The Pharmacological Management of Ketamine Use Disorder: A Systematic Review.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI:10.1097/ADM.0000000000001340
Emmert Roberts, Elizabeth Sanderson, Irene Guerrini
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Abstract

Objectives: There has been limited evidence synthesis examining treatment of ketamine use disorder. We aimed to conduct a systematic review to assess the efficacy and tolerability of pharmacological interventions in the management of ketamine use disorder.

Methods: We searched MEDLINE, EMBASE, PsychINFO, and CENTRAL (Cochrane Central Register of Controlled Trials) from database inception to November 14, 2023, for studies of any design that reported on any pharmacological intervention in the management of ketamine use disorder. We extracted any reported measure of efficacy or tolerability and assessed outcome quality using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. We planned to combine outcomes using random-effects meta-analysis, where this was not possible results were reported narratively.

Results: Twelve studies met the inclusion criteria reporting on 368 participants. These comprised 1 controlled trial, 2 retrospective case series, and 9 case reports. Two studies reported on ketamine intoxication, 6 on withdrawal, and 4 on craving/relapse prevention. All studies reported only descriptive outcomes, and all evidence was of very low quality. Benzodiazepine regimens and haloperidol were reported to have potential utility in intoxication and withdrawal, whereas naltrexone, lamotrigine, and a combination of paliperidone palmitate and bupropion were reported to have potential utility in craving/relapse prevention.

Conclusions: There is a paucity of research into pharmacological management of ketamine use disorder. The limited very low-quality evidence suggests benzodiazepine regimens may be most salient for future exploration in management of ketamine intoxication and withdrawal, whereas case reports suggest naltrexone, lamotrigine, and paliperidone palmitate plus bupropion may potentially merit further investigation with regard to craving/relapse prevention.

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氯胺酮使用障碍的药物治疗:系统性综述。
目的:有关氯胺酮使用障碍治疗的证据综述十分有限。我们旨在开展一项系统性综述,评估药物干预治疗氯胺酮使用障碍的疗效和耐受性:我们检索了MEDLINE、EMBASE、PsychINFO和CENTRAL(Cochrane对照试验中央注册中心)从数据库建立到2023年11月14日期间的资料,以查找在氯胺酮使用障碍的治疗中报告任何药物干预的任何设计的研究。我们提取了所有报告的疗效或耐受性指标,并采用 GRADE(建议评估、开发和评价分级)框架对结果质量进行了评估。我们计划采用随机效应荟萃分析法合并研究结果,如果无法合并,则以叙述方式报告结果:有 12 项研究符合纳入标准,报告了 368 名参与者的情况。其中包括 1 项对照试验、2 项回顾性系列病例和 9 项病例报告。2 项研究报告了氯胺酮中毒情况,6 项报告了戒断情况,4 项报告了渴求/复吸预防情况。所有研究都只报告了描述性结果,所有证据的质量都很低。据报道,苯二氮卓类药物治疗方案和氟哌啶醇对氯胺酮中毒和戒断有潜在作用,而纳曲酮、拉莫三嗪和帕利哌酮棕榈酸酯与安非他酮的组合对渴求/复吸预防有潜在作用:关于氯胺酮使用障碍的药物治疗研究很少。有限的极低质量证据表明,苯二氮卓类药物治疗方案可能是今后探索氯胺酮中毒和戒断管理的重点,而病例报告表明,纳曲酮、拉莫三嗪和帕利哌酮棕榈酸酯加丁丙酮可能在渴望/复吸预防方面值得进一步研究。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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