A systematic review of pharmacological treatments for ketamine use disorder found only 12 studies (368 participants), including 1 controlled trial, 2 retrospective case series, and 9 case reports. All evidence was very low quality, with only descriptive outcomes reported. Benzodiazepine regimens and haloperidol showed potential utility for managing intoxication and withdrawal, while naltrexone, lamotrigine, and a combination of paliperidone palmitate and bupropion were reported as potentially useful for craving and relapse prevention. The review highlights a severe lack of rigorous research, with benzodiazepine regimens appearing most promising for future investigation in intoxication and withdrawal.
A 25-year-old woman with ketamine use disorder (KUD) who used ketamine daily and experienced intense cravings was prescribed naltrexone off-label, starting at 25 mg/day and increasing to 50 mg/day after 7 days. After starting naltrexone, she reported a marked reduction in cravings, maintained abstinence, and progressed in recovery. This case, consistent with two prior reports where 50 mg/day naltrexone helped patients achieve abstinence, suggests naltrexone may be an effective intervention for KUD. Larger double-blind studies are needed to evaluate its efficacy, safety, and optimal dosing.