Texas law bans the sale of synthetic kratom, but it isn’t enforced. Earlier this year, legislation died in the Texas House to ban the natural plant, too.

Court records claim Dr. Nathan Starke was performing surgery on a patient when he first “showed signs of impairment.” He was suspended a month later and a month after that, he tested positive for cocaine and kratom.

Georgia’s governor has signed a bill putting new regulations on the production and sale of products containing kratom, a plant-based supplement.