Ketamine Infusion Experiences Among Medical Inpatients with Alcohol Use Disorder: Initial Findings of a Pilot RCT

Background: Early evidence suggests that a single ketamine infusion can reduce alcohol intake, with effects that last beyond its direct chemical action (Dakwar, Levin, et al. 2019). A medical hospital admission is an opportune moment to administer this intervention.

Methods: Our open-label, pilot trial (target n=45-60) randomizes patients with alcohol use disorder (AUD) to receive extended-release naltrexone, intravenous ketamine (0.5mg/kg over 40 min), or neither prior to discharge. All three study arms receive enhanced linkage to addiction clinic. We present baseline and intervention data related to those who randomize to the ketamine arm. Quantitative data include demographics, clinical characteristics, Clinician Administered Dissociative States Scale (CADSS, 23-item version, score 0-92), changes in pre-/post-infusion vital-signs and physical symptoms, and acceptability (10-point Likert scale). Qualitative data are derived from an open-ended reflection question asked post-infusion.

Results: For this abstract, the ketamine arm includes ten patients. They are 70% male with mean age 45.7 years-old. Clinical characteristics: mean daily drinks 6.8, mean PHQ9 score 14.4 (of 27), median past-year ED visits 9.5, with median 4.5 of those visits resulting in admission. Blood pressures temporarily increased at infusion completion. No clinically significant, immediate adverse events were observed. Mean CADSS score is 21.5. Mean pre-discharge acceptability score is 9.3. Four of the five that presented in-person to follow-up rated acceptability as 10. Qualitative data regarding infusion experiences are presented, including direct quotations such as: “it was…mesmerizing.”

Discussion: This population appears to be high acuity in terms of depression and hospital utilization. All participants had an overall positive infusion experience along with some symptoms of dissociation. In a study of ketamine for cocaine use, Dakwar, Nunes et al. (2019) reported a median CADSS score of 22, similar to our results. Among a similar safety-net patient population, Collins et al. (2015) administered XR naltrexone; median acceptability was 6 (of 10) at study conclusion.

Conclusion: In this pilot trial, ketamine appears safe and acceptable among high-utilization patients with AUD in the hospital setting. If efficacious, it is well suited as an initial intervention to engage these patients in treatment prior to discharge.

 

Collins SE. et al. 2015. “Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People with Alcohol Dependence.” Substance Abuse 36(1): 21–33.

Dakwar E, Nunes EV, et al. 2019. “A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial.” The American Journal of Psychiatry 176(11): 923–30.

Dakwar E, Levin F, et al. 2019. “A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial.” The American Journal of Psychiatry: appiajp201919070684.