The Therapeutic benefit of Established “Drugs of Abuse”


Drugs of abuse have always had a negative connotation. Since the use of illicit drugs skyrocketed during the 1970s and during the counterculture era, there have been concerns of ethics, legality, and of artistic freedom that have surrounded this topic for decades. However, with the surge of research being done into agents that were formerly recognized as illicit, are health care professionals and patients alike withholding effective treatment due to these “negative connotations”?

An agent that has recently drawn a lot of attention is ketamine. In my research into this agent, there has been numerous trials since the early 2000s suggesting that ketamine is useful in patients with depression. In 2000, a group of scientists found that a single exposure to IV ketamine produced very rapid antidepressant effects (within 240 mins) lasting up to 3 days in treatment-resistant patients. After this study there was a rise in the investigation into ketamine for its antidepressant effects. In 2013, a group of scientists conducted a randomized control trial comparing the use of ketamine to a standard clinical dose of fluoxetine in patients with diagnosed treatment-resistant MDD. Results of this study also show that even a single dose of IV ketamine can produce very rapid antidepressant effects (within hours) in treatment-resistant patients, lasting several days when compared to SSRIs that take weeks to have a beneficial effect (if any, in patients with treatment-resistant depression). Also, in 2013, a group of scientists found that ketamine (20 mg/kg) reversed the chronic unpredictable stress-induced depression-like behaviors. Their study showed that repeated ketamine exposure resulted in anxiolytic and antidepressant responses 2 months after drug exposure. None of the ketamine doses used in this trial were shown to induce drug-seeking behaviors. As all the research of the positive outcomes of ketamine surfaced, Janssen Pharmaceutical’s released SPRAVATO®, an intranasal ketamine-based spray for use in patients with treatment-resistant depression. Nearly 20 years later, the hurdles preventing ketamine from coming to market were breeched to allow a “potential drug of abuse” to be used for therapeutic purposes.

Though ketamine was finally released to market as a therapeutic agent, were there societal and ethical barriers that prevented or stalled the research into its therapeutic use? As we have learned in the past year, LSD, cannabis, and other psychoactive agents have shown evidence of positive therapeutics outcomes in patients with CNS disorders. As research accumulates, I think it is really important to keep an open mind to the therapeutic use of these types of agents for our patients.  Moreover, though an opposing argument for the use of these agents can be made in regard to the addictive potential of these drugs, the responsibility lies on science and specifically Pharma to create an optimized route of administration that will decrease the addictive potential of these agents, as what was done with ketamine. With more research being done to find the therapeutic uses of these psychoactive drugs, I will be interested to see how the implications of their use in patients may impact healthcare and society. We definitely have room for improvement as a society to be more accepting and tolerant in regard to healthcare.

References:
https://www.ncbi.nlm.nih.gov/pubmed/10686270
https://www.ncbi.nlm.nih.gov/pubmed/25038867
https://www.ncbi.nlm.nih.gov/pubmed/23790225


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