Low-dose ketamine may ease fentanyl withdrawal. Many people switch from fentanyl to buprenorphine to treat opioid addiction. For many, withdrawal gets worse during the switch. A new pilot study found that ketamine taken under the tongue could help with this step.
Summary: Buprenorphine works well for opioid addiction, including fentanyl addiction. But many people get worse withdrawal when they switch from fentanyl to it. A new pilot study shows that sub-lingual ketamine could be an answer to this problem. Sub-lingual means it goes under the tongue.
Despite years of effort, opioid overdose deaths are still a big problem in the US. But the epidemic has changed. Fentanyl, a strong synthetic opioid, is now a leading cause of opioid overdose deaths. In 2022, about 83,000 people died of fentanyl overdose or of drugs laced with fentanyl.
So this drug is now one of the major problems. Doctors now focus on treating fentanyl addiction. Fentanyl withdrawal is severe. So doctors treat people with safer opioids like buprenorphine. It was the first drug approved in the US for opioid use disorder (OUD). Doctors can give it in their offices. It has an excellent safety record.
But it is not that simple. A few people get a rare problem when they start buprenorphine for fentanyl addiction. It is called buprenorphine-precipitated opioid withdrawal (BPOW). These patients feel major pain, discomfort, and distress when they get the drug. Put simply, for some patients withdrawal gets worse when treatment starts.
Now a new study shows that ketamine may help these patients. Ketamine is a well-known anesthetic, a drug used to put people under for surgery. It may help them get past BPOW. That may make it useful for fentanyl withdrawal.
Doctors have used ketamine for more than half a century. Interest in it is back because it can help rewire the brain. It can help with OUD, other addictions, and mental health problems like depression. At low doses, it has shown great results. Addictionology Center provides opioid addiction treatment as part of full care.
There are many ways to give ketamine. One is a slow IV drip in a doctor’s office under close watch. A newer way is a low dose under the tongue. At low doses, it is fairly safe and helps with many problems. It looks best for people moving from fentanyl, or even methadone, to buprenorphine.
The new study on sub-lingual ketamine was a small clinical trial. It enrolled 37 patients, and just 16 finished it. Still, the results in this small group were striking. Almost all of them (92%) reported significant benefits, with fewer opioid withdrawal symptoms.
Doctors have used ketamine for decades. Still, we do not fully know how it works. We do know it acts mainly on the NMDA-type glutamate receptor (NMDAr), a switch on brain cells. It also acts on many other brain receptors.
Ketamine still holds a lot of mystery. For example, it wears off fast, even in small doses under the tongue. Yet studies show its good effects may last much longer. It may ease pain and distress for a long time. So ketamine seems to cause real changes in the brain.
So we need bigger trials to learn its role in treating drug addiction and OUD. Used the right way, it does not cause addiction and is quite safe.
Frequently asked questions
What does precipitated withdrawal mean?
Precipitated withdrawal is withdrawal that gets worse when treatment starts. It can happen when people switch from fentanyl to buprenorphine. Doctors call it buprenorphine-precipitated opioid withdrawal (BPOW). Instead of relief, the first doses bring major pain, discomfort, and distress. Buprenorphine itself has an excellent safety record. The trouble comes during the switch.
Can ketamine help with opioid withdrawal?
A small pilot study says it can. Patients moving from fentanyl to buprenorphine got low-dose ketamine under the tongue. The study enrolled 37 patients and 16 finished it. Of those who finished, 92% reported a significant drop in opioid withdrawal symptoms. Larger trials are still needed to define ketamine’s role in treating opioid use disorder.
How is ketamine given for withdrawal?
There are two main ways. One is a slow IV drip in a doctor’s office under close watch. The other, newer way is a low dose placed under the tongue (sublingual). At low doses ketamine is fairly safe. The sublingual form looks most useful for people moving from fentanyl or methadone to buprenorphine.
Is ketamine like fentanyl?
They are different drugs. Fentanyl is a strong synthetic opioid and a leading cause of overdose deaths. Ketamine is an anesthetic that doctors have used for more than half a century. It works mainly on the NMDA-type glutamate receptor and other brain receptors. Used the right way, it does not cause addiction and is quite safe.
Related reading
Isotonitazene: The Opioid Stronger Than Fentanyl · Buprenorphine Treatment Gaps Raise Overdose Risk · Fentanyl-Laced Marijuana and 39 Connecticut Overdoses
Source:
Grande, L. A., Hutch, T., Jack, K., Mironov, W., Iwuoha, J., Muy-Rivera, M., Grillo, J., Martin, S. A., & Herring, A. (2024). Ketamine-assisted buprenorphine initiation: A pilot case series. Addiction Science & Clinical Practice, 19(1), 60. https://doi.org/10.1186/s13722-024-00494-2