Intravenous Ketamine in the Treatment of Substance Use Disorder

Background: Substance use disorders (SUD) represent a critical public health issue, significantly contributing to global morbidity and mortality. Traditional pharmacotherapies for SUD have limited efficacy, necessitating innovative treatment approaches. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has shown promise beyond its anesthetic and analgesic uses, demonstrating potential therapeutic effects in SUD management. Objective: This study explores the efficacy of intravenous ketamine as a therapeutic intervention for SUD, including alcohol, opioids, cocaine, and other substances. Methods: A comprehensive review of clinical trials conducted in preclinical studies essential to assessing the potential effects of intravenous ketamine on various SUDs. The review focused on ketamine's impact on withdrawal symptoms, cravings, abstinence rates, and overall treatment outcomes across different substances. Results: Studies indicate that ketamine infusions, combined with psychological therapies, significantly increase abstinence days and reduce alcohol intake. Ketamine also appears effective as an adjunctive treatment for benzodiazepine-resistant alcohol withdrawal. Clinical trials reveal that ketamine can alleviate withdrawal symptoms and reduce cravings. High-dose ketamine administration showed a sustained reduction in craving and increased abstinence rates compared to lower doses. Ketamine treatment significantly reduces cocaine-seeking behavior and cravings in both preclinical and clinical settings. Participants reported reduced cocaine consumption and cravings post-infusion, with effects lasting up to several weeks. Preliminary studies also suggest ketamine's potential in reducing nicotine self-administration and aiding cannabis use disorder treatment when combined with behavioral therapies. Conclusion: Intravenous ketamine shows promise as a treatment for various substance use disorders by reducing cravings and withdrawal symptoms and promoting abstinence. However, further research with larger sample sizes and extended follow-up periods must confirm these findings and establish ketamine's long-term efficacy and safety in SUD treatment.