Low Dose Ketamine May Help With Fentanyl Withdrawal Symptoms

Low Dose Ketamine May Help With Fentanyl Withdrawal Symptoms

Summary: Buprenorphine is quite effective for managing opioid addiction, including fentanyl addiction. However, many of those who transition from fentanyl to buprenorphine experience worsening withdrawal symptoms. A new pilot study shows that sub-lingual ketamine could be an answer to this problem.

Despite much effort in recent years, opioid overdose-related deaths continue to be a significant issue in the US. However, the characteristics of this epidemic have changed over the years. Fentanyl, a potent synthetic opioid, is now among the primary causes of opioid overdose-related deaths. Thus, in 2022, about an estimated 83000 individuals died due to fentanyl overdose or due to fentanyl-laced drugs.

It means that over the years, this synthetic opioid has become one of the significant issues. Hence, the focus of doctors has also shifted to treating fentanyl addiction. Since fentanyl withdrawal causes severe symptoms, those addicted to the substance are treated with safer opioids like buprenorphine. It was the first drug approved in the US for treating opioid use disorder (OUD) and can be dispensed in physicians’ offices. It has an excellent safety record.

However, things are not that simple. Some individuals develop rare complications when they are prescribed buprenorphine for fentanyl addiction. They develop a condition called buprenorphine-precipitated opioid withdrawal (BPOW). It is a condition when patients experience significant pain, discomfort, and distress when they are given buprenorphine to manage their fentanyl addiction. Simply said, in some patients, opioid withdrawal symptoms rather worsen on treatment initiation with the drug.

Now, one of the new studies shows that ketamine, one of the well-known anesthetic drugs, may help such patients. It may help overcome BPOW and thus may be useful in managing fentanyl withdrawal symptoms.

Ketamine has been in clinical use for more than half a century, and interest in this drug has been reignited due to its ability to help rewire the brain and manage OUD and other kinds of addictions and mental health conditions like depression. This drug has shown some wonderful results in low dosages. Addictionology center provides opioid addiction treatment as a part of a comprehensive care approach

There are many strategies for giving ketamine to patients. One strategy is giving patients slow IV infusion in a physician’s office under controlled conditions. Another emerging strategy is using low-dose ketamine sub-lingually. At lower dosages, it is relatively safe and helps overcome a range of conditions. It appears the sub-lingual ketamine is especially good for those transitioning from fentanyl or even methadone to buprenorphine.

This new study that reported the benefits of sub-lingual ketamine was a small clinical trial. It enrolled 37 patients, and out of them, just 16 completed the study. Nevertheless, the results were just astonishing in this small number of patients. Almost all of them (92%) reported significant benefits with a reduction in opioid withdrawal symptoms.

Although ketamine has been in clinical use since ages, its mechanism of action is not fully understood yet. Nevertheless, it is known that it particularly affects the so-called NMDA-type glutamate receptor (NMDAr) and many other brain receptors.

However, much mystery still remains around ketamine. For example, it does not work for long, even when taken sub-lingually in small dosages. However, studies show that its benefits may last for much longer. It may reduce pain and emotional distress for much longer periods. So, it appears that ketamine causes certain brain changes.

Hence, there is a need for more extensive trials to understand its role in managing substance abuse disorder and also managing OUD. When used responsibly, it does not cause addiction and is pretty safe.

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

Gurpreet Singh Padda, MD, MBA, MHP

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