As overdose rates rise, governments seem more willing to loosen drug restrictions, than to find actual workable solutions. Opioids are responsible for the biggest number of these deaths and the numbers only grow more each year. What if a possible answer already exists, and we’re simply not being told about it? When it comes to opioids, the issue of pain is integral, and the question of ketamine vs opioids for modern treatment, is a thing. So how does ketamine compare to opioids for pain management, and can it be a substitute?
The opioid issue is getting to a fever pitch, and the question of ketamine vs opioids is gaining prominence, and for a good reason. We’re an independent news site focusing on the growing cannabis and psychedelics fields going on today. Keep up with everything by subscribing to the THC Weekly Newsletter, which is also a great source for deals on items like cannabinoid products including HHC-O, Delta 8, Delta 9 THC, Delta-10 THC, THCO, THCV, THCP & HHC. Check out all your choices, and make sure to make the best purchase possible.
Opioids and the overdose toll
We’ve been talking about it for years now. How every year more and more people overdose on drugs, with the grand majority doing so on synthetic opioids. Opioids are a class of synthetically made drugs based on the opium plant. These are unlike the natural components taken out of the plant which are called opiates. Opiates are compounds like codeine or morphine. Opioids are represented by drugs like fentanyl and oxycodone.
Opioids attach to receptors in the central and peripheral nervous systems, and in the gastrointestinal tract. There are three main opioid receptor classes: μ, κ, δ (mu, kappa, and delta), though a total of 17 are known. Opioids are primarily used as pain relievers and anesthetics. They are also prescribed medically for issues like diarrhea and cough suppression.
Users experience an intense euphoria on opioids, which often leads to a sedation and a semi-unconscious state. Opioids are respiratory depressants, which is the main reason they cause so many deaths, as its easy to overdose on them. This happens a lot when tolerance to the euphoria or pain-killing effects increases, leading users to need more and more to get high. Other effects of the drugs include itchiness, nausea, confusion, and constipation.
Opioids can be deadly on their own, but become that much more dangerous when mixed with other drugs, particularly other drugs with a depressant effect. It’s common for overdose victims to have drugs like alcohol or benzodiazepines in their system as well. Alcohol is commonly mixed with other drugs (probably because of its own prevalence in society), and benzodiazepines are often used with opioids to combat the sickness they bring on.
In terms of where we are with overdoses, the latest numbers come from a CDC release on May 11th, 2022. These preliminary numbers show an overdose total of 107,622 for the year 2021. This number includes all drug overdose deaths, with no specific number given for opioid deaths. How do we therefore know the majority are opioid related? Well, we know that in 2020 there were 93,000 overdose deaths, and that there were 73,000 in 2019. We also know that of the 73,000 from 2019, 48,000 were from synthetic opioids, and that 68,000 of 2020’s numbers were related to synthetic opioids as well. It stands to reason that well over 70,000 of 2021’s overdoses, were due to these medications.
One of the big problems with the current crisis, is that its not just about getting people off of a drug they’re addicted to, but providing an ongoing way to handle the issue that got them addicted in the first place. If people are experiencing pain, and using opioids to treat their pain issue, it’s hard after acclimation to a working treatment, to not offer something else. Perhaps if a patient is never given such a medication, they may be fine without it. However, after acclimating a patient to a medication, it can create a situation where they now need it and its expected effects.
Obviously, people have undergone and withstood extreme pain for millennia without the help of synthetic opioids, so there is really no case to continue their use under the circumstances of their danger. However, the question of how to get people off these highly addictive medications still remains. And one of the best answers, is sadly not only not being used, but is barely mentioned at all. And this despite the skyrocketing death toll.
Ketamine is a dissociative hallucinogen created by Parke Davis Pharmaceutical company in 1962 and cleared by the FDA for use as an anesthetic in 1970. Though it was understood from preliminary testing on prisoners that ketamine could treat acute pain, and without the death toll of drugs like opioids, the FDA never officially cleared it for this purpose. It was, however, subsequently used on the fields of Vietnam, if this is any indication of its actual abilities.
Ketamine is legal for off-label use, and this has spawned a gray-market ketamine industry, whereby ketamine is prescribed and administered by doctors in medical clinics. In these settings, the ketamine is used for any purpose the prescribing doctor sees fit, and has become a new mainstay for the treatment of both pain, and psychological issues like depression.
Ketamine vs opioids
Alright, so they’re both painkillers, but the most important question in the conversation of ketamine vs opioids, is can ketamine work for the same things? After all, it wouldn’t make sense to try to replace one drug, with another that can’t help in the same way. Luckily, there is already research into this exact question, and the results look promising for ketamine use in place of opioids.
In 2020 a review was published called Ketamine vs Opioids for Acute Pain in the Emergency Department. The review looked at 870 adult patients who ended up in emergency rooms with acute pain. In all cases the pain could have been trauma or non-trauma related. The patients came from two meta-analyses, in which 11 trials were done in total. Pain measurements were made using the VAS – Change in Visual Analog Scale.
Of the two meta-analyses, Karlow et al. contained trials that directly compared “a sub-dissociative intravenous dose of ketamine with a single IV dose of opioid/opiate analgesia.” While ketamine was related to more adverse effects (e.g. agitation, hallucination, dysphoria, and confusion), the only life-threatening event was associated with morphine.
The other main part of the review came from the Ghate et al. systematic review which compared “low-dose ketamine with opioids in adults with acute pain in the ED.” The eight studies looked at included a total of 609 patients. The review found that “Both low-dose ketamine (dose range: 0.1-0.6 mg/kg IV/SC/IM) and morphine (dose: 0.1 mg/kg IV or 0.5 mg hydromorphone IV) appeared to provide some level of analgesia in individual studies (compiled data was not reported), but no significant difference was demonstrated between the two agents.” This review also found more adverse effects with the ketamine, but nothing life-threatening.
Between these two separate reviews, the authors concluded that “ketamine appears to be comparable to opioids for acute pain control.” They did stipulate that there were several limitations to the studies done, including comparing single doses rather than longer term treatment. They end by saying more research into the matter should be done.
As emergency rooms are a great place to try out pain medications, yet another emergency room piece of research backs up the efficacy of ketamine in comparison to opioids. A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department, looked at whether low dose ketamine is a safe and effective alternative to opioids in an emergency situation. The review covers randomized controlled trials which compare intravenous opioids to low dose ketamine.
As per the usual, more adverse reactions were seen with ketamine treatment, but none were deadly. The authors concluded “Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short-term pain control.”
Another interesting piece of research came out in 2019, and is called Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial. The study examined intranasal ketamine vs intranasal fentanyl, specifically in children with pain in their extremities. The study included 90 children, half of whom were given ketamine, and the other half fentanyl.
Study authors found “Ketamine was noninferior to fentanyl for pain reduction based on a 1-sided test of group difference less than the noninferiority margin.” As with previously mentioned studies, there were more adverse effects in the ketamine group, but all effects were minor and went away quickly. The study authors concluded:
“Intranasal ketamine may be an appropriate alternative to intranasal fentanyl for pain associated with acute extremity injuries. Ketamine should be considered for pediatric pain management in the emergency setting, especially when opioids are associated with increased risk.”
What about chronic pain?
Emergency rooms are a great example of looking at the comparison of ketamine vs opioids for acute pain issues. But what about ketamine for chronic pain? Acute pain represents pain that’s intense and happening right now. Chronic pain denotes a pain issue whereby pain is experienced on a long term basis. Think of the difference between the pain of a standard broken arm, and pain from an ongoing bad back.
One of the interesting things found in this review, Ketamine for chronic pain: risks and benefits, is that ketamine treatment for at least some kinds of pain, can last way past the time of treatment. In fact, the review, which references several studies, says “Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion.”
They conclude, “Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain.” Though the authors make a good point about needing more info, in this study, as per the rest, all adverse reactions were minimal. The main issues of concern brought up were around “CNS, haemodynamic, renal and hepatic symptoms,” though how much of an issue these actually are, is not very clear. Deaths did not come up at all.
Though indeed more research should be done, that several investigations have turned up this ability for such long-lasting effects from shorter treatment regimens, is not only incredible in general, but makes ketamine that much more of a better option vs opioids in the current situation. While we don’t know the extent that ketamine can do this, we do already know for sure that opioids will never last longer than the immediate time frame they are given in.
Another systematic review, Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials investigated “the effectiveness of IV ketamine infusions for pain relief in chronic conditions”, in order to “determine whether any pain classifications or treatment regimens are associated with greater benefit.” To do this, the researchers used Medline, Embase, Google Scholar, and clinicaltrials.gov to gather information. They used “randomized control trials comparing IV ketamine to placebo infusions for chronic pain that reported outcomes for ≥48 hours after the intervention.”
The results? Three of the seven studies usable for the review showed “significant analgesic benefit favoring ketamine, with the meta-analysis revealing a small effect up to 2 weeks after the infusion”, backing up the idea of long-term effects from short-term use. They also found “In the 3 studies that reported responder rates, the proportion with a positive outcome was greater in the ketamine than in the placebo group.”
According to the authors, “IV ketamine is effective for a wide array of chronic pain conditions, although the benefits dissipate with time.” How long? “Use of IV ketamine resulted in a reduction in pain scores between 48 hours and 2 and 8 weeks after the infusion, but the pooled difference in pain reduction at 4 weeks fell shy of significance.” As in, on average, the effects lasted up to about four weeks, but became less significant at that point. When you think about it though… up to four weeks of chronic pain relief with a non-lethal option, sounds pretty damn awesome. Especially in the current situation.
There’s still plenty to learn, and plenty to research, but when it comes to ketamine vs opioids, one of the most important things to consider, is that one causes mass death, and one doesn’t. Evidence shows ketamine as noninferior in terms of both acute pain and chronic pain, and unlike with opioids, it has the ability to reduce pain for weeks after administration, at least in some cases. What with the awfulness of the opioid epidemic going on, once again I have to ask, why isn’t ketamine being substituted for opioids, immediately!?
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