Low-Dose Ketamine Eases Fentanyl Withdrawal Symptoms

The AHA! Team — Thu, 17 Oct 2024 08:22:08 +0000

University of Washington School of Medicine via News-Medical – Drug overdose is the leading cause of injury deaths in young adults in the United States, with fentanyl causing over 70,000 deaths annually. Many people who use fentanyl become trapped in their addiction out of fear and a low tolerance for the withdrawal symptoms, which include muscle cramps, nausea, chills, sweats and intense cravings. They can’t stop using fentanyl, and they also have trouble starting either of the two medications, methadone and buprenorphine, that can dramatically reduce their risk of overdose death. Research findings published Aug. 29 in Addiction Science & Clinical Practice may offer hope. A pilot study showed that a small amount of ketamine can reduce or eliminate the withdrawal symptoms associated with quitting fentanyl. “The main takeaway is that we have found an easier way for people trapped in the grip of fentanyl addiction to get started in treatment.” Dr. Lucinda Grande, clinical assistant professor of family medicine, University of Washington School of Medicine She was the study’s lead author. “Methadone can be difficult to access due to strict federal regulations, and starting buprenorphine can cause severe withdrawal symptoms before those who start it become stabilized,” added study co-author Dr. Tom Hutch. He is the medical director of the opioid treatment program at We Care Daily Clinics in Auburn, Wash. “Ketamine, at an imperceptibly low dose, helps bridge that gap.” Over 14 months, Grande and colleagues in Auburn and Olympia prescribed ketamine to 37 fentanyl-addicted patients whose fear of withdrawal symptoms had deterred them from trying buprenorphine. Twenty-four patients actually tried the drug, and 16 completed the transition to buprenorphine. Most patients reported a reduction or elimination of withdrawal symptoms after each ketamine dose, the effect 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 lozenge or syrup under the tongue. The 16 mg dose is a small fraction of that typically used for anesthesia, the main clinical role of ketamine for 50 years, according to Grande. That dosage also is less than half of the smallest ketamine dose prescribed for depression treatment, an increasingly common use of this medication. Researchers monitored patients daily or almost daily, and refined the treatment strategy based on patient response and prescriber experience. Grande developed the concept after she learned that emergency-medicine physician and coauthor Dr. Andrew Herring of Oakland, California, used a higher, sedating dose of ketamine successfully in his emergency department to resolve a patient’s severe case of withdrawal from fentanyl addiction. Grande is a primary-care and addiction doctor in practice near Olympia who, in the past dozen years, has used low-dose ketamine to treat more than 600 patients for chronic pain and depression. Ketamine has gained prominence in the news since actor Matthew Perry of the sitcom “Friends” overdosed on the drug and drowned. Perry had undergone high-dose ketamine treatment for depression, news reports have suggested. “Our study underscores the enormous potential of this medication for addressing important health problems such as depression, chronic pain and now fentanyl-use disorder,” said Grande. Ketamine’s positive attributes have been overshadowed by Perry’s death, she said. Grande hopes this pilot study’s results will be confirmed by larger studies. “I am excited about these results,” she said. “This is a wonderful opportunity to save lives.” Source: University of Washington School of Medicine Journal reference: Grande, L., et al. (2024) Ketamine-assisted buprenorphine initiation: a pilot case series. Addiction Science & Clinical Practice. doi.org/10.1186/s13722-024-00494-2. To read the original article click here.

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Prevalence of Nicotine Pouch Use Found to be Low Among U.S. Adults

The AHA! Team — Tue, 20 Aug 2024 04:45:40 +0000

Keck School of Medicine of USC via News-Medical – A new study found that the prevalence of nicotine pouch use was low in U.S. adults despite a 641% increase in sales of the products between 2019 and 2022. Researchers say the findings raise questions about who is using the millions of nicotine pouches sold in the U.S. and why. Nicotine pouches, a new commercial tobacco product, contain a crystalline powder with nicotine, flavorings (including fruit, mint or candy) and other additives. They do not cause respiratory harm and are perceived by some as an alternative to help adults who smoke tobacco quit. Nicotine pouches have recently gained attention over concerns that their flavors and trendy social media marketing campaigns are attracting youth users. However, limited data on usage among adults has been collected since the new products entered the market. Now, a study from the Keck School of Medicine of USC and the University of Nebraska Medical Center analyzed nicotine pouch use in a nationally representative sample of 39,557 U.S. adults. The study found that 2.9% of adults had ever used nicotine pouches, with 0.4% reporting current use. The majority of adults currently using pouches also currently smoke cigarettes. Additionally, 5.2% of those who attempted to quit smoking in the past year and had relapsed back to smoking reported using pouches to help with their cessation efforts. The study, funded by the National Institutes of Health (NIH), was just published in JAMA. “The low prevalence of nicotine pouch use in adults surprised us, given the rapid increase in sales. But it’s also possible that the sales are being diverted to adolescents, who were not represented in this survey.” – Adam Matthew Leventhal, PhD, study coauthor, professor in the department of population and public health sciences at the Keck School of Medicine and executive director of the USC Institute for Addiction Science Patterns of pouch use Data for the study were collected through the Current Population Survey (CPS) Tobacco Use Supplement in September 2022. The CPS is a monthly survey of U.S. adults that uses rigorous research methods to ensure its participants represent an accurate cross-section of the country’s population, making the results reliable enough to influence important policy decisions. The Tobacco Use Supplement includes straightforward questions about cigarette smoking, attempts to quit smoking and-;for the first time in September 2022-;the use of nicotine pouches. Of 39,558 survey respondents, 2.9% had ever used nicotine pouches, and 0.4% were currently using them. Adults who currently smoked (10.8%) or formerly smoked (6.7%) were more likely to report ever using nicotine pouches compared to people who had never smoked (1.1%). Current use of nicotine pouches was also higher among adults who currently smoked (1%) and formerly smoked (0.7%) compared to those who had never smoked (0.2%). Pouch use, both past and present, was lower in adults under 65, but higher in males and non-Hispanic whites. Among those who currently smoked who tried to quit in the past year, more reported trying to switch to e-cigarettes (21.6%) than nicotine pouches (5.2%) to help them quit. One question raised by the findings is whether adults who use nicotine pouches may be using them to “top off” nicotine in situations where they cannot smoke or use other tobacco products, Leventhal said, rather than as a way to quit smoking. Instead of reducing the health risks of cigarette smoking, that use pattern could actually make nicotine dependence more severe. Based on the study results, Leventhal estimates that of all U.S. adults who currently used nicotine pouches in 2022, about 35% had previously smoked cigarettes and 25% were currently smoking cigarettes. The remaining 40% of adult pouch consumers had never regularly smoked cigarettes and could be at risk for developing nicotine dependence. “In summary, we didn’t see a large population of adults using nicotine pouches, and fewer appear to be using them in a fashion that would potentially reduce their harm from smoking cigarettes,” Leventhal said. Regulating nicotine pouches New nicotine products typically go straight to market before the U.S. Food and Drug Administration (FDA) reviews marketing applications and decides whether to authorize or ban each product. That decision involves weighing potential public health benefits, such as whether a product provides a safer alternative for adults who smoke, against risks, such as whether it may increase nicotine dependence among youth. Applications from major manufacturers of nicotine pouches are currently under review by the FDA. “Regulators can take our data and put it into that equation,” Leventhal said. “What our study suggests is that there’s not a large population of adults who smoke who are using these products to quit.” This study is part of the USC Tobacco Center of Regulatory Science, one of seven national centers supported by the NIH and FDA to collect evidence that can inform tobacco product regulation. In collaboration with the University of Michigan and other institutions, USC researchers are also conducting a parallel study to investigate adolescent use of nicotine pouches. They are looking at how pouch use relates to shifting teen usage patterns of other nicotine products, including e-cigarettes. About this research In addition to Leventhal, the study’s other author is Hongying Daisy Dai from the College of Public Health, University of Nebraska Medical Center, Omaha. This work was supported by the National Cancer Institute [U54CA180905] and the National Institute on Drug Abuse [R21DA058328]. Source: Keck School of Medicine of USC Journal reference: Dai, H. D., et al. (2024). Prevalence of Nicotine Pouch Use Among US Adults. JAMA. doi.org/10.1001/jama.2024.10686. To read the original article click here.

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Low-Dose Ketamine Eases Fentanyl Withdrawal Symptoms

Prevalence of Nicotine Pouch Use Found to be Low Among U.S. Adults