Update on Ketamine Infusion Therapy for Sustained Opioid Cessation for Chronic Pain and for Depression
Objectives: Opioid abuse and opioid use disorders (OUD) continue to threaten the veteran population of America with chronic opioid use estimates of over 28 percent for non-cancer pain . Long-term opioid cessation is the primary consequence of the original analysis using ketamine-assisted opioid detoxification, whereas secondary results are evaluations of opioid withdrawal, pain relief, and side effects of ketamine. The composite outcomes to date are also checked in this update. Design: Preliminary retrospective analysis requiring a systematic examination of a database that has been collected prospectively. Setting: Veterans Affairs Medical Center in Nashville, Tennessee; report from Franklin, TN, private practice clinic. Subjects: 41 veterans with chronic non-cancer pain and chronic opioids who underwent opioid detoxification aided by ketamine; update contains 114 patient results. Methods: The authors analyzed a real-time data set of forty-one patients who met the criteria for inclusion. Data collected over a 28-month period April 2016-July 2018) was reviewed by the authors. Following detoxification and the initial ketamine infusion sequence, patients were tracked for up to 12 months after infusion at regular intervals, extending this monitoring duration to October 2018 to ensure that all patients had at least 3 months of follow-up results.
Results: Long after therapy, most veterans stayed opioid-free: 83%, 75%, and 58% at one, three, and six months, respectively (p=0.0001). Seventy-six percent of patients reported either no or moderate severity of opioid withdrawal. At one and three months, median pain declines were 50 percent and 40 percent respectively. The frequency of alarming side effects of ketamine was poor.
Conclusion: Overall, this update offers new proof that the use of a standardized procedure for ketamine infusion combined with rapid detoxification of opioids is quite successful, results in a high rate of sustained reduction of opioids, reduces chronic pain, minimizes withdrawal of opioids using purely non-opioid analgesics, and reduces depressive symptoms. A randomized controlled trial may be used in future research, but blinding patients and clinicians could be difficult. Opioid detoxification aided by ketamine tends to be a safe and efficient method for targeting opioid addiction and has the potential to decrease opioid consumption, deaths associated with overdose, and chronic pain.
Author (s) Details
Randall J. Malchow
VA Tennessee Valley Healthcare System, USA and AMG Ketamine and Wellness Center, USA.
Jennifer W. Baker
VA Tennessee Valley Healthcare System, USA
Ashley P. Yost,
VA Tennessee Valley Healthcare System, USA.
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