Published by Joshua Kleinstreuer
More than 100,000 Americans died of drug overdoses in a one year period, according to the Centers for Disease Control and Prevention (CDC), which has drug policy experts and healthcare professionals alike reexamining age-old treatment options.
Deaths due to drug overdoses have been rising for more than two decades yet skyrocketed during the past two years and jumped nearly 30%, according to the CDC.
The grim statistic came from available death certificate data and marks an unprecedented milestone. Health experts said overdose deaths are connected with the COVID-19 pandemic, a more abundant supply of dangerous drugs such as fentanyl, and the lack of effective treatment or support options for addicts.
The alarming numbers are causing health experts to revisit the potential of ketamine as a treatment for substance use disorder (SUD). As it currently stands, despite the high prevalence of SUDs, effective pharmacotherapy options are limited. FDA-approved treatment options for opioid dependence include full opioid agonists such as methadone, partial agonists including buprenorphine, and antagonists. For cannabis and stimulant use disorders, there are no FDA-approved treatments (Mann et al. 2016).
With limited options to treat substance use disorders, medications which are not FDA-approved for that specific purpose are tried as standalone, off-label pharmacotherapies and in conjunction with behavioral interventions (Jones et. al 2018).
Ketamine is FDA-approved as an anesthetic, yet decades of research dating back to 1992 at Yale University show promising potential for the treatment of mental health issues. Among those with treatment-resistant depression, PTSD, and suicidality, more than 75% found relief of symptoms after receiving ketamine therapy. Researchers also discovered through brain imaging that ketamine promoted the growth of new neurons that had been damaged by years of depression and anxiety (Krystal et al. 2019). This characteristic of ketamine means that the benefits of the medication can last even when it is no longer in the body. Many patients feel the benefits of IV Ketamine Therapy for weeks, months, or even longer.
Ketamine is also an ideal alternative to traditional opioids for pain management in emergency departments on patients who suffer from substance use disorder. Researchers found that ketamine is “noninferior to morphine for the control of acute pain.” The results from the study indicate that ketamine can be considered as an appropriate alternative to opioids in the emergency department for short-term pain control (Karlow et al. 2018). Outside the hospital walls, ketamine can be used for long-term pain control as an alternative to opioids.
Ketamine is shown to be effective for patients living with chronic pain conditions including cancer-related neuropathic pain, by working to combat the pain sensations that were over emphasized due to opioid use to treat their pain while having a safer index of use in terms of adverse effects including but not limited to addition (Culp, Clayton, et al. 2021).
Ketamine may be the answer to the dilemma of finding an effective pharmacotherapy for substance use disorder. Seven human studies were completed between January 1997 and January 2018 examining the efficacy of ketamine to treat alcohol use disorder, cocaine use disorder, and opioid use disorder. Two studies focused on alcohol, two studies focused on cocaine, and three studies focused on opioids. Both studies involving cocaine use disorder found improvements in craving, motivation, and decreased usage rates.
Studies concerning alcohol use disorder and opioid use disorders found improvement in abstinence rates, with significant differences noted for up to two years following a single ketamine infusion. The results of the studies suggest that ketamine may promote abstinence across multiple substances prone to abuse and justify a more extensive study about ketamine for the treatment of addiction (Jones et. al 2018).
Considering the efficacy of ketamine for treating mental health conditions such as PTSD, generalized anxiety, and depression where patients failed to find relief in the past, this latest potential use comes as no surprise.
If you or someone you know is struggling with substance use, you are not alone. The Substance Abuse and Mental Health Services Administration (SAMHSA) can help.
The call is free: 1-800-662-4357.
Culp, Clayton, et al. “Ketamine Use for Cancer and Chronic Pain Management.” Frontiers in Pharmacology, vol. 11, 2021
Jones, Jennifer L et al. “Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review.” Frontiers in
psychiatry vol. 9 277. 24 Jul. 2018, doi:10.3389/fpsyt.2018.00277.
Karlow, N. et al. “A systematic review and meta‐analysis of ketamine as an alternative to opioids for acute pain in the emergency
department.” Academic Emergency Medicine, 25(10), 1086–1097. (2018). https://doi.org/10.1111/acem.13502.
Krystal, John H et al. “Ketamine: A Paradigm Shift for Depression Research and Treatment.” Neuron vol. 101,5 (2019): 774
Mann K, Torup L, Sørensen P, Gual A, Swift R, Walker B, et al. “Nalmefene for the management of alcohol dependence: review
on its pharmacology, mechanism of action and meta-analysis on its clinical efficacy”. European
Neuropsychopharmacology. (2016) 26:1941–9. 10.1016/j.euroneuro.2016.10.008.