Role of ketamine in the treatment of substance use disorders: A systematic review

0 PSYCHOLOGY, CLINICAL
Reinhard Janssen-Aguilar , Shakila Meshkat , Ilya Demchenko , Yanbo Zhang , Andrew Greenshaw , Walter Dunn , Robert Tanguay , Leah M. Mayo , Jennifer Swainson , Rakesh Jetly , Venkat Bhat
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Abstract

Background and aims

Substance Use Disorders (SUDs) involve diminished control, risky use, impaired social interactions, and physical dependence. Despite their global prevalence and burden, treatment options remain limited. Ketamine (KET), an NMDA receptor antagonist, may aid SUD treatment by modulating glutamatergic neurotransmission. This systematic review evaluates KET's role in SUD treatment.

Methods

This review surveyed three databases until June 2024, including 14 studies with 551 participants.

Results

Among the 14 studies, 6 focused on alcohol, 3 on cocaine, 4 on opioids, and 1 on cannabis. Seven studies (50 %) combined KET with psychotherapy, while seven (50 %) focused solely on KET's pharmacological effects. KET dose ranges varied from 0.11 mg/kg to 2.0 mg/kg and study primary endpoints ranged from less than a day to two years. The results of the included studies demonstrated KET's efficacy across various SUDs. In Alcohol Use Disorder (AUD), KET reduced withdrawal symptoms and benzodiazepine requirements. In Cocaine Use Disorder (CUD), KET decreased craving and increased abstinence rates. In Opioid Use Disorder (OUD), high-dose KET psychotherapy (KPT) improved abstinence and reduced craving. In Cannabis Use Disorder (CNUD), KET reduced weekly use and increased abstinence confidence.

Conclusions

Conclusion: While preliminary studies suggest that KET may have short-term benefits in treating SUDs, the evidence remains limited by small sample sizes and a lack of randomized trials. Further research with larger, well-controlled studies is needed to determine optimal dosing, clarify mechanisms of action, and assess long-term efficacy and potential risks, including abuse liability, before broader clinical implementation can be recommended.
氯胺酮在药物使用障碍治疗中的作用:系统综述
背景和目的物质使用障碍(SUDs)包括控制能力下降、危险使用、社会交往受损和身体依赖。尽管它们在全球流行并造成负担,但治疗选择仍然有限。氯胺酮(KET),一种NMDA受体拮抗剂,可能通过调节谷氨酸能神经传递来帮助治疗SUD。本系统综述评价KET在SUD治疗中的作用。方法本综述对三个数据库进行了调查,截至2024年6月,包括14项研究,551名参与者。结果14项研究中,酒精6项,可卡因3项,阿片类药物4项,大麻1项。7项研究(50%)将KET与心理治疗相结合,而7项研究(50%)仅关注KET的药理作用。KET的剂量范围从0.11 mg/kg到2.0 mg/kg不等,研究的主要终点从少于一天到两年不等。纳入的研究结果证明了KET对各种sud的疗效。在酒精使用障碍(AUD)中,KET减少了戒断症状和苯二氮卓类药物的需求。在可卡因使用障碍(CUD)中,KET降低了渴望并增加了戒断率。在阿片类药物使用障碍(OUD)中,高剂量KET心理治疗(KPT)改善了戒断和减少了渴望。在大麻使用障碍(CNUD)中,KET减少了每周的使用并增加了戒断的信心。结论:虽然初步研究表明KET在治疗sud方面可能有短期益处,但由于样本量小,缺乏随机试验,证据仍然有限。在推荐更广泛的临床应用之前,需要进行更大规模、对照良好的研究,以确定最佳剂量,阐明作用机制,并评估长期疗效和潜在风险,包括滥用责任。
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来源期刊
Journal of substance use and addiction treatment
Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)
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