A preliminary study indicated that administering a small dose of ketamine may alleviate or completely remove withdrawal symptoms that occur when someone stops using fentanyl.
In the United States, drug overdoses rank as the top cause of fatal injuries among young adults, with fentanyl responsible for more than 70,000 deaths each year.
Individuals who use fentanyl often find themselves ensnared in addiction, largely due to their fear of withdrawal symptoms. These symptoms can include muscle cramps, nausea, chills, excessive sweating, and overwhelming cravings.
This fear makes it challenging for them to stop using fentanyl, and it also complicates their initiation of methadone or buprenorphine, two medications that could significantly lower their risk of dying from an overdose.
Recent research published on August 29 in Addiction Science & Clinical Practice may provide a promising solution. The pilot study demonstrated that ketamine, at a small dose, can mitigate or even eliminate withdrawal symptoms related to ceasing fentanyl use.
“The key finding is that we have discovered a simpler method for individuals ensnared in fentanyl addiction to begin their treatment,” explained Dr. Lucinda Grande, who serves as a clinical assistant professor of family medicine at the University of Washington School of Medicine and is the lead author of the study.
“Accessing methadone is challenging due to stringent federal regulations, and the initial use of buprenorphine can trigger severe withdrawal symptoms before patients reach a stabilized state,” added Dr. Tom Hutch, a co-author of the study and medical director of the opioid treatment program at We Care Daily Clinics in Auburn, Washington. “Using ketamine at a barely noticeable low dose helps fill that gap.”
During a period of 14 months, Dr. Grande and her colleagues in Auburn and Olympia provided ketamine to 37 patients addicted to fentanyl, whose fear of withdrawal symptoms had prevented them from trying buprenorphine. Out of these, 24 patients attempted the drug, and 16 successfully transitioned to buprenorphine.
The majority of patients indicated experiencing a reduction or complete elimination of their withdrawal symptoms after each ketamine dose, with effects lasting for several hours. Among the last 12 patients to complete the transition, an impressive 92% remained in treatment for a minimum of 30 days.
Patients received a ketamine lozenge or syrup to be placed under their tongue. The administered dose of 16 mg is a small portion of the dose typically utilized for anesthesia, which has been the primary medical use of ketamine for the last half-century, according to Dr. Grande. This dosage is also less than half of the lowest ketamine dosage used in treating depression, a growing application for this medication.
Researchers conducted daily or nearly daily monitoring of patients, adjusting the treatment approach as needed based on the responses of patients and the experiences of the prescribing doctors.
The concept for this approach was developed by Grande after she discovered that Dr. Andrew Herring, an emergency medicine physician and coauthor from Oakland, California, successfully used a higher, sedating dose of ketamine to address a patient’s severe withdrawal symptoms in the emergency room.
With over a decade of experience using low-dose ketamine to treat chronic pain and depression in more than 600 patients, Grande works as a primary-care and addiction doctor near Olympia.
Ketamine has gained significant media attention following the overdose and drowning of actor Matthew Perry, known for his role in the sitcom “Friends.” Reports suggest that he had undergone high-dose ketamine therapy for his depression.
“Our research highlights the significant possibilities this medication offers for tackling critical health issues such as depression, chronic pain, and now fentanyl use disorder,” stated Grande. She believes that the positive aspects of ketamine have been overshadowed by the tragedy of Perry’s death.
Grande is hopeful that the results from this pilot study will be validated in more extensive research. “I am thrilled about these findings,” she expressed. “This represents a remarkable opportunity to save lives.”
