This talk will provide a background on traditional kratom and an overview of the recent proliferation of novel, kratom-derived products. Industry marketing, confused media coverage, and dynamic government policy will be described, as all influence public health responses. What is known about the harm-reduction aspects of these kratom compounds will be considered. Next steps for developing a better epidemiological understanding will be identified along with the roles clinicians play. The pharmacology of kratom, 7-hydroxymitragynine (7-OH), and mitragynine pseudoindoxyl will be explained in a manner geared at helping clinicians understand how pharmacology influences addiction potential. Patient-level factors that may influence substance use disorder or adverse event trajectories will be articulated. Use motivations will be discussed alongside risks. Case reports will be used to highlight the complexity of assessing, diagnosing, and treating patients consuming new kratom-derived products. Ample time for attendee Q&A will be reserved to facilitate learning and discussion.
Kirsten Smith, Ph.D., L.M.S.W., is one of the nation’s leading clinical experts on kratom. Dr. Smith has authored over 90 peer-reviewed publications, most focused on kratom or related topics, including kava and tianeptine. Between 2023-2025, Dr. Smith was an Assistant Professor in the Department of Psychiatry and Behavioral Sciences in the Johns Hopkins University School of Medicine. She joined Johns Hopkins after earning her Masters in Social Work from the University of Kentucky, Ph.D. from the University of Louisville, and after completing a 4-year postdoctoral fellowship at the National Institute on Drug Abuse Intramural Research Program (NIDA IRP). At NIDA IRP Dr. Smith completed her K99-funded project that involved a national ecological momentary assessment of kratom use and a controlled drug administration substudy that investigated the acute effects of commercial kratom products. Her NIDA R00-funded study at Johns Hopkins examined the pharmacokinetics/pharmacodynamics of kratom and assessed spontaneous kratom withdrawal among daily consumers. Dr. Smith was awarded a NIDA R01 to investigate the safety, tolerability, and human abuse potential of kratom extract in healthy adults, which is ongoing. She has also conducted numerous surveys and qualitative data projects on kratom and 7-hydroxymitragynine use. Presently, Dr. Smith is transitioning from academia to clinical practice but consults on kratom regularly and welcomes opportunities for collaboration.