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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Acupuncture Reduces Pain and Opioid Use for Total Knee Replacement Surgery Patients

AHA Publisher — Tue, 12 Oct 2021 07:00:31 +0000

American Society of Anesthesiologists (ASA) via Newswise – SAN DIEGO – Patients who have acupuncture during total knee replacement surgery report less pain and need far fewer opioids to manage their discomfort, according to a study being presented at the ANESTHESIOLOGY® 2021 annual meeting. Results of the study showed that 65% of patients who received acupuncture during surgery achieved a low-dose or opioid-free postoperative experience, compared to 9% of patients outside of the study. “Total knee replacements are one of the most common operative procedures in the United States and often very painful, so there’s a great need to explore non-opioid pain relief techniques for this type of surgery,” said Stephanie Cheng, M.D., DABMA, lead author of the study and assistant attending anesthesiologist at the Hospital for Special Surgery and assistant professor of clinical anesthesiology at Weill Cornell Medicine, both located in New York City. “Acupuncture is extremely safe and can help reduce pain with few unwanted side effects, but it has not been well researched as part of surgical anesthesia.”The study included 41 patients undergoing primary total knee replacement at the Hospital for Special Surgery. All patients received the institution’s standard opioid-sparing multimodal analgesic protocol, with the addition of electroacupuncture — a modified form of traditional acupuncture that applies a small electric current to thin needles that are inserted at known acupuncture points on the body. The acupuncture was administered during surgery by Dr. Cheng, who is board-certified in medical acupuncture, to eight specific points in the ear to provide targeted pain relief in the knee. With the addition of acupuncture, the majority of patients had a significant reduction in postoperative opioid use, compared to historical controls. Sixty-five percent of patients maintained a low-dose opioid regimen of 15 oxycodone pills or less (57.5%) or remained completely opioid-free (7.5%) from induction of anesthesia to 30 days after surgery. Historically, only 9% of patients outside of the study maintained a low-dose or opioid-free regimen post-surgery. All patients studied discontinued opioid use after 30 days following surgery. “Our study shows that if a trained medical acupuncturist is available to perform acupuncture in the operating room, it can help patients with postoperative pain recovery,” said Dr. Cheng. “Most studies fail to incorporate nontraditional techniques, such as acupuncture, to help decrease the dependance on opioid medications for postoperative pain control.” In the context of the opioid epidemic, achieving low-dose perioperative opioid consumption is critical to reducing the risk of long-term opioid use in patients. With acupuncture being commonly used outside of the hospital as an effective therapy for pain management and treatment for a range of health issues and symptoms, it’s time to consider its benefits inside the hospital as well, Dr. Cheng said. “Additional research is needed to further define acupuncture’s effects and encourage its use in all aspects of disease treatment.” To read the original article click here.

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Low-Dose Ketamine Eases Fentanyl Withdrawal Symptoms

Acupuncture Reduces Pain and Opioid Use for Total Knee Replacement Surgery Patients