Our guest writer identifies ways in which ketamine could develop into a viable substitute for opioids as a prescribed painkiller
By Jason Duprat, MBA, MSA, APRN, CRNA
By now, the world is well aware of the risk and dangers of opioids, even when they are used as directed to treat pain. Since the publicized fallout of the highly addictive opioid Oxycontin, patients have wondered where they could turn for effective pain relief. A novel idea brought to the forefront has been the replacement of opioids with ketamine.
Ketamine is a medication that has been primarily used for anesthesia. Approved by the Food and Drug Administration (FDA) in the 1970s, it was first used on the battlefields of Vietnam to treat wounded soldiers. Given its potency and ability to induce a trance-like state, ketamine had been used less frequently by anesthesiologists in recent years in favor of forms of anesthesia that are less often associated with post-operative delirium. However, recent studies have shown that ketamine could offer significant uses for pain management and depression, as well as potentially treat opioid addiction.
The Different Roles for Ketamine
Ketamine is considered a dissociative drug, as its effect on brain chemistry distorts sensory perception. As such, it can disrupt the messages in the brain that lead to the sensation of pain in patients.
One way ketamine can be used that differs from other pain medications is its application in chronic pain cases. It has shown to be useful for people with neuropathic issues, like those who suffer from long-lasting post-surgery pain. An initial study on ketamine use for post-operative pain indicated that up to 20% of post-operative patients experience chronic nerve pain. Whereas those patients have struggled to find relief from more oft-used pain medications, ketamine has brought much-needed relief.
When administered intravenously, a single dose of ketamine can produce a positive reaction within hours for those with depression that is resistant to other medications.
Ketamine has also been an effective treatment for some mood disorders like depression. When administered intravenously, a single dose of ketamine can produce a positive reaction within hours for those with depression that is resistant to other medications. Although the effect is temporary, the drug is highly effective in treating periods of suicidal ideation in patients. The exact effectiveness of ketamine for mood disorders and suicidal thoughts is still undergoing studies, although initial research has been promising.
Uses for Addiction Treatment
The opioid epidemic has produced a nationwide onslaught of addiction issues. While opioids are successful in treating pain, their extremely addictive properties also have caused rampant misuse. The withdrawal symptoms associated with detoxing from opioids can not only be extremely difficult to endure but also can reactivate pain issues. As a result, some treatment facilities and physicians have started to use ketamine to help patients weather the adverse effects of opioid withdrawal.
Recent studies have shown some patients have successfully reduced—or even eliminated—their opioid dependency after just one dose of ketamine. The ketamine was then given a chance to be metabolized, and the patients did not present any withdrawal symptoms, thus leading to the first crucial step in recovering from opioid addiction.
Ketamine has been suggested for use as a stand-in for Suboxone, a medication that is often relied on to help wean people off of opioids.
In addition, ketamine has been suggested for use as a stand-in for Suboxone, a medication that is often relied on to help wean people off of opioids. Suboxone, while demonstrably effective, can also be addictive because it also contains an opioid. If used under the guidance of a trained professional, ketamine could not only help people kick opioids like Oxycodone and Hydrocodone but also aid in eliminating dependence on substances like Suboxone.
Pros and Cons
While the potential applications for ketamine that are currently being studied are producing promising results, doctors and treatment specialists are still hesitant to completely open the floodgates for broader ketamine patient use. It is still a highly potent and potentially dangerous drug that needs professional oversight to be used correctly. In fact, ketamine is classified as a Schedule III controlled substance and can lead to addiction if a person is not careful. This is, however, typically a psychological addiction for those who enjoy the dissociative mental state that ketamine causes, rather than the severe physical addiction seen with opioids.
If ketamine is administered in doses that are too high, some patients have reported an experience or feeling of being “near death,” as high doses of ketamine can render someone unable to move or lead to major hallucinogenic episodes. The blissful state that ketamine can produce has led to abuses in some cases (just as with opioids), which helped it become a popular club drug in the 1980s and 1990s under the street name “K” or “Special K”.
Since hitting the headlines, the opioid crisis has been at the center of many debates regarding proper pain management and prescription drug use.
To some, using ketamine to replace opioids or treat opioid addiction may seem like trading one flawed medication for another. Still, the studies conducted on ketamine use for pain management, mood disorders and addiction treatment have been done under strict supervision from scientists and medical professionals. There is no suggestion that anything akin to “ketamine pills” be given regularly to patients in order to treat these issues.
Since hitting the headlines, the opioid crisis has been at the center of many debates regarding proper pain management and prescription drug use. The medical community has worked hard to bring other solutions to the millions suffering from unmanaged, chronic pain. When taken under proper guidance, the potential for ketamine’s use outside the operating room remains promising.
Jason Duprat is founder of the Ketamine Academy.
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