Safely viewing the solar eclipse; climate's health effects; is kratom risky?: Upstate Medical University's HealthLink on Air for Sunday, April 7, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an ophthalmologist tells how to protect your eyes from tomorrow's total solar eclipse.

Robert Fechtner, MD: ... You can't use sunglasses. In fact, any lens that you're able to see through in daylight is not dark enough. ...

Host Amber Smith: A researcher discusses the impact climate change is having on public health.

Augusta Williams, DSc: "...Heat is one of the most pressing challenges we're actually facing today from a health standpoint. It doesn't look as scary as something like a tornado or a hurricane or a fire, but it is in fact more dangerous. ...

Host Amber Smith: And a toxicologist gives some facts about the use of kratom.

Willie Eggleston, PharmD: ... Unlike vitamins and unlike melatonin, the FDA has not said that this is a dietary supplement, and it's not something the FDA has said is generally recognized as safe at this point. ...

Host Amber Smith: All that, and a visit from the Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll explore how climate change is affecting public health. Then we'll learn about an opioid-like herb called kratom. But first, are you prepared for tomorrow's total solar eclipse with proper eye protection?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." If the weather cooperates and the clouds stay away, Central, Northern and Western New Yorkers will be able to observe a total solar eclipse on Monday, April 8, tomorrow afternoon. For help understanding how to avoid severe eye injury, I'm talking with Dr. Robert Fechtner. He's professor and chair of ophthalmology and visual sciences at Upstate.

Welcome back to "HealthLink on Air," Dr. Fechtner

Robert Fechtner, MD: Thanks. It's great to be back here with you Amber.

Host Amber Smith: A lot of people who live here and a lot of people who travel to Central or Western or Northern New York plan to watch the total eclipse, so what's important to know about how to do this safely?

Robert Fechtner, MD: First of all, how lucky are we that the solar eclipse is coming to us, and we don't have to travel across the country to see this? I am so excited to see a total solar eclipse. It is truly a wonder of nature. In ancient times, it was a very frightening experience. And now the only thing that frightens me is the weather. So I'm hoping for a really clear, sunny day.

People will, and if they can, should take the opportunity to go out and witness this. It is spectacular, and it is very easy to do it safely. So I'm glad we're talking today about how to safely experience this wonder of nature.

Host Amber Smith: So is it safe to just look through binoculars or a telescope?

Robert Fechtner, MD: Amber, there's a great temptation to look up into the sky and look at the sun. And as all of us know, every once in a while you look up, you catch the sun, that's not dangerous. You know, an instant of sunlight in your eye is just part of every day.

The danger is that it's going to be so fascinating, we're going to want to watch the whole thing, and you cannot do that with the naked eye. Even worse would be to try to do it with binoculars or telescope. And let me tell you why that is. And I'll go back to when I was a little kid, and I had a magnifying glass. You can guess that I'm a professor, and I was always a science nerd, but on a bright, sunny day, we could take our magnifying glass and a piece of paper and burn a hole through the piece of paper with the magnifying glass. The magnifying glass is a lens.

Your eye works very similarly. There's a lens inside your eye, and its only purpose is to focus light on the retina. So that same sunlight that could burn a piece of paper when I was a kid can burn the retina if you are looking at it.

If you use a telescope or binoculars, you amplify that concentration of sunlight. So absolutely, you have to avoid those unless it is a specially made optical device for viewing a solar eclipse.

Host Amber Smith: So I'm guessing the camera in my cellphone also has a lens, so that's probably a no-no as well?

Robert Fechtner, MD: Your cellphone will be very unhappy if you try to take pictures. And that is not a good idea, and trying to use the cellphone to look at it. Fortunately, your cellphone screen is not bright enough to injure your eye, but the sun is bright enough to injure your cellphone.

Host Amber Smith: So we really kind of are left with the naked eye, but we need protection. Do sunglasses offer that?

Robert Fechtner, MD: You can't use sunglasses. In fact, any lens that you're able to see through in daylight is not dark enough. I just went on Amazon last week and bought a hundred pairs of eclipse sunglasses. So plan early. You've got to get them. I don't think people will sell out, but you don't want to be looking for those a day or two in advance.

Regular sunglasses are filtering a little bit of daylight. You need a much, much darker, denser lens to be able to safely look at the sun.

Host Amber Smith: Can you put those eclipse glasses over the binoculars?

Robert Fechtner, MD: You know, it sounds like a clever idea to do that, but the binoculars concentrate the light further, and that's not considered a safe practice. And for somebody who is truly devoted to watching this eclipse, you can go online and you can buy binoculars that are so densely filtered that they are safe, but you have to make sure that they're coming from a reputable source. And if you look through something, and you can see the light in your ceiling, then it is not dense enough. They really have to filter out a lot of light for you to be able to point it at the sun.

Host Amber Smith: What if it's overcast on April 8? Can you safely look at the eclipse through the clouds?

Robert Fechtner, MD: The rays are still strong. They will be slightly filtered, but not enough that you should be looking directly at the sun. It's a dose response. So a somewhat filtered sun will take longer to burn the retina, but it will burn the retina. And you're going to watch the eclipse for 10 or 15 minutes.

Host Amber Smith: So these eclipse glasses, do they need to be worn during the partial eclipse, as the moon moves in front of the sun?

Robert Fechtner, MD: The recommendation is as long as it's a partial eclipse, you still have that very bright portion of the sun. And as an ophthalmologist, I've seen people who've had sun damage. There are people who have, for various reasons or mental illness, decided to stare at the sun, and they end up having a circular burn in their vision. If you test them, there's just a circle that's punched out they can't see.

If you were looking at a partial eclipse, you wouldn't have a circle. You would have a semicircle or a crescent burn.

No, it is not safe to look at the sun anytime other than the totality when the entire sun is blocked out. And that's brief, but I expect it to be really dramatic.

Host Amber Smith: Can you describe an alternative way to watch, without looking at the sun?

Robert Fechtner, MD: Sure. I'll start out by saying now that you can buy cardboard eclipse sunglasses for a dollar or two,I hope most people will go that direction.

There's an optical trick you can do, which is called a pinhole projector. And if you took something as simple as a 3-by-5 file card, and you poke a hole in it, and a ballpoint pen tip is a good size to do that. Then you can turn your back to the sun, hold up that pinhole and put a piece of paper behind it, and it will project the circle of the sun on it. As the eclipse is projecting, you will see that circle start to shrink as the moon comes into view.

I love optics. I'm an ophthalmologist, so I'll have some of my friends around me, and even though we'll have the sunglasses, we're going to do that just because it's a fun science experiment. And there are instructions online how to make a pinhole eclipse viewer.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking about how to safely view the total solar eclipse with Upstate's chair of ophthalmology, Dr. Robert Fechtner. The total solar eclipse crosses North America on Monday, April 8, tomorrow, from Mexico through the United States and into Canada. The partial eclipse starts at 2:09 p.m. in Syracuse, with the total eclipse lasting one minute, 24 seconds, starting at 3:24. The partial eclipse then ends at 4:35.

So you mentioned that you've seen patients that you've cared for that have looked directly at the sun and have suffered, is this lasting damage?

Robert Fechtner, MD: Sadly, Amber, when you burn the retina, and that's the inside part of the eye that senses light, there are no longer rods and cones there. And that part of the retina won't be able to see light anymore. It is truly a punched out small circle, but because people stare at the sun, it's a punched-out circle right in the center of their vision.

It can make it nearly impossible to read. And I would roughly equate it to having something like macular degeneration. It takes away your central vision. It is not worth taking the risk you have to get a proper pair of solar eclipse glasses. Or, if for some reason there are none available, do the pinhole projector we just talked about. The American Astronomical Association has some descriptions online. There are other reliable sites online, and don't take the risk of burning the retina. Do not look directly at the sun, no matter how attractive this event is going to be, unless you're wearing proper protection.

Host Amber Smith: If someone does look at the sun, does it hurt? Will they feel that they are hurting their eyes?

Robert Fechtner, MD: The body is interesting, the way it protects it. We have pain receptors all over our skin. There's no need for pain receptors inside the eye in the retina, and there are no pain receptors inside the eye and retina. So it would just be a right dazzling view, but it would have lifelong consequences.

So if you're looking at something, and it seems really bright, it's a good time to look away. I'll draw a little parallel. Many of us have had a photograph with a flash camera, and you notice right after the flash, you can't see where that flash was. Imagine that being a permanent blind spot. That's what happens if you look at the sun for too long.

Host Amber Smith: If someone realizes that they've done that, or maybe their child has done that, is there any emergency care that they can render, or do they need to do anything right then?

Robert Fechtner, MD: This is where prevention is the only answer. We do not yet have the ability to transplant or restore burned nerve cells. So for your children, supervise them. I have a hundred sunglasses here. If you're in the neighborhood, stop by. I'll give you a pair. And we are handing them out to all of our staff and patients who are in the office. We'll go out the back door, and we are going to take a break for the solar eclipse.

Host Amber Smith: Now, for the eclipse glasses, is there a way to tell whether you're getting good-quality eclipse glasses?

Robert Fechtner, MD: Well, there is a standard for them, and I won't give you the numbers because nobody's going to take a look and see that it's ISO (International Organization for Standardization) 1 2 3 1 2 - 2. I just gave you the numbers. But there is a standard for them. The ones online are probably reliable. And I expect we're going to see them in an awful lot of stores along the path of the total eclipse. But do look and make sure that they are certified as being solar eclipse safe. Or it will say "filters for direct observation of the sun."

And a quick test you can do is if you put them on, the only thing you should be able to see through them is the sun. You won't see other people, you won't see a flashlight. They are a very dark, dark glass to let just enough light through for you to be able to safely watch the eclipse.

Host Amber Smith: So they're not at all like regular sunglasses.

Robert Fechtner, MD: They are not like sunglasses. Save your sunglasses for going out on a bright, sunny day. You need these special glasses. And fortunately now they are so inexpensive, I think most people will find it quite affordable. Buy some. Buy some for friends. Hand them out to anybody standing next to you who doesn't have them. Be generous.

There are also binoculars that have these filters built in. So if you are truly devoted, you can find those. But don't try to put on the eclipse sunglasses and then look through binoculars. The binoculars concentrate too much sunlight and will make it too bright for the eclipse glasses to do their job.

Host Amber Smith: Well, this has been really important advice, and I thank you so much for making time to tell us about it, Dr. Fechtner.

Robert Fechtner, MD: Amber, I'm so glad to be here. I hope everybody has a bright sunny day on April 8th. Go see the eclipse, and be safe.

Host Amber Smith: My guest has been Dr. Robert Fechtner, professor and chair of ophthalmology at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

The impact of climate change on public health -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

To learn about how human health is threatened by climate change. I'm talking today with a researcher from Upstate's department of public health and preventive medicine. Augusta Williams is an assistant professor at Upstate. She earned her doctor of science degree from the Harvard School of Public Health, and her master's degree in environmental health sciences, climate and health comes from Columbia University.

Welcome to "HealthLink on Air," Dr. Williams.

Augusta Williams, DSc: Thank you so much for having me.

Host Amber Smith: I'd like to first ask you to explain what impact climate has on our health, and I know there's a lot of different areas you want to cover. Should we start with air pollution?

Augusta Williams, DSc: Sure. Yes, like you said, there are many different pathways through which climate change impacts our health, and we're seeing a lot of these unfolding today, whether that's in different parts of the United States or internationally. For air pollution, this kind of has multiple pathways that it impacts our health. Human-made climate change is driven largely by burning of fossil fuels, and that burning of fossil fuels releases greenhouse gases like carbon dioxide, which warm Earth and change our climate, but they also release air pollution, which is harmful to health.

So the longer we're contributing to climate change, the longer we are also dealing with that pollution that harms our health. But on the flip side, there's various climate events like heat and wildfires that also produce more or trap more air pollution in our environment, also harming health. So it's really this double-edged sword of air pollution that we're experiencing these health impacts from.

Host Amber Smith: Now, you mentioned wildfires, and it seems like there's a wildfire every week. California, Texas had huge wildfires. Are we seeing more of those, or does it just feel like it?

Augusta Williams, DSc: We are definitely, and unfortunately, seeing more wildfires in terms of the amount of land and area and people impacted by wildfires.

We're also seeing more days of wildfire smoke. For people who were on the East Coast in the summer of 2023, you may have seen and experienced wildfire smoke to a new level for the very first time. I know that was the first time I personally had experienced such poor air quality due to wildfires located many hundreds of miles away from where I was living.

So it's important to think about those impacts and how that air can travel to other places as well.

Host Amber Smith: So with that air quality being so questionable, people who have asthma or allergies --- that's a big deal for them, right?

Augusta Williams, DSc: It's a huge deal for them. People who have respiratory diseases like asthma or COPD chronic obstructive pulmonary disease (people who have cardiovascular disease or other heart issues, older adults, young children, pregnant individuals -- they're all extremely susceptible to these negative air-quality impacts.

But anybody could be vulnerable to some of the negative health impacts of these different exposures.

Host Amber Smith: I think a lot of people were coughing and irritated when that smoke came, when our skies turned orange. You know, it was weird.

Augusta Williams, DSc: Definitely. I know I could feel my eyes being irritated and burning respiratory impacts from coughing and wheezing.

I have asthma, so could feel those effects being much worse than on a normal day without that exposure. So it's very important that we're all paying attention to our health and the health of our neighbors, friends and family.

Host Amber Smith: I've spoken with your colleagues in global health about tropical diseases that we never saw in the U.S. before, unless someone went away and came back with one, but that we're seeing in the U.S. now, the Zika virus, dengue virus.

Is that all because of climate change?

Augusta Williams, DSc: Climate change is definitely one of the big drivers behind that. When we're seeing things like warmer temperatures, changes in precipitation, those impacts have downstream consequences on our ecosystems.

Whether that's the ecosystems that we as humans depend on, but also the ecosystems of other things like bugs, mosquitoes and ticks that transmit different diseases. We're making the environment potentially more favorable for their survival, for their reproduction for the transmissibility of the diseases they carry, but also the behaviors of humans, who then are outside more potentially interacting with these mosquitoes or ticks.

So that can lead and has been shown to be leading to more vector-borne (spread by insects, for example) diseases, whether that's tropical diseases, but also Lyme disease. That's one of the biggest climate health indicators, here in New York state and throughout the Northeast, is seeing just more and more transmission of Lyme disease from ticks.

So being cautious about those activities and checking yourself, getting seen by a health care provider at the first sign of different symptoms, is really important.

Host Amber Smith: How is food, our food sources and food security, how is that impacted?

Augusta Williams, DSc: Very similarly to the ecosystem shifts I was talking about previously. As we're changing temperatures, we're seeing more heat waves, we're seeing more droughts, or even on the flip side, too much precipitation with extreme flooding that can threaten our agricultural crops. It can threaten what food we have available globally, nationally, and also the amount of water that's available in certain places.

And when we threaten those things, that impacts the health of communities who depend on those resources. And if that continues for periods of time or multiple geographies, it (can really take a toll globally on our very much interconnected food and water systems.

Host Amber Smith: We've talked about physical health, but what about mental health?

Augusta Williams, DSc: If you're anything like me when hearing of all these impacts, you might be able to easily see how this could impact your stress, the mental load that people are carrying, having to deal with that. Some have called this "eco-anxiety," where the threat of all of these different changes and seeing them unfolding every day and them being such a big issue to solve can result in this widespread anxiety.

But there's also the risk of those who are directly impacted by any one event or responding to an event or whose livelihood may be upended by any one climate event. There's very real mental health challenges in those communities, in those populations, that are also critical to think about.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Augusta Williams. She's a researcher in Upstate's department of public health and preventive medicine.

So what do you think is the most pressing public health or personal health challenge tied to climate change?

Augusta Williams, DSc: I think heat is one of the most pressing challenges we're actually facing today from a health standpoint.

If I were to ask any of our listeners here to close their eyes and think of a hot day, most of them will picture something that is sunny, blue sky, maybe involves some type of recreation that looks and is fun and playful, but heat is actually the most harmful of all of these different events we've talked about today. It results in more deaths per year than most of these other events combined.

And this is why heat is often deemed a silent killer by people working in that space. It doesn't look as scary as something like a tornado or a hurricane or a fire, but it is in fact more dangerous than those items, and it has so many different pathways through which it can harm our body and our health. And I don't think it gets the full recognition of those many different impacts.

And so getting the message out, communicating about the dangers of heat, whether that means it's worsening your heart health issues, or respiratory issues like asthma. It has impacts on maternal and child health, is a huge hazard to indoor and outdoor workers in many different parts of the world and has been associated with just excess health impacts across a wide variety of body systems. And communicating about that, making sure those most vulnerable populations are protected, is really key because it can truly impact everyone and is largely preventable.

So I think that's one of the most pressing public health issues, from my standpoint.

Host Amber Smith: Is increasing heat more of an issue around the Equator, or is the whole globe feeling increased heat?

Augusta Williams, DSc: The answer to this question, I think, is both. We are seeing the most severe heat in places around the Equator, and unfortunately, there's projections coming out each year, showing that with more and more heat in those spaces, there may become regions that are uninhabitable in future years because it's too hot for human bodies to be able to effectively survive in those places.

But we also see extreme heat across the U.S., including here in New York state, in Syracuse. There's different things that make certain areas more or less vulnerable. Cities are prone to what's called the "urban heat island," where, because of their density and the materials they use and high-rise buildings, cities can be many degrees hotter than the surrounding suburban or rural areas.

They also might have less shading from trees. They may have communities where there may not be the financial resources or cultural acceptance of air conditioning to cool off buildings, but then in rural areas you might not have dedicated cooling relief resources, leaving communities more vulnerable in that sense.

So, there might be different sectors of our world and population, from locally to globally, that are more susceptible to heat, and Equator locations have definitely seen the most severe of those temperatures, but there's regions all over where heat can impact individuals and their health.

Host Amber Smith: So it sounds like there's vulnerable people, potentially, everywhere.

Augusta Williams, DSc: Potentially everywhere. Potentially everywhere, but there's so much we know and have learned that there's actions and steps we can take to make these communities help individuals be more resilient to heat. Because again, any heat illness or injury is largely preventable, and I think there's so much we can be doing to make that happen in communities across the globe.

Host Amber Smith: Well, let's talk about what can be done about climate change. I know nationally there's talk about phasing out some of the fossil fuels and transitioning to renewable energy, but are there things that states and cities can do now to protect humans from the effects of climate change?

Augusta Williams, DSc: Definitely, and that's the great news about this topic, that even though climate change is real and here and impacts our health, we have so many solutions that we can take to tackle this. And there's been so much movement in states and cities across the country and the world making these changes, whether that's communities who may be dealing with the urban heat island or older housing infrastructure.

How can those buildings be retrofitted with cooler materials?

How can we add more trees to a community that lacks them? And the good news about trees is they have so many other health benefits as well, in addition to reducing extreme heat,

How can we make our homes and offices more energy efficient, so we're using less electricity and fewer fossil fuels?

How can we drive less? How can we advocate for community design that allows more walking, more biking, more carpooling, so, again, we're burning fewer fossil fuels?

How can states and cities. better protect workers who are outdoors or indoors without climate control exposed to these different climate events, especially heat, and also taking steps to ensure our health care system is truly sustainable, that it's resilient to best help and protect people when they're impacted by climate change, but is also sustainable in the sense that it's not contributing to climate change through the burning of fossil fuels?

And given we're in a big election year from local to national, voting is such a key thing that protects people's health, especially in relation to climate change.

Host Amber Smith: Well, I want to ask you about what individuals can do, and you mentioned carpooling, walking -- does walking or biking instead of driving really make much of a difference?

Augusta Williams, DSc: I am in the camp that climate action really needs to be multi-pronged and needs to come from all levels. There's large-scale policy and action we need at the national and international level, from states and cities as well, but there's also so many things we can all do in our everyday actions to help with this. And biking and walking is one of those, making sure areas are safe to do that in, reducing consumption.

Things like fast fashion and really quick shipping, that generates a lot of fossil fuels, whether through the transportation or the eventual waste of those items.

Things like turning off the lights when you leave a room can reduce energy usage and fossil fuel burning as well.

So all of these things are really important from all levels.

Host Amber Smith: I've heard people say that eating less meat and dairy is good also for the environment. How does that work?

Augusta Williams, DSc: So I think for climate action, one thing that individuals can think about is more mindful consumption of foods that in some way produce a lot of greenhouse gases.

So that could be meat or other animal products, which through their production generates greenhouse gases. But you may also think of foods that require a lot of land or water and can only be grown in areas where land and water are not as readily available. Things like palm oils or sugar canes require a lot of deforestation and water intensity that further contributes to climate change as well.

Or even foods that may be grown very far away and require a long transportation. So all of these things, as long as we can be more mindful about them as a collective in our day-to-day actions, I think they can make a lot of difference.

Host Amber Smith: So what do you say to people who don't think this is worth bothering with?

Augusta Williams, DSc: Well, the good news is that most people do think that climate change is happening. Last year's survey out of the Yale Climate Connections Group found that more than three quarters of Americans agree that climate change is happening. Almost the same percentage are worried about it, the same percentage, or above, support various climate actions.

People know that this is going to impact people that they love and care about, either today or in future generations, but only a third of people report that they regularly talk about this issue. And talking about climate change, especially framing it around health impacts, can be a really critical driver to encourage people to take action, in any small or large way. It can help promote new social norms. It can help people feel more connected and involved. And if that doesn't work, by kind of making the case for more people are on board with this than people might originally think.

All of these different solutions also help to strengthen our economy. They make our communities more resilient. They better protect our health, of ourselves, our friends, our families, our patients. And they also create a more just, sustainable and equitable world. And to me, why wouldn't we want to do all of those things?

So I think it's a really critical but exciting time, where we're seeing a lot of action, and we can make a lot of headway.

And being at a medical school, students who are future public health and health care professionals are very much engaged in this and making sure that their communities are resilient to climate change and fighting for better public health protection and promotion of their communities.

And it's just a really fantastic thing to see.

Amber Smith: Well, Dr. Williams, thank you so much for making time for this interview.

Augusta Williams, DSc: Thank you so much for having me.

Host Amber Smith: My guest has been Dr. Augusta Williams from Upstate's department of public health and preventive medicine. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- is ingesting kratom safe?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

A growing fraction of the overdose deaths in America involve an herbal substance that people may use for pain and anxiety. It's called kratom. And to learn more about it, I'm talking with Dr. Willie Eggleston, a toxicologist from the Upstate New York Poison Center.

Welcome back to "HealthLink on Air," Dr. Eggleston.

Willie Eggleston, PharmD: Thanks for having me back.

Host Amber Smith: Compared with prescription medications and illegal street drugs that people may turn to to help with chronic pain, kratom is a lot easier to obtain. What can you tell us about it?

Willie Eggleston, PharmD: Kratom is an herbal supplement. It's a product that's derived from a plant. The plant is mostly grown in parts of Southeast Asia, like Vietnam, and generally the plant makes its way over into the U.S. That plant is dried and then turned into a powder. And folks who are using this are either using the powder to make a tea that they would then drink, or the powder is put into empty capsules, so it can be taken more like a pill that you would take for a disease. And you can buy it pretty much anywhere online and at stores that sell kratom supplies.

Host Amber Smith: Is there any age limit, or can anyone buy it?

Willie Eggleston, PharmD: Currently in the United States, federally, it's an unregulated product. So there's no rules or regulations around kratom, including that technically it's not a legal product to have in the U.S.

It's just that that's not typically something that's enforced. There are certain states and counties that have set age restrictions that have made it impossible to buy if you're under 18 or 21, but it varies from region to region.

Host Amber Smith: Now, some states have banned it, though, right?

Willie Eggleston, PharmD: Yes, there are states that have outright banned it.

We don't know how effective that is, when the state next door has not done so, or you can buy it online. But some states have banned the product entirely.

Host Amber Smith: How expensive is it?

Willie Eggleston, PharmD: It really depends on where you're purchasing it and what type you're purchasing, but, generally speaking, it's not something I would consider like a really expensive product. It's not something that you're paying hundreds and hundreds of dollars for. It's a reasonably priced product, where you may pay anywhere from $25 to $100 for your normal supply.

Host Amber Smith: Now, do you get calls about kratom at the Upstate New York Poison Center?

Willie Eggleston, PharmD: We do. It's not a big group of our calls, but, generally speaking, over the last few years, we get anywhere from 20 to 25 calls a year related to kratom use. And usually what it is, is either someone with questions wanting to know what the heck is this, and is it safe or something that I should be using, or what we've been seeing more of, is folks who are using the product, they don't realize that, like other opioid drugs, it has addictive properties, and they're in withdrawal when they've stopped using it.

Host Amber Smith: So it is here in Central New York in some capacity?

Willie Eggleston, PharmD: Oh, absolutely. You can go into a shop here in Central New York and buy kratom products fairly easily.

Host Amber Smith: So it's considered an herbal product. Does that fall under the FDA (Food and Drug Administration) or the USDA (U.S. Department of Agriculture) or the DEA (Drug Enforcement Administration) or ... who regulates this?

Willie Eggleston, PharmD: Yeah, herbal product is an unfortunate term that normally gets used for it because it's a term we use to describe that it comes from a plant, but it does not mean that it's regulated as a dietary supplement, the way our other dietary supplements that we buy over the counter are in the U.S.

So, for example, if you go to buy your multivitamins at the grocery store or local pharmacy, those are regulated as a dietary supplement. Kratom doesn't have any status in the U.S. under the FDA, and so it's not regulated as a dietary supplement. It just exists as an unregulated product, so essentially no one's setting the rules on it unless a certain state has put some rules in place.

Host Amber Smith: So would it be seen the same as a candy bar?

Willie Eggleston, PharmD: It's not considered a food, either. It's completely unregulated, which can be a confusing proposition for folks, that you want to put it in some sort of bucket, but right now it doesn't exist in a bucket.

But I think the concerns around that are the way that it's sold and the way that it's marketed. I think most folks sort of make the conclusion on their own that it is a dietary supplement, you know, it is like the melatonin or the vitamins that you go and buy at your pharmacy, because it comes from a plant, and it's generally viewed there as safe.

But I did want to be clear: Unlike vitamins and unlike melatonin, the FDA has not said that this is a dietary supplement, and it's not something the FDA has said is generally recognized as safe at this point.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Dr. Willie Eggleston. He's a toxicologist from the Upstate New York Poison Center, and he's also a clinical assistant professor of emergency medicine at Upstate.

So how does kratom work? What does it do in the body? You told me people will either make it into a tea, or it might be in a capsule. So once they ingest it or eat it, what does it do?

Willie Eggleston, PharmD: The plant itself has several different compounds within it that can affect the body in different ways, but the most important ones to be aware of are that it does have a compound that acts in the body just like an opioid would. So that compound is called mitragynine, and it works in the same receptors in your brain that opioids act with. And so people will use it as a way to potentially treat chronic pain or longstanding pain issues. And they will also report using it if they are stopping an opioid, and they're having withdrawal symptoms to try to manage those withdrawal symptoms.

But just like an opioid, it also carries the same risk of potentially causing an opioid use disorder or addiction. And when you stop it after a long period of use, you can experience some of the same withdrawal symptoms that you would experience if you were stopping an opioid after long-term use.

Host Amber Smith: So do you have to be careful if you're already taking a prescription opioid? Is it safe to add this to that?

Willie Eggleston, PharmD: I would definitely recommend against adding it to that.

We know that a prescription opioid on its own has an increased risk for side effects, like slowed breathing, that can be very dangerous and potentially life threatening.

When you're adding another opioid-acting product on top of that, that can increase that risk.

So just to be clear, when we're talking about opioids like fentanyl, which is an opioid people use illicitly, I think most of us realize that's a very dangerous drug. It has a high risk for overdose, a high risk for slowed breathing.

Prescription opioids at the appropriate dose still have that risk. It's just less. And then kratom still has that risk, but it appears that it's even smaller than prescription opioids. But when you mix those things together, it's just a recipe for a bad outcome.

Host Amber Smith: So would kratom make a person high, or does it just relieve anxiety?

Willie Eggleston, PharmD: Like any other opiate, it can make you high. When you talk with folks who are using opiates for the sensation they get when, say, they use fentanyl, the high is very different with kratom. It's not the same head rush, it's not something they would seek out, right? They're going to seek out fentanyl first. They're going to seek out prescription opioids second. And they're going to seek out kratom last. And they're probably not, honestly, going to be able to get enough of a high to make it useful, so they're really just using it for withdrawal in that case.

But if it's someone who's never used an opioid in their life, and they don't have a tolerance, and they take a bunch of kratom, they'll definitely have the same sort of euphoria that you would have with another opioid. It's just not quite as strong.

Host Amber Smith: I guess this is a bit of a trick question: Is it safe to take this if this is the only thing you're taking? And if so, if you do take it, does it work? Is there any evidence that it reduces pain or anxiety?

Willie Eggleston, PharmD: So, to answer your first question, I think that the risks with kratom use on its own are low, but they're not zero.

We do know that it has some side effects. It can cause injury to the liver. It can cause, as I mentioned earlier, addiction and potentially withdrawal. And in really high doses, just like an opioid, it potentially could slow someone's breathing to a dangerously low level.

And then because of the other compounds that are there in the plant, there's other side effects that we see as well that are not consistent with an opioid, things like increased heart rate or, in severe cases, maybe even like a seizure. And so, for those reasons, because we don't have a lot of information at this point as to potential side effects, and because it's unregulated, so it's unlikely that the dose that it says it is is probably not what it actually is, there's a lot of inherent risks with using the product.

As far as does it work? We just don't know. It's very possible it could be a reasonable option sometime down the road for patients suffering with pain or for patients suffering with opioid use disorder or addiction. But no one has done those trials, that research, to figure out does it actually work.

That's the take-home point I have for folks who are curious about it, is that it does appear to be safer than prescription opioids for risk for slowed breathing. But as far as other side effects, we really just don't know, and then we have no idea if it works.

Host Amber Smith: So how addictive is it? Is it as addictive as a prescription opioid?

Willie Eggleston, PharmD: That's another one we don't know because the research hasn't happened yet. From anecdotal experience in talking with patients who are stopping kratom, they do describe the withdrawal symptoms as more mild than the withdrawal symptoms that they experience with stopping something like heroin or fentanyl.

But that doesn't necessarily give us a lot of information as far as how potentially addicting this product is. Certainly, it's not as safe as other dietary supplements like vitamins and melatonin, where we know that those side effects are mild to nonexistent, and we know there's not a risk for addiction or withdrawal.

Host Amber Smith: So when you hear about people who have taken kratom, is it usually mixed with other drugs or alcohol, or is it usually people just taking a high dose of it, where they would end up calling the poison center, maybe?

Willie Eggleston, PharmD: So, for folks who are using it for pain management or management of withdrawal or addiction, in my experience, those individuals are using it on its own. They're not mixing it with other substances. And in those cases, the common question that we get is about the withdrawal when they stop the product.

Now, there are also cases of folks who do mix the drug with other substances, and in those cases it's probably more likely they're using the kratom as a means to get a high sensation, as opposed to using it for chronic pain or treatment of a substance use disorder.

And in those cases where you are mixing it, we do know there's risks. And when you look at the overall number of opioid overdose deaths reported by states, about 2% of those have kratom involved.

It's along with other substances a lot of the time, like fentanyl or other sedatives, but it's certainly involved in that process.

Host Amber Smith: What happens if someone takes too much and overdoses? What does that look like, and what do you do to help that person?

Willie Eggleston, PharmD: For someone who has taken too much kratom and is experiencing symptoms of an overdose, we can see mild opioid effects, like they're being sleepy or, difficult to wake up. At very large levels, potentially slowed breathing.

But then because of the other compounds in the plant, we do also commonly see things like increased heart rate, anxiety, seizures. In fact, we see seizures more frequently than we see slowed breathing, so the stimulant effects of the other compounds in the plant can play a role in dictating how someone comes into the hospital with toxicity.

Host Amber Smith: Would naloxone be used for someone who overdoses on this?

Willie Eggleston, PharmD: If someone is having symptoms of slowed breathing from the opioid effects of kratom, the information that we have up to this point suggests that naloxone would work just fine. It will reverse the effects and allow that person's breathing to go back to normal.

It's just not something we have to do very frequently, because it doesn't seem that that's a big risk factor with kratom, like it is with other substances like fentanyl.

Host Amber Smith: We probably don't know the answer to this, but do we know if there are longer-term effects on the body of someone who uses kratom?

Willie Eggleston, PharmD: We don't have a full picture at this point, but the two that we do know are, the longer you're using the product, the more likely you are to develop an opioid use disorder or addiction to the product, and to develop a withdrawal when you stop the product. And in cases where patients have developed liver injury, it has been in people using the product for longer periods of time.

Aside from those two risk factors, at this point, we don't really have any data to suggest there are other potential long-term complications.

Host Amber Smith: So that liver toxicity, can that be a real serious problem for someone?

Willie Eggleston, PharmD: Oh, it definitely can, and it would require a good amount of time in the hospital to get treatment and to make sure that your lab values go back to normal.

But it's not something that we're seeing every other day. It's a less common side effect that we see with long-term use.

Host Amber Smith: Well, that's good to know. I appreciate you making time for this interview, Dr. Eggleston.

Willie Eggleston, PharmD: Of course. I appreciate you having me, and I hope the folks learned a little more about kratom today.

Host Amber Smith: My guest has been toxicologist Willie Eggleston from the Upstate New York Poison Center and the department of emergency medicine at Upstate Medical University.

I'm Amber Smith for Upstate's "HealthLink on Air." Here's some expert advice from sleep medicine specialist Dr. Ryan Butzko from Upstate Medical University. What do you tell patients who ask you about the recall of Philips CPAP machines?

Ryan Butzko, DO: So unfortunately, the recall started actually in 2020, just after the COVID pandemic, so it got swept under the rug a little bit. And we've been dealing with it ever since. And they've had multiple recalls since. The original recall was due to a breakdown of a certain foam within the machine that was potentially carcinogenic, which means that it has the potential to cause cancer.

That breakdown was more or less associated with a certain cleaning product, and mostly an ozone-based cleaning product. One of the brands is called SoClean. If the patients weren't using that brand and just cleaning the tubing with soap and water, the risk was demonstrably lower than if they did use that SoClean. So initially what I would counsel patients is to 1., obviously, get your machinerecalled by Philips. And you can go to the Philips website, apply for the recall, and they will put you on the list to replace your machine. But in the meantime, to just clean the machine with soap and water. And as long as you aren't noticing that black debris on the tubing which signals the breakdown of the foam, then it's probably safe.

That being said, if you are that uncomfortable, and you feel that any risk associated with any carcinogens is too much, then what I would recommend is just stopping to use the machine and talk to your sleep doctor to see if you can be a candidate for a different machine, which in some instances, as long as the insurance has approved, I've been able to do. Alternatively, I have had patients go and buy their own machines commercially, which can be an alternative option, which unfortunately sometimes is cost prohibitive, but it can be done.

The two main manufacturers of machines are Philips Respironics and ResMed.

Basically, all of the new patients that are diagnosed with sleep apnea are essentially only getting ResMed machines. And this is because Philips is still working on replacing the machines from the initial recall in 2020. Until they do that, they have not been giving out new machines. So it's almost a certainty that you will end up with a ResMed machine or one of the newer available machines, one of which is called a Luna. But, by far and large, the most common machine that we deal with now is, one of the ResMed.

Host Amber Smith: You've been listening to sleep medicine specialist Dr. Ryan Butzko from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: David Radavich is a poet and playwright whose most recent book is "Under the Sun." His short poem "Close Call" delicately sketches a hoped-for return to health.

"Close Call"

Your voice is frail

as the whisper

of a monarch's wing --

I try to hear carefully,

imagine how a stroke

might feel, its capillaries

feeding all those memories

with a blitz of loss.

how you must be

sitting up in bed now,

phone in hand, speaking

unfamiliar words

that come from elsewhere --

maybe Mexico, that last

lepidopteran migration --

so far away, yet in the blood

as a luminous treasure,

yes, you will be coming

home soon, someone will help

you for the first month,

you'd like me to bring you

a rose from your garden

on my first visit --

I will see you then

with new wings scarcely

perceptible, words flying

from face to face,

this bouquet

a charm

for hovering.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," staying safe from the growing threat of measles.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.