Is Ketamine a Safe Treatment for Opioid Use Disorder?

Treatments for opioid use disorder (OUD) are very effective and can reduce the use of opioids by up to 90 percent. However, many people find it difficult to get care and stick with treatment plans. Ketamine, a medication that’s been used since the 1960s, is being explored as a potential new treatment option for OUD.

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Ketamine isn’t one of the medications approved by the U.S. Food and Drug Administration (FDA) for OUD, but recent studies have found it may be a promising option. In this article, we’ll explain what ketamine is, how it can help treat OUD, and what we know about its safety and side effects.

What Is Ketamine?

Ketamine is a medication that affects the brain. It was first developed in the 1960s and approved by the U.S. Food and Drug Administration (FDA) as an anesthetic — a medicine that puts someone into a sleeplike state during surgery or helps control pain. Today, ketamine is still widely used for anesthesia.

Ketamine is called a “dissociative anesthetic” because it can make people feel detached from pain and from what’s happening around them. It may cause feelings of calm or relaxation, and it can also prevent memories of events that occur while the medication is active.

Some people also use ketamine outside of medical care for its mind-altering effects. In these cases, people often describe sensations as more intense or dreamlike, and some report feeling separated from their body or surroundings.

Is Ketamine Used for Other Mental Health Disorders?

You may have heard of ketamine therapy for depression. In 2019, the FDA approved an antidepressant medication for use in people whose depression was resistant to other treatments. This medication is esketamine, which is very similar to ketamine. Esketamine isn't approved for use in other mental health disorders, including OUD.

How Is Ketamine Used for OUD Treatment?

So far, scientists have done only small studies on the use of ketamine to treat opioid use disorder. The FDA has not approved ketamine as a treatment for OUD. Because research is still new, we don’t yet know how safe or effective ketamine is when used long term. This is important, since many people with OUD may need medication support for years to manage their condition.

Some clinics may offer ketamine as a treatment for OUD, but this is called off-label use. “Off-label” means the medicine is being used for something it wasn’t officially approved for by the FDA. Some doctors have raised concerns about this approach because there is not enough evidence yet to understand how ketamine works for OUD or what risks it might carry.

Currently, methadone and buprenorphine — both opioid agonist medications — remain the gold-standard medicines for OUD. These medications, often used together with counseling or behavioral therapy, have been shown to be highly effective in supporting long-term recovery and reducing the risk of relapse and overdose.

What Are the Benefits of Ketamine for OUD?

Some studies have explored whether ketamine could help people with opioid use disorder. Most of this research has looked at whether ketamine can ease withdrawal symptoms.

Withdrawal symptoms happen when people suddenly stop taking opioids. Symptoms can begin within hours of the last dose. While withdrawal is usually not life-threatening, it can be so uncomfortable that people are afraid to stop using opioids.

Common withdrawal symptoms include:

• Nausea
• Vomiting
• Stomach cramps
• Diarrhea
• Depression
• Drug cravings
• Dilated pupils

In some studies, people got ketamine through an injection into their muscle or through an intravenous (IV) line. In another study, people took small amounts of ketamine orally (by mouth). Overall, the studies showed that ketamine may help reduce withdrawal symptoms and improve engagement in counseling-based treatment.

Importantly, the studies followed participants for only a few months. None reported serious side effects, but longer-term safety and effectiveness remain unknown.

Ketamine Combined With Psychotherapy for OUD Treatment

Two studies have looked at whether ketamine can improve the success of psychotherapy-based treatment for OUD. In this type of treatment, people work with a trained psychotherapist. The psychotherapist uses talk therapy to help them through detoxification over the course of regular meetings.

In those studies, people who were given high-dose ketamine by IV reported fewer cravings and were more likely to avoid opiates for up to one year after treatment. While these results are promising, the research studies have limitations. More research on larger groups of people is needed to understand how ketamine can improve psychotherapy treatment for OUD.

Treatment With Ketamine and Rapid Opioid Blockers

One study of 58 people gave participants ketamine or a placebo (inactive treatment) by IV before treating them with a high-dose opiate blocker (naloxone) in the hospital. Participants then went into an outpatient treatment program with counseling or residential care.

The people who were given ketamine reported significantly fewer opioid withdrawal symptoms. They also needed less medication immediately after treatment to manage the withdrawal period. However, the study found that ketamine treatment didn’t work any better than the placebo to prevent relapse after four months.

Ketamine for Transitioning to Buprenorphine

Another major study from 2024 looked at how low-dose ketamine could help people with opioid use disorder transition to the medication buprenorphine. Buprenorphine is used to treat OUD, but the transition period may cause withdrawal symptoms that deter many people from making this change.

In this study, 24 participants were given ketamine as a syrup or lozenge four to eight times while transitioning to buprenorphine. The results showed that 43 percent of people successfully moved to buprenorphine therapy. Most people reported lower withdrawal symptoms after each ketamine dose.

Ongoing Clinical Trials

Research on ketamine in OUD treatment is ongoing. Some clinical trials and studies currently in progress are looking at topics like:

• How ketamine can help people with OUD and depression
• How ketamine can help people with OUD and anxiety disorders
• How ketamine can help people with OUD and suicidal thoughts
• How ketamine can be used in a type of treatment called mindfulness-based recovery enhancement

Is Ketamine Treatment Safe?

There isn’t enough data available on long-term ketamine use to know how safe it is. From its use in anesthesia, scientists know that some of the side effects of ketamine include:

• Irritability or restlessness
• Anxiety
• Confusion
• Drowsiness and fatigue
• Blurred vision
• Hallucinations

Ketamine can also reduce breathing, blood pressure, and heart rate, which can be dangerous outside a supervised medical setting. For example, people with preexisting heart problems might be at risk of more severe side effects from ketamine therapy.

Also, ketamine may cause issues with memory and thinking that happen even when someone isn’t taking the medication anymore.

Moreover, ketamine can erode the epithelium (bladder lining), leading to bladder scarring and cystitis (inflammation).

There is also a risk that ketamine itself may be misused, particularly for people with a history of substance use disorder. Some studies have raised concerns that ketamine could increase the risk of suicidal thoughts in certain individuals.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Because of these risks, more research is needed to understand the safest ways to use ketamine for OUD. Scientists are still studying what doses of ketamine and methods of administration — such as IV infusion, oral tablets, nasal spray, or injection — might be effective. Long-term studies are especially important to determine the safety and potential benefits of this treatment approach.

How Can You Use Ketamine for OUD Treatment?

If you choose to join a study or find a healthcare provider that uses ketamine for OUD treatment, it’s important to consider the potential risks and benefits of taking this medication. Be sure to ask questions about how you’ll be medically supervised while taking ketamine to make sure any side effects are managed.

Remember that an effective OUD treatment plan involves medications in addition to counseling and support systems. This might include education about relapse prevention, community support programs, and peer support groups like Narcotics Anonymous. The recovery journey can be difficult, and drawing on as many resources as possible can help make it a little easier.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

Have you or a loved one with OUD explored using ketamine as a treatment? Let others know in the comments below.