Anesthesiology

The researches find that the ketamine infusion combined with mindfulness-based relapse prevention therapy (MBRP) improves abstinence and cuts cravings in cocaine-dependent adults, new research suggests. Results of a randomize control trial show that rates of abstinence are significiantly higher in patients who receive ketamine plus MBRP compare to control patients. Moreover; those in the group that received ketamine were significantly less likely to experience relapse compare to control persons; and cravings are also significantly lower in the ketamine group throughout the trial.

The ketamine infusion

“In individuals receiving MBRP; a single ketamine infusion led to significantly greater odds of abstinence and delayed the time to first use or dropout; suggesting that a single ketamine infusion promoted engagement with the behavioral treatment and led to better treatment outcomes;” study investigator Elias Dakwar, MD, associate professor of psychiatry; Columbia University Medical Center, New York City, told Medscape Medical News.

“Behavioral modification for substance use disorders may benefit from certain medications; even when they are administer once;” he added. A “promising” line of research focuses on modulating glutamate neurotransmission. The N-methyl-D-aspartate receptor (NMDAR) is the predominant glutamate receptor involve in learn behavior. In animal studies; NMDAR modulators have been shows to disrupt reinforcing effects of cocaine, but such modulators have not shows similar efficacy in human beings.

Glutamate neurotransmission

Ketamine modulates NMDAR but may have additional downstream effects on other neurotransmitter systems, as well as prefrontal synaptogenesis, mechanisms that may be relevant to the treatment of cocaine use disorder. Successful treatment of cocaine use disorder has been undermined by craving, low motivation, and high behavioral reactivity, the authors note. “Efforts at behavioral modifications are challenging for cocaine use disorder, with precarious motivation, craving, reactivity, and fixed perspectives impacting on the ability for people to benefit from behavioral, interventions,” said Dakwar.

“Ketamine may improve many of these vulnerabilities. Further, it may serve as an experiential stepping stone for mindfulness training specifically,” he added. To investigate this hypothesis, the researchers randomly assign 55 individuals who are seeking treatment for cocaine dependence to receive either a 40-minute intravenous infusion of ketamine (0.5 mg/kg) or midazolam(multiple brands) (0.025 mg/kg) in a 5-week trial.

A psychiatric research

Participants are hospitalize in a psychiatric research unit for 5 days. They receive  an infusion on day 2 and MBRP sessions daily from day 2 to day 5. After trial completion, participants were referr to other treatments and are interview by telephone at 6 months. The MBRP focused on cultivating mindfulness, integrating mindfulness into daily life, and promoting application of mindfulness to “addiction-related vulnerabilities” (eg, reactivity in high-risk situations).

During the follow-up clinic visits, which were conducted weekly during weeks 2 through 5, participants completed measurement tools related to vulnerabilities associated with cocaine (eg, craving), mindfulness (using the Five-Facet Mindfulness Questionnaire), and stress sensitivity (the Perceived Stress Scale). Additionally, urine toxicology was performed, and participants were asked to report drug use, using a timeline follow-back method.