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Kratom with a side of cheesesteak: A sub shop’s vending machine draws customers desperate to kick opioids

TUCSON, ARIZONA - May 10, 2017: A kratom vending machine dispenses
TUCSON, ARIZONA - May 10, 2017: A kratom vending machine dispenses packages of kratom for customers at East Coast Subs in Tucson. Ilana Panich-Linsman for STAT
 TUCSON, Ariz. — Besides the psychoactive properties of eggplant parm and mid-century nostalgia, there isn’t much about East Coast Super Subs that you would describe as medicinal.

It’s a Wednesday during the late afternoon lull and Keith McNesby, who owns the place, is shuttling back and forth between the deep fryer and the griddle, sweat coating his forehead, grease lodged in the grooves around his fingernails. At this hour, most orders are coming in by phone or online, and he’s making red sauce, he’s assembling subs to go, he’s yelling for two more crates of wings. The only eat-in customer is a heavy-equipment mechanic whose knuckles are covered in blue tattoos.

But the front door keeps swinging open. The new arrivals don’t head to the counter; instead they walk back, toward the dispenser that spits out gumballs and bouncy balls for a quarter a pop. They’re heading for a vending machine that they hope will keep them off opioids.

These customers have been on heroin, hydrocodone, OxyContin — and they swear that the greenish powder dispensed by this machine is what allowed them to escape their addictions. It’s called kratom. It is the pulverized version of a plant from Southeast Asia. And it’s got thousands upon thousands of fans, who credit it with everything from ending their opioid habit to treating their anxiety to controlling their arthritis pain. In a single hour, some five people stop by, and the servers say it gets even busier right around opening and closing.

Now, it’s a young father with a barefoot toddler squirming in his arms. Now, a middle-aged man who just got out of jail, wearing torn, paint-splattered jeans. Now, a bright-eyed kid who looks like a college student.

Each feeds in some cash or dips a credit card — as little as $5 for 10 grams, or as much as $50 for 120 — and down tumbles a bag of kratom as if it were a pack of chips. Most of them will mix a few grams of powder into water — or a smoothie, to mask the bitter taste — and drink it down.

They know it isn’t regulated. Without performing chemical tests, they can never be quite sure that the powder they’re ingesting isn’t contaminated, or even that it’s kratom at all. They can’t be sure, either, that some of the stuff dispensed by the  machine won’t get in the hands of kids looking for a buzz. But they have come to trust the owners of this machine. The company is called Tucson Kratom, and customers swear by it.

Last fall, the Drug Enforcement Administration nearly made kratom as illegal as the federal government can make a substance, on par with heroin and LSD, because of an increase in poison center calls about the substance, as well as worries that it might be addictive. That would have put an end to the kratom trade that goes on in East Coast Super Subs. “If it’s illegal, I want it out in five seconds,” McNesby said.

After a huge public outcry, though, the government reversed course, delaying a decision on whether to outlaw kratom until there was time for a public comment period and a thorough review of the scientific literature.

That brush with illegality turns out to have been good for sellers. “A lot of people found out about kratom because of all the bad publicity. … People were like, ‘Wow, if the government doesn’t want me to have it, I want to try it,’” said Drew Fickett, a mixed martial arts fighter who used to be involved in Tucson Kratom, but has since opened his own storefront under the name Arizona Kratom. He estimates that the proposed ban caused sales to jump by 400 percent, and business is still good.

Fickett also has a vending machine in his own storefront, in case customers want to buy his kratom without having to engage in any human interaction. These two machines, stationed some 10 blocks apart, may well be the only ones in the country.

“A lot of people found out about kratom because of all the bad publicity. … People were like, ‘Wow, if the government doesn’t want me to have it, I want to try it.’”

Drew Fickett, kratom salesman

That may seem like a dubious claim to fame — after all, kratom is hardly as common as coffee or tobacco, but if you’re looking for it, it is easy enough to find. With a few clicks and a credit card number, you can buy kratom online. You can find it in gas stations and head shops and convenience stores and apothecaries selling herbal supplements.

Yet as a substance that’s been banned in some states and that’s still teetering on the edge of federal law, kratom isn’t always sold as if it were a type of sage. It also pops up in unexpected places, where unusual lines of business meet.

In Austin, Texas, you can get it from a boutique that also offers ammunition, water purification systems, whey powder, 18th-century coinage, and a bitcoin ATM. In Dinkytown, Minn., you can get it from a store that specializes in texts and talismans of the occult.

And here in Tucson, there’s the vending machine at East Coast Super Subs, just past the shrine commemorating the Philadelphia Flyers’s Stanley Cup wins in ’74 and ’75. The kratom machine is here through an unlikely symbiosis with a master sandwich-maker. Like a wrasse picking parasites off a shark, it benefits all parties involved: Tucson Kratom gets a local spot in which to sell, while some kratom-seekers also end up staying for lunch.

As server Jonathan Wade puts it, “The first time they come in for the kratom. The second time they look at the menu. The third time they sit down for a sub.”

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Packages of kratom for sale in a vending machine for customers at East Coast Super Subs. Ilana Panich-Linsman for STAT

The cheese steak master and the vending machine

Keith McNesby first came to Tucson because of an illness. In 1979, his grandmother was diagnosed with cancer, and, as he remembers it, “they said this is the place to go for breathing and things of that nature.” His uncle came out here, too, and then McNesby followed. But he didn’t move across the country for family reasons alone. It was also that old American itch to pick up and make a name for yourself someplace new.

“I didn’t want to be an average person in life,” he said. “I was living in my hometown, and I just went through the same motions as so many people. … I feel like I was just would have been a statistic. Some statistics aren’t bad. Some are great. But I wanted to be more than just a guy who stayed in my hometown. So I came here, didn’t know what the hell I was going to do. And I realized that no one could make a back-east cheesesteak. Nobody. So I said, you know what? I can. And I will. And I did and I have — and it’s great, I humbly say.”

 McNesby knew a thing or two about East Coast cooking. He’d grown up in Brigantine, an island town in South Jersey, separated from Atlantic City by the Absecon Inlet. His family had run a sandwich shop, an Italian eatery, and a seafood restaurant. “My dad, my uncle, my grandma, they have all just had their hands in the cooking cookie jar,” he said. His dad’s specialty was lobster tail, breaded and dunked in the deep fryer. When he describes the memory of it, McNesby leans back in his chair and lets out a breath. “Talk about one of the greatest things you could taste in the history of man.”

But among the saguaros of southern Arizona, the ingredients for a true back-east cheesesteak were about as common as lobsters. The secret, McNesby said, is the bread — and it was nowhere to be found.

To get as close as he could, he gave his grandma’s recipe for an Italian loaf to a local French baker. That was almost 20 years ago. Now, the subs come with lettuce, tomatoes, fried onions, and crushed cherry peppers unless you specify otherwise, and if you want the real deal, you can order your Italian subs “greasy,” with the meatball or chicken parm tucked between hunks of garlic bread. The style isn’t 100 percent Philly, but “more like a flare for New York, Jersey, Philly,” said Wade. “It’s a confluence if you will, where they meet. Where the meats meet.”

When kratom-buyers walk into East Coast Super Subs, they aren’t just stepping into an outpost of the Northeast Corridor; they also encounter a kind of history museum gone mad.

Rolling Stones posters hang beside license plates from Rhode Island and the Garden State. Barbara Streisand is there, her hooded eyes staring out of a poster from her 1967 sing-in on the Sheep Meadow of Central Park, and just below her is Albert Einstein looking like he’s just stuck his finger in a socket. There are dusty cans of Canada Dry and Iron City Beer beside a bobble-headed figurine of NBA all-star Allen Iverson. Photos of boxing matches, vinyl records of Beethoven and the Commodores and Star Wars soundtracks — you name it, it’s there, on the walls or the ceiling or displayed on a shelf in the corner. Even the men’s room is a wall-to-wall mosaic of sports cards, with Dallas Cowboys stickers inside the toilet bowl and sink.

The bluish light of the kratom machine wasn’t intended as part of the décor, or even as a boon for the business. Instead, McNesby allowed it in his restaurant three years ago as a favor to a friend, who runs Tucson Kratom. “We get a lot of people who eat here because of that,” McNesby said. “It’s worth it. But she’s also a single mom and I wanted her to make it, you know?”

The friend, who recently moved from Tucson to New York, declined a request for an interview because she worried that the publicity might cause trouble for her customers. As she put it, “we want to help the cause, but we have thousands of people who need us for their pain ‘meds.’”

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Gabriel Raffai, 41, with Abraxas, 1, purchases kratom from the vending machine. Raffai takes kratom for pain management after breaking his leg and being on opiates for over two years. Ilana Panich-Linsman for STAT

‘False hope’ in tidy green bags?

Kamren Alexander is one of those people. “I originally got on the kratom kick because I was a heroin addict and I needed to stop doing heroin, and that helped me do that without using Suboxone or methadone or anything,” he said.

He started with little liquid vials of kratom concentrate that he bought from a head shop. That was six years ago. Then last year, he relapsed, and ended up back on heroin for months before using kratom to wean himself off opioids for the second time.

Relapsing is just one of the things that toxicologists and physicians worry about when it comes to kratom.

Dr. Mazda Shirazi first heard about the machine a year ago, when a patient of his started to show signs of liver toxicity after using kratom from the machine every day. Shirazi wanted to see what this vending machine was selling, so he went over, had a cheese steak, and took a look for himself. He didn’t buy any of the product for chemical testing, and so couldn’t be sure that this was the culprit in his patient’s liver issues, but the machine still worries him.

“To give false hope that you can go buy some tea, some herbal remedy, and that will allow you to get off the addiction, I think it actually prolongs the addiction cycle and puts the patient in a dangerous situation, whereas by getting help they might be better off,” said Shirazi, who is the medical director of the Arizona Poison and Drug Information Center at the University of Arizona’s College of Pharmacy.

Shirazi also worries about the fact that kratom is largely unregulated: Without testing it, nobody can be sure that what they are buying is, in fact, pure kratom.

Many kratom users are themselves deeply aware of the lack of regulation. Through a private Facebook group with over 27,000 members, some have even set up a do-it-yourself regulatory committee to try to prevent contaminated or spiked product from hitting the market. But the committee doesn’t do spot checks of kratom sold in stores or vending machines; they only test samples that businesses send to them in hopes of getting on their list of vetted vendors. As of late May, Tucson Kratom was not on that list, according to Kathy Timinskis, one of the group’s administrators.

To Susan Ash, founder of the American Kratom Association, the vending machine’s presence in East Coast Super Subs is not just a smart business move, but a sign of how pervasive the opioid epidemic has become.

“What it shows is that our opioid epidemic is touching everyone,” she said. “Maybe a person who is going to walk into that sandwich store and has never heard of kratom — maybe that will be their first day off of opiates. We need anything and everything in this war on the opioid epidemic.”

“Maybe a person who is going to walk into that sandwich store and has never heard of kratom — maybe that will be their first day off of opiates. ”

Susan Ash, American Kratom Association

She likes the idea of people being able to go buy kratom without having to wait a day — or longer — for a package to arrive in the mail. Her only worry is that the vending machine makes kratom available to children under 18; she feels there is not enough research to know how the substance affects developing brains.

In a corner booth at East Coast Super Subs, Alexander, who’s 27, said he first found the machine because kratom from head shops was getting pricey. But he hopes now to wean himself off kratom, too. “I’ve been using it in small, decreasing quantities, on a daily basis,” he said. “I start with a lot of it initially … and then I taper down. I’ve been doing it very gradually and probably in the next two or three months, I’ll be done with it.”

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East Coast Super Subs in Tucson. Ilana Panich-Linsman for STAT

Helping people build character

It was that kind of dedication to self-improvement that convinced McNesby to keep the machine in his shop in the first place. He’s an old-fashioned guy. He believes in hard work. He doesn’t own a cellphone or a computer, and still memorizes his friends’ phone numbers. “When you say Facebook, Twitter … that’s all Chinese algebra to me,” he said.

He’s had his own issues with pain, and he’s tried kratom, but he thinks he can will his way through just about anything, so he didn’t stick with it.

When the vending machine first arrived, McNesby worried about his restaurant becoming a hot spot of Tucson’s opioid epidemic. “I did until I saw people who I believe had character. Or people who were trying to gain character. And there was a thing that seemed to be sincerely helping them,” he said.

So he’ll allow them to keep coming in as long as kratom’s still legal, treating them just like he does his regulars, be they students from the University of Arizona, or bands like Flying Donkey Punch and Scattered Guts who come in from the club across the street for post-sound-check chow.

“The people who come in here so swear by it,” he said. “Just yesterday somebody came in, they drove from two hours away, and they ate lunch, and they bought some of the kratom, and they’re pastors. … All walks of life come in here. They’re trying to better themselves or they wouldn’t be getting this.”

Then, a few minutes later, he gets up and heads back to the fryer. In not too long, he’ll meet with some customers about a catering job. In the meantime, he’s got subs to make.

 

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Ilana Panich-Linsman contributed reporting. 

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