From the Department of Clinical Pharmacy, Gelre Hospitals, Apeldoorn.
Novadic-Kentron Addiction Care Network, Sint-Oedenrode, The Netherlands.
J Clin Psychopharmacol. 2020 May/Jun;40(3):300-304. doi: 10.1097/JCP.0000000000001191.
PURPOSE/BACKGROUND: Ketamine (K) is used as a party drug with hallucinogenic properties with a half-life of about 2.5 hours. Data are available with respect to the detection window (ie, when a person is still tested positive for the drug and/or metabolite after use) of K after single use. Nevertheless, no data are available with respect to the detection window of K in urine after chronic use.
METHODS/PROCEDURES: This retrospective case series describes 7 patients with K dependency as their main addiction who have been admitted to an addiction center for K detoxification. Their abstinence-oriented care involved routine urinary screening of K and its metabolites, as well as traditional drugs of abuse, such as cocaine and cannabinoids.
FINDINGS/RESULTS: Urine samples remained positive for all the cases identified after 22 to 96 days. A peak detection period of 61, 40, and 96 days for K, norketamine, and dehydronorketamine, respectively, measured using liquid chromatography-tandem mass spectrometry at a cutoff concentration of 1.0 ng/mL, is defined. The K/norketamine and K/dehydronorketamine ratios varied over time between 0.33 and 3.06, and 0.01 and 0.36 for all patients, respectively, implying a large interindividual variation in K metabolism.
IMPLICATIONS/CONCLUSIONS: Ketamine and its metabolites have a prolonged excretion profile in urine, which requires frequent measurements (at least weekly) to guide abstinence treatment. Further research is needed to develop an algorithm that can differentiate new K use from residual urinary K excretion in urine of chronic daily users.
目的/背景：氯胺酮（K）作为一种具有致幻特性的派对药物使用，半衰期约为 2.5 小时。有关于单次使用后 K 的检测窗口（即，在使用后，一个人仍被检测出药物和/或代谢物呈阳性）的数据。然而，关于慢性使用后尿液中 K 的检测窗口尚无数据。
方法/程序：本回顾性病例系列描述了 7 名以 K 依赖为主要成瘾的 K 成瘾患者，他们已被收治到成瘾中心进行 K 脱毒治疗。他们以戒断为导向的护理包括常规的尿液 K 及其代谢物筛查，以及传统的滥用药物，如可卡因和大麻素。
结果/发现：在 22 至 96 天后，所有鉴定出的病例的尿液样本仍呈阳性。使用液相色谱-串联质谱法，在 1.0ng/mL 的截止浓度下，分别定义 K、去甲氯胺酮和去氢去甲氯胺酮的峰值检测期为 61、40 和 96 天。所有患者的 K/去甲氯胺酮和 K/去氢去甲氯胺酮比值在 0.33 到 3.06 之间，在 0.01 到 0.36 之间变化，表明 K 代谢存在个体间的巨大差异。
氯胺酮及其代谢物在尿液中的排泄时间较长，需要频繁测量（至少每周一次）以指导戒断治疗。需要进一步研究以开发一种算法，以区分慢性每日使用者尿液中新的 K 使用和残留的尿液 K 排泄。
