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

A systematic review of pharmacological treatments for ketamine use disorder found only 12 studies (368 participants), including 1 controlled trial, 2 retrospective case series, and 9 case reports. All evidence was very low quality, with only descriptive outcomes reported. Benzodiazepine regimens and haloperidol showed potential utility for managing intoxication and withdrawal, while naltrexone, lamotrigine, and a combination of paliperidone palmitate and bupropion were reported as potentially useful for craving and relapse prevention. The review highlights a severe lack of rigorous research, with benzodiazepine regimens appearing most promising for future investigation in intoxication and withdrawal.

Study at a glance

Abstract

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. 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. 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. 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.