Steve Levine, MD: Ketamine's Role in Solving the Opioid Crisis

The United States's opioid epidemic may have help from ketamine - a common therapy for major depressive disorder.

Steve Levine, MD, founder and CEO of Actify Neurotherapies, sat down with MD Magazine to discuss a multitude of topics, one being the opioid crisis in the United States. Levine's Actify Neurotherapies works closely with patients that have experiences with long-term opioid use, and Levine has found that the use of ketamine, a common major depressive disorder therapy, can alleviate chronic pain for these patients as an alternative to opioids.

Steve Levine, MD, founder and CEO of Actify Neurotherapies:

As everybody knows, at this point, we have an opiate crisis in this country. Opiates themselves are not very effective for treating chronic pain, and then we have the problems of addiction and abuse and the difficulties people have with getting off of these medicines once they start them, and then leading to illicit drug use. Ketamine, in addition to its role in treating things like depression and post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), is a very effective pain medication.

So, we actually have a proprietary technology, a way of delivering ketamine for chronic pain, that I'm very excited about. There's a technology called iontophoresis, which is really cool. It's essentially needleless IV. It takes advantage of the idea that most liquid solutions are composed of charged particles and if you apply an energy current to that solution, you can divide those particles and move them - in this case through the skin into systemic circulation.

So this is something that's been used by a couple of commercial products on the market. Fentanyl - speaking of opiates - is one just for in-hospital use. There was a migraine medication that was delivered in a similar way. Physical therapists use this a lot for local pain treatment, but again it also can be used to get medicine into the central systemic circulation. It's a way of delivering ketamine slowly over a long period of time in a way that, really, has very few side effects and does not have the risk of abuse that opiates have, and does not impair quality of life in the way that opiates do.

Because when people take opiates chronically they tend not to be very functional - they're sleepy, they're cognitively cloudy - it's very difficult to have much of a quality of life if you're on high-dose opiates. So we're very excited that this may offer a more effective, better long-term solution, a path away from opiates. And it's something that will really help improve quality of life.

We see many patients who've been on chronic opioids for a long time, and maybe in the past they've wanted to get off of these medicines and had a difficult time doing so, or it wasn't much of a push, though, because the prescriptions continue and they're difficult to get off, so people just continue on the opiates. Now that we've really identified that this is such a crisis in this country and many doctors are trying to get people off of opiates and they're prescribing them less commonly, that has changed.

Prescriptions are going down, but the conditions that require pain treatments haven't gone anywhere. People still continue to struggle with chronic pain, chronic migraine, fibromyalgia - the same conditions that people were prescribed opiates for, we now need another solution. So we wind up seeing many patients who either are currently on opiates or have a chronic pain condition that might otherwise have been treated with opiates, and they're looking for an alternative. And so, for many of these folks, ketamine can provide that alternative.