Elias Dakwar1, Frances Levin2, Richard W Foltin2, Edward V Nunes2, Carl L Hart3. 1. New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: dakware@nyspi.columbia.edu. 2. New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York. 3. New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York; Department of Psychology, Columbia University, New York, New York.
Abstract
BACKGROUND: Cocaine dependence involves problematic neuroadaptations that might be responsive to modulation of glutamatergic circuits. This investigation examined the effects of subanesthetic ketamine infusions on motivation for quitting cocaine and on cue-induced craving in cocaine-dependent participants, 24 hours postinfusion. METHODS:Eight volunteers with active DSM-IV cocaine dependence not seeking treatment or abstinence were entered into this crossover, double-blind trial. Three 52-min intravenous infusions were administered: ketamine (.41 mg/kg or .71 mg/kg) or lorazepam 2 mg, counterbalanced into three orderings in which ketamine .41 mg/kg always preceded the .71 mg/kg dose. Infusions were separated by 48 hours, and assessments occurred at baseline and at 24 hours postinfusion. Outcomes were change between postinfusion and preinfusion values for: 1) motivation to quit cocaine scores with the University of Rhode Island Change Assessment; and 2) sums of visual analogue scale craving ratings administered during cue exposure. RESULTS: Compared with the active control lorazepam, a single ketamine infusion (.41 mg/kg) led to a mean 3.9-point gain in University of Rhode Island Change Assessment (p = .012), which corresponds to an approximately 60% increase over preceding values. There was a reduction of comparable magnitude in cue-induced craving (p = .012). A subsequent ketamine infusion (.71 mg/kg) led to further reductions in cue-induced craving compared with the control. Infusions were well-tolerated. CONCLUSIONS:Subanesthetic ketamine demonstrated promising effects on motivation to quit cocaine and on cue-induced craving, 24 hours postinfusion. Research is needed to expand on these preliminary results and to evaluate the efficacy of this intervention in clinical settings.
RCT Entities:
BACKGROUND:Cocaine dependence involves problematic neuroadaptations that might be responsive to modulation of glutamatergic circuits. This investigation examined the effects of subanesthetic ketamine infusions on motivation for quitting cocaine and on cue-induced craving in cocaine-dependent participants, 24 hours postinfusion. METHODS: Eight volunteers with active DSM-IV cocaine dependence not seeking treatment or abstinence were entered into this crossover, double-blind trial. Three 52-min intravenous infusions were administered: ketamine (.41 mg/kg or .71 mg/kg) or lorazepam 2 mg, counterbalanced into three orderings in which ketamine .41 mg/kg always preceded the .71 mg/kg dose. Infusions were separated by 48 hours, and assessments occurred at baseline and at 24 hours postinfusion. Outcomes were change between postinfusion and preinfusion values for: 1) motivation to quit cocaine scores with the University of Rhode Island Change Assessment; and 2) sums of visual analogue scale craving ratings administered during cue exposure. RESULTS: Compared with the active control lorazepam, a single ketamine infusion (.41 mg/kg) led to a mean 3.9-point gain in University of Rhode Island Change Assessment (p = .012), which corresponds to an approximately 60% increase over preceding values. There was a reduction of comparable magnitude in cue-induced craving (p = .012). A subsequent ketamine infusion (.71 mg/kg) led to further reductions in cue-induced craving compared with the control. Infusions were well-tolerated. CONCLUSIONS: Subanesthetic ketamine demonstrated promising effects on motivation to quit cocaine and on cue-induced craving, 24 hours postinfusion. Research is needed to expand on these preliminary results and to evaluate the efficacy of this intervention in clinical settings.
Authors: Olga Rass; Annie Umbricht; George E Bigelow; Eric C Strain; Matthew W Johnson; Miriam Z Mintzer Journal: Psychol Addict Behav Date: 2014-11-03
Authors: Rafael G Dos Santos; Flávia L Osório; José Alexandre S Crippa; Jordi Riba; Antônio W Zuardi; Jaime E C Hallak Journal: Ther Adv Psychopharmacol Date: 2016-03-18
Authors: M D Scofield; J A Heinsbroek; C D Gipson; Y M Kupchik; S Spencer; A C W Smith; D Roberts-Wolfe; P W Kalivas Journal: Pharmacol Rev Date: 2016-07 Impact factor: 25.468