Research team looks at a safer pain management option.
In a systematic literature review of 15 studies that included 2218 adult patients, intravenous (IN) ketamine was found to improve pain, leading researchers to believe that it could be a viable, safe opioid alternative. Their findings were presented at the online American Academy of Pain Medicine (AAPM) 2021 Annual Meeting. Ketamine (Ketalar) is a dissociative drug that is injected and has been on the market in the U.S. since the 1970s.
Ketamine is available in a clear liquid or powder form for intravenous injection or as a nasal spray. It is classified as a Schedule III drug under the Drug Enforcement Administration’s (DEA) Controlled Substances Act, meaning it is not classified as an opioid narcotic or barbiturate. It does come with some risk, however, of being abused and is sometimes smoked with cannabis or tobacco.
Gregg Peterson, a biopharma entrepreneur who co-founded Bexson with psychiatrist Jeffrey Becker, said the dissociative psychedelic has a lower abuse potential than morphine. The company is currently working on a wearable device that administers ketamine for at-home use. “Post-operative pain is one of the leading drivers in the opioid crisis. If you want to move the needle on opioid addiction in America you need to provide a new, non-opioid therapy that patients can go home with that has opioid-level efficacy,” Peterson said. “We think our product will be able to do that.”
IN ketamine study investigator Dr. Anne Hermon of the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, said, “While covering the acute pain service, myself, and my co-author, [Dr. Anisha Nadkarni] noticed how effective intravenous ketamine was in treating acute postoperative pain, even in adult patients with chronic pain who were not opioid naïve. We knew ketamine has multiple routes of administration and wanted to identify whether intranasal ketamine could prove to be a safe and effective alternative to opioids. We did a basic literature search and found that IN ketamine has been used to treat acute pain in multiple settings and patient populations, and we wanted to do a more extensive review.”
A keyword search was first performed, and studies were included in the data if they detailed primary outcomes related to IN ketamine for the management of acute pain, showing promise that it could be use as an opioid alternative. Exclusion criteria “included primary outcomes related to procedural sedation, intraoperative analgesia, neuropathic pain, chronic pain, depression, or other psychiatric problems,” the researchers noted, stating further, “Of the 15 articles that met the inclusion criteria, 12 were prospective randomized control trials, and three were observational studies. The studies included a total of 2218 adolescent and adult patients aged 15 years and older. Ketamine doses ranged from 0.4 mg/kg to 84 mg/kg.”
Hermon was encouraged by the team’s results showing the drug as a potential opioid alternative, saying, “We look forward to seeing prospective randomized control trials comparing IN ketamine to opioids in the post-op and post-discharge period. If such research indicates that IN ketamine effectively reduces pain, there would be reason to explore it as an adjunct or substitute for opioids to manage pain post discharge…In the context of an ongoing opioid epidemic, it is important to identify strategies to mitigate the harm that opioids can cause.”