Friday, February 4, 2022

Is Ketamine treatment addictive?

One question we often hear from patients is “will I become addicted to ketamine during ketamine assisted psychotherapy (KAP) treatment?”

This is an important question with a somewhat complex answer, because addictions themselves are complex and multifactorial. 

Ketamine itself does have addictive potential. The exact instance of how many people become addicted to ketamine per year is generally unknown. The majority of the case reports of people experiencing ketamine addiction are often addicted to other substances as well. Ketamine, when used very frequently, does have physical dependence potential, although it is less than caffeine, alcohol, and marijuana. 

Gable, R. S. (2006)

Ketamine is considered by the FDA to be a schedule III medication. This class of medications is defined as having a “moderate or low potential for physical or psychological dependence.”

Ketamines physical dependance potential exists mostly because of its actions on the dopamine receptor (1).  Generally speaking, most molecules that act on the brains dopaminergic system have at least some degree of addiction potential. While ketamine does have a history of being used in non-medical settings as a recreational substance the chances of becoming addicted to Ketamine that is administered in a clinical setting, the way Transcend utilizes it, are extremely low.

Even given this data, the potential of physical dependence to Ketamine while undergoing KAP is something we take very seriously at Transcend, especially when utilizing KAP to address addiction related issues.

At Transcend, we believe that the risk of dependence to Ketamine can be avoided nearly entirely by ensuring a few factors.

First, session frequency: Generally at Transcend, most patients do one KAP session per week, max two. There are therapeutic reasons for this session frequency, but it also greatly reduces any tolerance to ketamine and the risk for physical dependance.

Second, initial series length: It is always our intention to only do the minimal number of KAP sessions required to help a patient reach sub-clinical levels of distress for their presenting mental health condition. Most of our patients will do 5-6 sessions in their initial series, but if a patient is subclinical after 2-3 then we will begin tapering sessions sooner. We will never do more than 10 sessions in an initial series without reassessing the treatment plan and ensuring that any session beyond 10 is absolutely necessary.

Third, maintenance: Most ketamine infusion clinics maintain therapeutic gains made through ketamine administration by doing “maintenance sessions”. At Transcend, we believe that the vast majority of patients that work with a therapist will likely be able to discharge after an initial series and not need any “maintenance sessions.” This is because unlike the chemical effects of Ketamine, that can be transient in nature, therapeutic gains made through KAP offer longer lasting benefits. When treating chronic pain it is very difficult to maintain the pain reductions ketamine treatment has provided without maintenance infusions. In chronic pain treatment our goal is to continue to taper out maintenance sessions to as infrequent as possible, without losing traction on baseline pain level reduction. Generally speaking, most chronic pain patients seen at Transcend are able to go 30-45 days in between sessions.  Some patients have been able to do maintenance sessions as infrequent at once every 3 months and maintain low baseline pain levels and experience less frequent pain flares.

Fourth, home use ketamine prescriptions: Some ketamine providers prescribe oral or intranasal ketamine to their patients for at home use in between sessions or for ongoing maintenance. Generally, Transcend does not prescribe any at home use of ketamine. This is partly because not taking ketamine in between sessions helps to avoid ketamine tolerance and mitigate the risk of bladder toxicity, but also because Transcend sees Ketamine administration mostly as a tool to enhance the psychotherapy process, not solely as the treatment modality in and of itself.

So far at Transcend, we have not had a patient that has become addicted to ketamine by adhering to these processes. We have, on the contrary, helped many people with alcohol use disorder, problem drinking and some patients with co-morbid substance use disorders alongside treating their presenting mental health condition.

In summary, Transcend as an entity takes the potential risk of addiction to Ketamine very seriously. We would never tell a patient that Ketamine is not addictive. This risk may be low, but it can never be completely eliminated. That being said, with careful consideration of this risk, and going through the KAP process procedurally, this risk can be mitigated greatly.

1 Kapur, S., & Seeman, P. (2001). Ketamine has equal affinity for NMDA receptors and the high-affinity state of the dopamine D2 receptor. Biological psychiatry, 49(11), 954-955.

Is Ketamine treatment addictive?
February 4, 2022
Will Ratliff
Director of Operations