Janssen-Aguilar Reinhard, Meshkat Shakila, Demchenko Ilya, Zhang Yanbo, Greenshaw Andrew, Dunn Walter, Tanguay Robert, Mayo Leah M, Swainson Jennifer, Jetly Rakesh, Bhat Venkat
Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Subst Use Addict Treat. 2025 Aug;175:209705. doi: 10.1016/j.josat.2025.209705. Epub 2025 May 3.
Substance Use Disorders (SUDs) involve diminished control, risky use, impaired social interactions, and physical dependence. Despite their global prevalence and burden, treatment options remain limited. Ketamine (KET), an NMDA receptor antagonist, may aid SUD treatment by modulating glutamatergic neurotransmission. This systematic review evaluates KET's role in SUD treatment.
This review surveyed three databases until June 2024, including 14 studies with 551 participants.
Among the 14 studies, 6 focused on alcohol, 3 on cocaine, 4 on opioids, and 1 on cannabis. Seven studies (50 %) combined KET with psychotherapy, while seven (50 %) focused solely on KET's pharmacological effects. KET dose ranges varied from 0.11 mg/kg to 2.0 mg/kg and study primary endpoints ranged from less than a day to two years. The results of the included studies demonstrated KET's efficacy across various SUDs. In Alcohol Use Disorder (AUD), KET reduced withdrawal symptoms and benzodiazepine requirements. In Cocaine Use Disorder (CUD), KET decreased craving and increased abstinence rates. In Opioid Use Disorder (OUD), high-dose KET psychotherapy (KPT) improved abstinence and reduced craving. In Cannabis Use Disorder (CNUD), KET reduced weekly use and increased abstinence confidence.
Conclusion: While preliminary studies suggest that KET may have short-term benefits in treating SUDs, the evidence remains limited by small sample sizes and a lack of randomized trials. Further research with larger, well-controlled studies is needed to determine optimal dosing, clarify mechanisms of action, and assess long-term efficacy and potential risks, including abuse liability, before broader clinical implementation can be recommended.
物质使用障碍（SUDs）涉及控制能力下降、危险使用、社交互动受损和身体依赖。尽管其在全球范围内普遍存在且负担沉重，但治疗选择仍然有限。氯胺酮（KET）作为一种N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，可能通过调节谷氨酸能神经传递来辅助SUD治疗。本系统评价评估了KET在SUD治疗中的作用。
本评价检索了截至2024年6月的三个数据库，纳入14项研究，共551名参与者。
在这14项研究中，6项聚焦于酒精，3项聚焦于可卡因，4项聚焦于阿片类药物，1项聚焦于大麻。7项研究（50%）将KET与心理治疗相结合，而7项（50%）仅关注KET的药理作用。KET剂量范围从0.11mg/kg至2.0mg/kg，研究的主要终点从不到一天到两年不等。纳入研究的结果表明KET对各种SUDs均有效。在酒精使用障碍（AUD）中，KET减轻了戒断症状并减少了苯二氮䓬类药物的需求。在可卡因使用障碍（CUD）中，KET减少了渴望并提高了戒断率。在阿片类药物使用障碍（OUD）中，高剂量KET心理治疗（KPT）改善了戒断情况并减少了渴望。在大麻使用障碍（CNUD）中，KET减少了每周使用量并增强了戒断信心。
虽然初步研究表明KET在治疗SUDs方面可能有短期益处，但证据仍受样本量小和缺乏随机试验的限制。需要进行更大规模、严格控制的进一步研究，以确定最佳剂量，阐明作用机制，并评估长期疗效和潜在风险，包括滥用可能性，然后才能推荐更广泛的临床应用。
