Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report.
BACKGROUND
Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal.


METHODS
We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms.


CONCLUSIONS
Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal.
Department of Psychiatry and Addictology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France. laurence.lalanne@chru-strasbourg.fr.|INSERM 1114, Fédération de Médecine Translationnelle de Strasbourg (FTMS), University Hospital of Strasbourg, Strasbourg, France. laurence.lalanne@chru-strasbourg.fr.
Laurence
L
Lalanne
Department of Psychiatry and Addictology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France.
Chloe
C
Nicot
Department of Psychiatry and Addictology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France.
Jean-Philippe
JP
Lang
Department of Psychiatry and Addictology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France.|INSERM 1114, Fédération de Médecine Translationnelle de Strasbourg (FTMS), University Hospital of Strasbourg, Strasbourg, France.
Gilles
G
Bertschy
Centre d'Evaluation et de Traitement de la Douleur, University Hospital of Strasbourg, Strasbourg, France.|Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France.
Eric
E
Salvat
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D000700:Analgesics; D007649:Ketamine
Ketamine; Opioid addiction; Opioid withdrawal; Painkillers