Johns Hopkins Researcher Kirsten Smith Leads Charge to Understand Kratom Scientifically

Why it matters

With millions of Americans using kratom, Johns Hopkins assistant professor Kirsten Smith is providing some of the first rigorous scientific evidence on why people use it and what effects it actually has — critical context amid escalating regulatory debates.

The big picture

Kratom use has grown rapidly in the U.S., but peer-reviewed research has lagged behind the regulatory debate. Smith's work represents a pioneering effort to bring empirical science to a conversation long dominated by anecdote and advocacy. Her personal history with addiction informs a patient-centered, harm-reduction perspective that is influencing how clinicians and policymakers think about the substance.

Key findings

• Smith's 2024 JAMA Network Open survey of hundreds of kratom users found the vast majority use it not to get high but for pain, anxiety, opioid withdrawal, and fatigue
• 12.3% of kratom users qualify for kratom use disorder under DSM criteria, with most symptoms mild to moderate
• Preliminary FDA human studies of whole-leaf kratom did not show indicators of abuse potential or severe adverse effects
• Smith distinguishes sharply between traditional kratom and new semi-synthetic 7-OH products, which she calls deeply concerning
• She is conducting a clinical pharmacokinetics trial at Johns Hopkins to study kratom's effects in humans under controlled conditions

What they say

"What we see are people rebuilding their lives, sometimes using kratom to deal with the cravings, pain, and fatigue of early recovery," said Kirsten Smith. "Do we want to have a moral panic freakout about it? Or do we want to approach it in a sensible manner?"

Bottom line

Johns Hopkins research is revealing that most kratom users are seeking wellness benefits, not a high — but new synthetic derivatives like 7-OH pose a fundamentally different and more serious risk.