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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Ten Medical and Scientific Breakthroughs of 2021 at Mount Sinai

AHA Publisher — Tue, 04 Jan 2022 08:00:25 +0000

Mount Sinai Health System via Newswise 1. Ketamine Infusions Found Promising for PTSD A team of researchers led by Dennis Charney, MD, Dean of the Icahn School of Medicine, and Adriana Feder, MD found that repeated intravenous ketamine infusions appeared efficacious in reducing symptom severity among individuals with chronic PTSD. Their study was published in The American Journal of Psychiatry. “We want people suffering with PTSD to know that hope is on the horizon, and we are working diligently to collect the information that will help bring them the relief they so desperately need,” said Dr. Feder. Speech Changes Predictor of Schizophrenia Risk Researchers hope to use speech changes to predict which adolescents and young adults are at high risk for schizophrenia and may go on to develop the disease. In a new study published in The Lancet journal E Clinical Medicine found that the artificial intelligence program predicted, with 75 percent accuracy, who would get Alzheimer’s disease. Cheryl Corcoran, MD, explains, “It’s been a lot of small studies finding the same signals.” At this point, she said, “We are not at the point yet where we can tell people if they are at risk or not.” First Successful Trachea Transplant Eric Genden, MD, and Sander Florman, MD, led a large team to perform the first successful transplant of a trachea, giving hope for patients throughout the world and future treatments of those who have been on ventilators. Dr. Genden said, “Although it seemed like a pretty straightforward thing, because at first sight it seems just like a tube, it turns out it’s a highly complex organ system. New Cancer Vaccine a Game Changer for Young and Old Patients Thomas Marron, MD, PhD, is developing a personalized cancer vaccine that was tested in a phase one trial. Dr. Marron and a lung cancer patient in the trial, a 74-year-old retired attorney, discussed the promising outcomes in a news report. “The cancer vaccines try to teach your immune system how to recognize your cancer and eliminate it,” Dr. Marron said. “Our initial data suggest that, after getting all 10 vaccines, patients can be very strongly immunized against their cancer.” Apple Watch Used to Measure Resilience in Health Care Workers A new study led by Robert Hirten, MD, and Zahi Fayad, PhD, published in the Journal of Medical Internet Research, shows how using wearable devices can track health care worker resiliency during the pandemic. Researchers from Mount Sinai gave 361 health care workers from seven hospitals across New York City Apple Watches to measure their heart rate. The study’s participants also downloaded a customized app to complete surveys each week that measured resilience, emotional support, stress, optimism and quality of life. Dr. Fayad said, “The experience of this pandemic has been especially stressful for health care workers, and as a community we need to be able to support them, especially as the virus persists. Our study is one of the first to document not only the toll the pandemic has taken on our health care workers, but also the importance of resilience and social support as specific paths toward efficiently and effectively directing support.” Launch of Department of Artificial Intelligence and Human Health Thomas Fuchs, DSc, and Dennis Charney, MD, Dean of the Icahn School of Medicine, announce the first-of-its-kind Artificial Intelligence and Human Health Department at the Mount Sinai Health System. Dr. Fuchs said, “If you are serious about this, then computer scientists have to work together with the physicians in the trenches. One reason why big tech has failed in health care is that even with all their talent, if you’re just throwing artificial intelligence over the fence into a hospital, that doesn’t work. It has to come out of systems like ours.” COVID-19 Vaccine Less Protective for Multiple Myeloma Patients A new study led by Samir Parekh, MBBS, and published in the journal Cancer Cell shows how COVID-19 vaccines may be less protective for multiple myeloma patients. “[This research] suggests that booster shots are looking extremely promising for people with multiple myeloma,” said Dr. Parekh. “Patients who haven’t received them should do that immediately.” Long COVID Has Long-Lasting Impact A study published in the American Journal of Physical and Rehabilitation Medicine and led by David Putrino, PhD, showed that the impact on everyday functioning in patients with long COVID lasted at least a year after initial infection. “Our work and the work of others has shown that this affects people’s abilities to make plans, synthesize information, and do their daily activities of work,” said Dr. Putrino. “They suffer from a lot of memory loss and inability to form new memories, as well as difficulty with speaking. This is a very debilitating condition with serious cognitive conditions.” Cannabis Use in Pregnancy Women who use cannabis during their pregnancies could be putting their children at risk of developing mental health and behavioral problems, according to a new study by Yasmin Hurd, PhD, and published by the journal Proceedings of the National Academy of Sciences. “I do think that pregnant women and their physicians need to have more discussions about cannabis use, just like they have in terms of alcohol,” said Dr. Hurd. “Then they need to be given the resources to be able to get help for themselves and their children. This is not about stigmatizing women. It’s the opposite. It’s about the more knowledge you have, the more power you have.” Lung Cancer Screening Saves Lives Early detection and the increased use of screening for lung cancer are saving lives, according to a study published on JAMA Network Open. Screening patients using CT scans and following up on potential cancers helps physicians identify precancerous and early cancer tissue growth to surgically remove, leading to a decline in lung cancer deaths, Mount Sinai Health System researchers report. Raja Flores, MD, the study’s lead author and Chair of Thoracic Surgery at the Mount Sinai Health System, said, “If we find lung cancer early, we can cure it with surgery. Early screening is the key.” To read the original article click here.

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Low-Dose Ketamine Eases Fentanyl Withdrawal Symptoms

Ten Medical and Scientific Breakthroughs of 2021 at Mount Sinai