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Buprenorphine is a crucial medicine for many patients in treatment for opioid use disorder (OUD). But with the rise of deadly fentanyl, buprenorphine is becoming much harder to use effectively. That’s where another medicine, ketamine, is showing immense promise.
The entrance of fentanyl into the U.S. illicit drug supply has had many tragic results. Topping that list is an explosion of opioid-related deaths, now at over 80,000 a year. But another serious consequence is the increasing difficulty of applying some of the most effective medicines for the disorder.
Buprenorphine, widely used to help patients overcome craving and physical dependency on opioids, is far less potent that fentanyl. Consequently, many of those attempting to use buprenorphine have suffered exceptionally painful and traumatic symptoms known as “precipitated withdrawal.” The step down from fentanyl to buprenorphine, it appears, is often simply too great—so great that many OUDS suffers quit using buprenorphine altogether.
Enter ketamine, an anesthetic with moderate hallucinogenic properties. Recently, doctors in several West Coast locations have discovered that very small doses of ketamine administered alongside buprenorphine have greatly decreased, or even eliminated, those excruciating symptoms of withdrawal. The results are preliminary but striking. Ketamine also has the advantage of being relatively well-studied and widely-used surgical drug. If the good results continue to accumulate, access to ketamine should be far easier and more widespread than for experimental medications.
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