortunately, in the city of Lowell. where a young man, these are what we call freedom shots that we were seeing pop up. Just these little bottles, not to be sold to under 21, but you'd find them in your circle keys at your local little rich sales. And now this was, I picked up this morning down the street from a smoke shop. So apparently the young man and little added, this is a tiny bottle, I don't know if you can tell. But supposedly there are six, I'm telling you, there are six doses in here. You're not to drink more than one at a time. And I'm telling you there are six of them. The individual put this entire thing into an energy drink and then ended up taking his life. So these are, The regulation I sent you, which I will be forwarding to Kevin as a draft, was written up by the Massachusetts Health Board attorneys. And it does cover Delta-8, Delta-10, and Kratom as banned substances. Sophie Greenbaum and Catherine and their team are going to be doing what we call an environmental scan. I mean, I went out and I bought this Delta product right here. It's actually buds that you can smell.
[MCM00001745_SPEAKER_03]: Does the store know they're illegal in Massachusetts? And why are they there?
[MaryAnn O'Connor]: There's a very fine line the way they're selling them right now, and that's why we want to do this environmental scan to make sure we really know what products are legal, what products are illegal. Some of them, if they're CBD, they're supposed to be okay, but again, they can't claim to have any kind of health effects. They can't claim to make you better. They can't claim to make you, you know, feel less paid. So you see that a lot with CBD products being advertised illegally, wrong. This is a bag of Freedom powder. You're supposed to use a quarter of a teaspoon. I don't know that anyone would, but over a quarter of a teaspoon may have bad side effects. Again, we have some tough students as interns with us this semester. We want to do an environmental scan, really get out into our community, see what products are out there, and what products we need to be aware of, what products we need to educate people about, and what products we need to ban. So we'll be revisiting this. I just wanted you to kind of have a little bit of background And I think we'll be revisiting this regulation over the next couple of meetings, once we get more and more information. And again, make sure we have the appropriate education going on out there, as well as making sure that these products are available.
[SPEAKER_03]: Yeah, Kevin.
[Kevin Foley]: I was just wondering, who is enforcing this? Is it the Attorney General?
[MaryAnn O'Connor]: So right now, they're not. The FDA recently sent out warning letters to companies for illegally marketing products containing Kratom, because again, it's not a lawful dietary supplement or a food additive or an ingredient or any approved drug. So they did send out warning letters. But how to identify which products are illegal and which products are legal is very confusing. And every time we put out something, or the FDA puts out something, or MDAR puts out something, or GPH puts out something, they were able to tweak their formulation just a little bit to make sure it kind of falls outside of the regulations.
[Kevin Foley]: Well, I'm just sort of wondering, what would be your sense, would it be, or maybe the doctor would know on which entity, which agency, whether it's in terms of the state level. that would be involved with enforcement actions because, you know, my experience with this is that once enforcement actions begin, whether they're selective enforcement, and then they usually publicize, and then that gets the message out pretty quickly that this is not going to be acceptable. So I don't know whether or not you, Marianne, or the doctor would know, you know, for any illegal substance. drugs that are sold in this fashion, who would be the enforcement authority on it?
[MaryAnn O'Connor]: Yeah, well, it depends. Again, so MDOT would regulate the hemp, but they're not out there enforcing it as much as they could. They can't, I guess. FDA, again, they're issuing warning letters. I don't think they're out there doing the enforcement efforts. And DPH looks to us as both food enforcement agencies and the local community to really kind of police what's being added to our foods out there.
[MCM00001745_SPEAKER_03]: Now Miriam, the hemp is different though from the other synthetics lookalikes.
[SPEAKER_02]: Right.
[MCM00001745_SPEAKER_03]: Because hemp naturally occurring and Florida does that. They sell hemp to get around the marijuana loss. And there's some certain percentage THC in it. And it's legal for them to do it that way. But from the easy low hanging fruit, though, is the synthetics, because that's not covered by anything. Those are already illegal. And there's no reason why any of that should be being sold in Mefford right now. I'm surprised that that's even going on.
[MaryAnn O'Connor]: Yeah. Yeah, it's everywhere. It's not just in Bedford. We're finding them in all different communities.
[MCM00001745_SPEAKER_03]: Well, we're going to do, like you said, the environmental scan and craft up some letters to all those stores that are doing and tell them, you know, cease and desist.
[MaryAnn O'Connor]: Yeah. Yeah. As long as they contain less than 3% of the Delta 9 THC, the hemp is legal. Um, very interesting. The cannabis commission had a hearing a month or so ago and, uh, they, some of the, uh, the cannabis store owners had done their own environmental scan and went out and grab some products from different places. And then they actually sent them to laboratories for testing. And the testimony that they gave was incredible. The level of THC in the products they were collecting from these, you know, that was supposed to be hemp or non-THC, was higher than they were even allowed to offer. So that testimony was pretty intense. And I can certainly share that with you all. So again, yeah, we'll do that environmental scan. We'll really take a look at our community and the region. And then see what we can do, but I did want to put this regulation out in front of you as something that at least we have in our toolbox that we can move forward with when necessary.
[MCM00001745_SPEAKER_07]: Marianne, I know you mentioned the gentleman that passed away. Are we working with other cities on this? With who I'm sorry, we're working with other cities.
[MaryAnn O'Connor]: Yes. Yes. So we're looking at this as a region as a mystic Valley, public health agent. That's the joining communities, Malden, Wakefield. So, Melrose, Winchester. As a region where the survival scans will be done regionally as well. So. Got it. Okay, so. And I know Reading is already, and North Reading has been looking at this for some time as well. They've had their eye out there on this as well.
[SPEAKER_03]: So they were looking to be on Creighton going forward too. So we'll be working with them as well. Okay.
[MaryAnn O'Connor]: Next up, well, it's been an interesting road these last couple of months around vaccines. And we have Jill with us today. Jill could certainly join in and help me out here, but Massachusetts has decided to move forward on its own and actually recommend this season's flu and COVID vaccines, regardless of the federal recommendations. So, whatever the DPH Commissioner says is the recommendations is what Massachusetts is going to follow. Um, in that light, the governor also arranged that all Massachusetts based insurance companies will cover these recommendations. Um, no matter, regardless of the federal recommendations. Um, so what I sent you was Jill worked on, um, what will be our standing orders. We have flu clinics, uh, COVID clinics coming up shortly. So we need to have our standing orders in place. Jill, I don't know if you want to go over the recommendations that you made or the changes you made, but last year's standing orders that you updated, basically what we have.
[SPEAKER_07]: Yeah, so these are the standing orders that DPH issued for pharmacies or pharmacists to be able to use. And then they also issued a similar template that local boards of health can use and modify for their purposes. So, for the pharmacies, they are able to issue the vaccine to everyone unless it's contraindicated who's 5 and older. So, regardless of risk factors for our purposes, we. due to younger children as well, so I just modified it for six months and older, but similarly for everyone six months and older, regardless of risk factors, unless contraindicated.
[MCM00001745_SPEAKER_03]: Now these are recommendations, not mandates, right? Because there's a lot of people that disagree with immunization, especially COVID and young kids. Yeah, so this would just be for the... But there's no mandates with this anymore, right?
[SPEAKER_07]: No.
[MCM00001745_SPEAKER_03]: Good. Good.
[SPEAKER_07]: This would just be for our flu and COVID clinics.
[MCM00001745_SPEAKER_03]: Okay. Great.
[MaryAnn O'Connor]: So, uh, any problem then with the six months plus we'll go forward with the COVID vaccines and outstanding orders and being able to offer that to our community. Um, and, uh, yeah, we have, we already have the COVID vaccines in,
[SPEAKER_07]: Yep, we have them ready to go. We're just waiting for the orders so I can send those along to Dr. Plotowicz.
[MaryAnn O'Connor]: We'll just signature Dr. Plotowicz on those. And then we have first clinics coming up in October, Jill?
[SPEAKER_07]: Yep, so we're starting in the beginning of October and then starting next week we're going to be vaccinating our homebound residents. We have about 50 or so homebound residents that will go around and vaccinate as well as their caregivers, family members. And then we have multiple clinics across the city through October and November, library, city hall, senior center, housing authority, schools. So getting ready for all that. So we'll plan to offer both flu and COVID at those clinics.
[MaryAnn O'Connor]: Great. Thank you, Jill. and we'll send those over for your signature. And then I just included our monthly reportable disease updates. We didn't have a meeting in August, so I included both July and August. It was really kind of the enteric diseases that were interesting other than even the norovirus obviously, but other than norovirus, could see in July and August the spikes, and that's a good reminder for us to really emphasize food safety during the summer months. Again, it was up regionally, not just MedFed, but in the grant that we're with Arlington and Somerville, you could see that as a region, it's consistent. I don't know if you had any questions or comments on that report. And then I think we had mentioned to you in the past that we were involved in our young adult gambling assessment. We received funding to the Mass Gaming Commission to have casino mitigation funds to do this young adult gaming assessment, gambling assessment. And actually, Catherine was presented at a national conference, some of our preliminary results last month. So I wanted to kind of give you a little peek at that. Catherine, do I need to let you share your screen somehow?
[Catherine Dhingra]: Yeah, if you can enable for me to share.
[SPEAKER_03]: That would say.
[SPEAKER_02]: Hi, we should be able to now.
[MaryAnn O'Connor]: Okay, you're doing a larger presentation in October of the full results, but I think this you'll find this really interesting.
[Catherine Dhingra]: Yeah, I'll just do a sorry. All right, can everyone see that? Yes, okay, great. All right, so what is problem gambling? So like Marianne said, I a few weeks ago was down in DC and with our casino mitigation funds, we spent this last year doing a needs assessment around young adult gambling in Medford. So we were fortunate to present our consultants that we've been working with. wanted to spotlight a state so they spotlighted the state of Virginia and a local municipality on this data assessment stage of how to collect data around young adult or problem gambling because it's a growing concern and you'll see how it's impacting our community. So just a few overviews of gambling. The gambling is risking something of value on activity with an uncertain outcome in hopes of winning something of greater value. So common forms of gambling are the ones that we really can consider. Lotteries scratch off sports betting and lately the explosion of online betting and using even now the state lottery system has, you can purchase lottery tickets on your phone. So just a little bit about problem gambling disorder, often sometimes referred to as gambling addiction or gambling disorder, defined as when gambling behavior negatively impacted the individual or those around them. and experiencing four or more of the following. So the need to gamble with increasing amounts to achieve desired excitement, restlessness or irritability when trying to stop or cut down, repeated unsuccessful efforts to control and cut back on or stop gambling and frequent thoughts about gambling and often gambling when feeling distressed and often returning to the habit. So, when individuals have 4 or more of these. conditions, it's known as a problem gambling disorder. So a little bit on the data that we found here in Medford. So what we did was we worked with our consultants to develop a survey of 18 to 24 year olds. We actually hired with our Tufts and a young person living in the area, we hired PR data collection specialists because going out and getting this population isn't easy. They're not all in one place. So we had to really strategize on how to get these young people or young adults to fill out these rather lengthy surveys. And we were successful in getting 200 of them. We also conducted focus groups and did key informant interviews with both individuals. You know, they might have been athletes or tough students, and they were also youth coaches, educators, a lot of different folks. that we gathered this information from. And what we wanted to know was not just the gambling and gaming behaviors, but that correlation between that and mental health, financial wellness, substance use. So the survey tracked all of that. So of the over 200 young people that we surveyed, 90% had gamed in their life and 73%, so three and four young adults had gambled at some point in their lifetime. And then what we saw was over 1 in 4 young adults had placed a sports bet in person in the past months, which we were, we thought was a little high. We were thinking it might be online betting, but the in person sports betting. was the highest and then followed you can see there on the data bet on sports online and playing poker in person is still very popular and that's something that we got a sense of and then you can see about 17% of our young people had been to physically been to a casino in the past month so that's that's rather high. And then a lot of what we did was, in addition to the quantitative data, was that qualitative data and hearing the stories of young people and how they socialize at the casinos and how betting takes place and how the socialization, especially for young males, happens around poker playing. So it gave us a good sense of that. So one thing that we learned was we dove into the data and what it looks like if folks ever engaged in any type of gambling, we saw that those young adults were 75% of them had bet on sports online in the past month. So if they'd ever engaged, so that's telling us not only did you try it once, but there's a high probability that you're regularly participating in gambling behavior. So you can see, again, betting on sports online, betting on sports in person, poker playing were all common in the past 30 days. And then we saw a high correlation between substance use for those who gambled versus those who didn't gamble. You'll see in the blue. versus the purple are those who gamble. So it's significantly higher, particularly around tobacco is the highest where there's a much higher correlation between tobacco use and gambling versus non gamblers. And then we, what we really delved into is the social and economic consequences. and negative financial impacts being the most commonly reported among the young adult. So we saw that 43% of our past 30 day gamblers reported experiencing negative financial impacts. And that's a lot of young people when you think about that population. And most of those who gambled in the past 30 days spent between 50 and $100. And 16% of that population spent over $200. And it's not a, you know, usually at that age, you don't have a lot of disposable income. So spending 16%, spending over 200 really kind of tells us something. We also found out that young adults who gambled in the past 30 days were significantly more likely to report having too much debt compared to those who hadn't. Not a huge surprise. And then young adults who gambled in the past 30 days had different attitudes about borrowing money and about paying money back and their attitudes, whether they felt responsible for paying it back. So you can see those in the blue, 91% of non gamblers believed it was important to pay it back versus 65%. Young adults who gambled in the past 30 days were also less likely to keep a close eye on their personal financial affairs versus those who do not gamble. And then young adults who have gambled in the past 30 days were also less likely to say they've set long-term financial goals. So it's kind of telling us the story of what is going to happen for this population if this behavior continues. So what we wanted to do is just give you a snapshot of some of the data that we collected. On October 15th, we're going to be doing a full data report on everything from the literature review that we did with our consultants around national trends, local trends, and then giving us a sense of where we should start to develop and implement strategies to address these concerning behaviors. And whether it's partnering with the state on some of their strategies, looking at some of the local support systems we have around the area. So, for example, the bridge Recovery Center in Malden has reported that they've needed to expand their gambling anonymous support groups. And we're looking at expansion of gambling anonymous support groups around the state as the different avenues for betting. And I know personally having two teenage sons watching how they are targeted by online gaming. and sports betting is all over their social media feeds and it's really becoming a part of young adult culture. So, so much so that Medford High is very interested in this and they wanna bring this into their health curriculum. So, we're gonna have multi strategies to address this. So, that's just a snapshot. If anyone has any questions, go ahead.
[Kevin Foley]: Kevin? So Catherine, I may have missed it, but in terms of the young adults, was there an age range or a cutoff of that sample size? Yeah, so that was 18 to 24 year olds. Did it break out any further in terms of gender or any other demographics?
[Catherine Dhingra]: Yeah, so we'll be presenting that when we, but yes, yes, there are definitely, we got a really good cross-section, so a cross-section of college students, tough students, gender, so definitely you saw the higher percentage of males, and we can versus people who identified as females. And then we were able to break it down in the different racial ethnic groups as well. Was it all Tufts students? Was it all? No, no, it was not all Tufts students. And that was it was in the students weren't surveyed on Tufts campus, but they were surveyed around Medford. But they were able to identify whether they were a college student or non-college student. So we can break it down in that way. We had a pretty good call versus none. Yeah, but the college students, some of that qualitative data was really interesting as far as trends of them going to the casino and them and how kind of male athletes felt about it versus, so there's kind of a lot of nuanced information.
[MaryAnn O'Connor]: Yes, so that presentation will be happening on noon, I believe, right on October 15 at City Hall here in the chambers. I'll be sending an invite out to our board of health members with anyone else interested in joining is more than welcome. We'll have that information up on the website as well. Yeah, and as Catherine mentioned, we did get funding again this year from the Gaming Commission, from the Casino Mitigation Funds, to take this information and move forward and come up with some strategies and programming or services or education, whatever needs to be done within the schools or within the community. So we're grateful to the MassGaming Commission for refunding this year's efforts as well. Okay, see other business. The only other business I have is I made a mistake on the agenda. Our next meeting is not October 14th. It is in fact the third Tuesday. So thank you, Margaret, for reminding me. Our next meeting will be October 21st, not the 14th.
[SPEAKER_03]: So the day after Indigenous People's Day.
[MaryAnn O'Connor]: Any other business from anybody? Okay, motion to adjourn?
[MCM00001745_SPEAKER_03]: Motion to adjourn.
[SPEAKER_04]: Second? Second. Thank you. Will Dr. Palowicz?
[MCM00001745_SPEAKER_03]: Yes, please.
[SPEAKER_04]: Jenny Pytel? Yes. Okay, thank you very much. We'll see you in October.
[MCM00001745_SPEAKER_07]: Thank you. Bye-bye.