A single ketamine infusion combined with mindfulness-based therapy shows promise in treatment of cocaine addiction

A single infusion of ketamine combined with mindfulness-based addiction treatment shows promise in the treatment of cocaine dependence, according to a new clinical trial published in The American Journal of Psychiatry.

Ketamine, an anesthetic also known by its party drug name Special K, has been shown to produce rapid and lasting improvements in patients with treatment-resistant major depression. In March of this year, the U.S. Food and Drug Administration approved a nasal spray formulation of ketamine — called esketamine.

The researchers were interested in whether ketamine could enhance the effectiveness of mindfulness-based relapse prevention therapy (MBRP) for cocaine addiction.

“Interestingly, mindfulness practices are thought to provide benefit via neural mechanisms similar to those attributed to subanesthetic ketamine, including the regulation of mesolimbic functioning, the promotion of prefrontal neural plasticity and synaptogenesis, and sustained modulation of default-mode network hyperconnectivity,” the researchers explained.

In the study, 55 individuals seeking treatment for cocaine dependence were randomly assigned to receive either an intravenous infusion of ketamine or of the sedative midazolam. The participants then completed about 5 weeks of mindfulness-based relapse prevention therapy.

The researchers found that participants who received ketamine tended to have a lower likelihood of cocaine use and lower levels of cocaine craving. About half of the participants who received ketamine maintained abstinence over the last 2 weeks of therapy, compared to about 10% who received midazolam.

During a 6-month follow-up, 44% of the participants in the ketamine group reported that they were abstinent, while none of the participants who received midazolam reported abstinence.

“Ketamine was effective at providing individuals already engaged in mindfulness-based behavioral modification with significantly greater odds of maintaining abstinence, substantial protection from relapse and craving, and lower likelihood of cocaine use. These sustained benefits, in some cases lasting several months, suggest the potential of ketamine for effecting long-term behavioral changes,” the researchers wrote in their study.

But like all research, the study includes some limitations. For instance, the researchers did not compare the effects of ketamine alone to the effects of ketamine combined with mindfulness-based relapse prevention.

“It is conceivable, although unlikely based on previous work, that ketamine might have led to these results in the absence of any behavioral treatment,” the researchers said. They hope additional research will replicate the findings in a larger study.

The study, “A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial“, was authored by Elias Dakwar, Edward V. Nunes, Carl L. Hart, Richard W. Foltin, Sanjay J. Mathew, Kenneth M. Carpenter, C.J. “Jean” Choi, Cale N. Basaraba, Martina Pavlicova, and Frances R. Levin.