A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial.
Elias Dakwar, E. Nunes, C. Hart, Richard W Foltin, S. Mathew, K. Carpenter, C. J. Choi, Cale N. Basaraba, M. Pavlicova, Frances R. Levin
American Journal of Psychiatry June 24, 2019 DOI: 10.1176/appi.ajp.2019.18101123 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 55 |
| Population | Cocaine-dependent adults |
| Interventions | Ketamine Midazolam |
| Dose | 0.5 mg/kg |
| Duration | 5-week course of mindfulness-based relapse prevention; 5-day inpatient stay; end-of-study assessment at 2 weeks post-infusion for abstinence outcome |
| Topics | Addiction Esketamine Ketamine Meditation |
| Citations | 179 |
| Key findings | A single ketamine infusion significantly increased abstinence and reduced relapse risk and craving in cocaine-dependent adults engaged in mindfulness-based relapse prevention. |
Abstract
Objective: Research has suggested that subanesthetic doses of ketamine may work to improve cocaine-related vulnerabilities and facilitate efforts at behavioral modification. The purpose of this trial was to test whether a single ketamine infusion improved treatment outcomes in cocaine-dependent adults engaged in mindfulness-based relapse prevention.
Methods: Fifty-five cocaine-dependent individuals were randomly assigned to receive a 40-minute intravenous infusion of ketamine (0.5 mg/kg) or midazolam (the control condition) during a 5-day inpatient stay, during which they also initiated a 5-week course of mindfulness-based relapse prevention. Cocaine use was assessed through self-report and urine toxicology. The primary outcomes were end-of-study abstinence and time to relapse (defined as first use or dropout).
Results: Overall, 48.2% of individuals in the ketamine group maintained abstinence over the last 2 weeks of the trial, compared with 10.7% in the midazolam group (intent-to-treat analysis). The ketamine group was 53% less likely (hazard ratio=0.47; 95% CI=0.24, 0.92) to relapse (dropout or use cocaine) compared with the midazolam group, and craving scores were 58.1% lower in the ketamine group throughout the trial (95% CI=18.6, 78.6); both differences were statistically significant. Infusions were well tolerated, and no participants were removed from the study as a result of adverse events.
Conclusions: A single ketamine infusion improved a range of important treatment outcomes in cocaine-dependent adults engaged in mindfulness-based behavioral modification, including promoting abstinence, diminishing craving, and reducing risk of relapse. Further research is needed to replicate these promising results in a larger sample.