Summer 2002 Vol. 12, No. 2 From Celebration to Frustration, and Back Again
Note from MAPS: MAPS is now three years and $30,000 through its five-year and $50,000 pledge to Dr. Krupitsky’s study using multiple-dose v single dose ketamine-assisted psychotherapy (KPT) in the treatment of heroin addicts. We are currently seeking donations for the remaining $20,000, pledged over two years.
I am pleased to inform MAPS readers of several developments in research with ketamine and ketamine-assisted psychotherapy (KPT). Most importantly, we are successfully progressing with our MAPS and Heffter-supported study of ketamine-assisted psychotherapy in the treatment of heroin addiction. The double-blind, placebo-controlled study compares multiple v single KPT sessions. We have treated 59 subjects in the study to date and are beginning the third year of this five-year project. However, due to changing regulations regarding ketamine in Russia that went into effect recently, we cannot enroll more subjects until we implement new security procedures for the ketamine and obtain a new permit, though follow-up is continuing on subjects previously treated. It will probably take a few months before new patients can be treated.
In September and October of 2001, I attended two major international psychiatric conferences, with assistance from MAPS. The first conference was the Annual Conference of the International Society of Addiction Medicine (ISAM) in Tel Aviv, Israel. It was initially planned for the year 2000 but had been postponed until September 2001 because of the political situation in Israel. At the Israel conference, I presented the results of our recently finished study of high-dose v low-dose/placebo ketamine-assisted psychotherapy in the treatment of heroin addiction. The second conference was the International Congress of the World Psychiatric Association, held September 29- October 4 in Madrid, Spain. At the Madrid conference, I presented the results of a non-therapy ketamine study, and was able to include some discussion of our therapy study as well.
The study results I presented in Israel were from the first double-blind placebo-controlled randomized clinical trial of psychedelic psychotherapy conducted anywhere in the last thirty years. Our results have been submitted for publication to the Journal of Substance Abuse Treatment (see the abstract of our paper below). We used a single high-dose ketamine-assisted psychotherapy session as the experimental condition and a single low-dose ketamine-assisted psychotherapy session as an active placebo. The positive results in our two year follow-up data are a strong argument for the efficacy of ketamine-assisted psychotherapy for heroin addiction. After my presentation, several Israeli psychiatrists and medical officials expressed interest in ketamine-assisted psychotherapy and the possibilities of its implementation in Israel. We are now in the process of discussing the details of a visit by Israeli psychiatrists to our facilities in St. Petersburg, Russia, in order to teach them the technique and see how they could use it in Israel.
At the International Congress of the World Psychiatric Association in Madrid, I presented the results of a non-therapeutic ketamine study which I have conducted, and I also spoke about ketamine’s therapeutic and abuse potential. The study evaluated cognitive, behavioral, and ethanol-like effects of the interactions between two neuronal calcium channel ligands (blockers) in abstinent alcoholic subjects: ketamine, which is a NMDA-coupled calcium channel blocker, and nimodipine, a dihydropyridine-sensitive calcium channel blocker. We showed that nimodipine attenuates psychotogenic, hallucinogenic, cognitive and some ethanol-like effects of ketamine in abstinent alcoholic subjects. This finding is important in the study of subtle neuropharmacological mechanisms underlying mind, psychiatric disorders, and development of alcohol dependence. It is also valuable because it suggests nimodipine’s potential therapeutic use in psychiatry.
Krupitsky, E. et al. (2001). “Attenuation of ketamine effects by nimodipine pretreatment in recovering ethanol dependent men: psychopharmacologic implications of the interaction of NMDA and L-type calcium channel agonists.” Neuropsychopharmacology 25 (6):936-947.
I think that it is very important to present the results of rigorous scientific studies of psychedelics at international psychiatric conferences, in order to combat prejudice and to positively impact the psychiatric community’s attitude toward psychedelic psychotherapy. I am very grateful to MAPS for the financial support of my visits to both Tel Aviv and Madrid, and for my KPT research, which otherwise would not have been possible.