Drug overdose is the leading cause of injury-related death among young adults in the United States, with fentanyl causing more than 70,000 deaths annually.
Many people who use fentanyl become trapped in their addiction because of fear and a low tolerance for withdrawal symptoms, which include muscle cramps, nausea, chills, sweats and intense cravings.
They are unable to stop using fentanyl and also have trouble starting either of the two medications, methadone and buprenorphine, that can dramatically reduce the risk of death from overdose.
The results of the investigation were published on August 29 in Addiction science and clinical practice It may offer hope. A pilot study showed that a small amount of ketamine can reduce or eliminate withdrawal symptoms associated with quitting fentanyl.
“The main takeaway is that we’ve found an easier way for people caught in the grip of fentanyl addiction to get into treatment,” said Dr. Lucinda Grande, an assistant clinical professor of family medicine at Washington University School of Medicine. She was the senior author of the study.
“Methadone can be difficult to access because of strict federal regulations, and starting buprenorphine can lead to severe withdrawal symptoms before those who start it are stable,” added study co-author Dr. Tom Hutch, medical director of the opioid treatment program at We Care Daily Clinics in Auburn, Washington. “Ketamine, at an imperceptibly low dose, helps bridge that gap.”
Over 14 months, Grande and his colleagues at Auburn and Olympia prescribed ketamine to 37 fentanyl-addicted patients whose fear of withdrawal symptoms had deterred them from trying buprenorphine. Twenty-four patients tried the drug, and 16 completed the transition to buprenorphine.
Most patients reported a reduction or elimination of withdrawal symptoms after each dose of ketamine, the effects of which lasted for hours. Of the last 12 who completed the transition, 92% remained in treatment for at least 30 days.
Patients placed a ketamine pill or syrup under their tongue. The 16 mg dose is a tiny fraction of what is routinely used for anesthesia, ketamine’s primary clinical role for 50 years, according to Grande. That dose is also less than half of the smallest dose of ketamine prescribed for the treatment of depression, an increasingly common use of the drug.
The researchers monitored patients daily or almost daily and refined the treatment strategy based on patient response and the prescribing physician’s experience.
Grande developed the concept after learning that Oakland, California, emergency room physician and co-author Dr. Andrew Herring successfully used a higher, sedating dose of ketamine in his emergency department to resolve a severe case of fentanyl addiction withdrawal in a patient.
Grande is a primary care and addiction physician who practices near Olympia and has used low-dose ketamine to treat more than 600 patients with chronic pain and depression over the past dozen years.
Ketamine has been in the news since actor Matthew Perry of the sitcom “Friends” overdosed on the drug and drowned. Perry had been undergoing high-dose ketamine treatment for depression, media reports have suggested.
“Our study highlights the enormous potential of this drug to treat major health problems such as depression, chronic pain and now fentanyl use disorder,” Grande said. Ketamine’s positive attributes have been overshadowed by Perry’s death, she said.
Grande hopes the results of this pilot study will be confirmed by larger studies. “I’m excited about these results,” she said. “It’s a wonderful opportunity to save lives.”