Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review

Summary & key facts

Researchers reviewed human studies up to 2018 to see whether ketamine can help people stop or cut down problematic drug and alcohol use. They found seven finished studies—two on alcohol, two on cocaine, and three on opioids—and six more studies were still running. Some results were promising: studies on cocaine showed less craving and less use, and studies on alcohol and opioids reported higher abstinence after ketamine, sometimes lasting up to two years after one infusion. But the evidence is limited because studies were small, often not compared to a fake treatment, and had short or narrowly focused follow-up. Overall, ketamine looks worth studying more for addiction, but we don’t yet have strong proof it works for most people.

Key facts:

• The authors searched scientific databases for human studies of ketamine in substance use disorders done between 1997 and 2018.
• They found seven completed studies: two tested alcohol use problems, two tested cocaine problems, and three tested opioid problems.
• Both cocaine studies reported less craving, more motivation to quit, and lower cocaine use after ketamine, but these studies were small and had narrow participant groups and short follow-up time.
• Studies of alcohol and opioid problems reported higher rates of staying abstinent in people who got ketamine, and some reported differences lasting up to about two years after a single infusion, but those were not tested against a placebo (a fake treatment).
• The review notes six ongoing human studies of ketamine for alcohol, cocaine, cannabis, and opioid problems, showing more research is already underway.
• Because many studies were small, not placebo-controlled, or had other limits, the review says ketamine may help with addiction but that broader and stronger studies are still needed.

Abstract

Background: Despite advances in behavioral and pharmacotherapy interventions, substance use disorders (SUDs) are frequently refractory to treatment. Glutamatergic dysregulation has received increasing attention as one common neuropathology across multiple substances of abuse. Ketamine is a potent N-methyl-D-aspartate (NMDA) glutamatergic receptor antagonist which has been found to be effective in the treatment of severe depression. Here we review the literature on the efficacy of ketamine in the treatment of SUDs. Methods: A systematic review of the PubMed, Scopus, and ClinicalTrials.gov databases was undertaken to identify completed and ongoing human studies of the effectiveness of ketamine in the treatment of SUDs between January 1997 and January 2018. Results and conclusion: Seven completed studies were identified. Two studies focused on alcohol use disorder, two focused on cocaine use disorder, and three focused on opioid use disorder. Both cocaine studies found improvements in craving, motivation, and decreased cocaine use rates, although studies were limited by small sample sizes, a homogeneous population and short follow-up. Studies of alcohol and opioid use disorders found improvement in abstinence rates in the ketamine group, with significant between-group effects noted for up to two years following a single infusion, although these were not placebo-controlled trials. These results suggest that ketamine may facilitate abstinence across multiple substances of abuse and warrants broader investigation in addiction treatment. We conclude with an overview of the six ongoing studies of ketamine in the treatment of alcohol, cocaine, cannabis, and opioid use disorders and discuss future directions in this emerging area of research.

Topics

Neurotransmitter Receptor Influence on Behavior Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Abstinence Acamprosate Addiction Cannabis Clinical psychology Craving Environmental health Internal medicine Ketamine Medicine Meta-analysis Naltrexone Opioid Population Psychiatry Receptor Substance abuse

Substances

Cannabis Ketamine

Conditions & symptoms

Addiction Substance abuse disorder Addiction or harmful habbits