Using Ketamine for Opiate Cessation

[sekio]

I was under the impression that, except in special cases involving almost hourly use of injected K, there is nothing more than a short 'rebound' period after discontinuing ketamine usage, and that the main problem was the experience lends itself to an escapist psychological addiction.

It's certainly in the same league as cannabis withdrawal, in that if you are an infrequent user you will likely not suffer very much if you stop using it on weekends.

 

[pasha]

I was under the impression that, except in special cases involving almost hourly use of injected K, there is nothing more than a short 'rebound' period after discontinuing ketamine usage, and that the main problem was the experience lends itself to an escapist psychological addiction.

It's certainly in the same league as cannabis withdrawal, in that if you are an infrequent user you will likely not suffer very much if you stop using it on weekends.

Agreed, for infrequent users its benign.

It's actually national geographic not discovery.

Edit:

These are some physical symptoms of use and withdrawal discussed in the documentary:

Ketamine bladder syndrome is a newly discovered consequence of long term use and withdrawal. Ketamine damages the bladder, causing ulcers, as well as fibrosis; stiffening of the bladder walls. Symptoms include pelvic pain, blood in the urine and needing to pee hundreds of times a day.

Heavy users complain of severe abdominal pain when coming off ketamine and describe the sensation as 'having hot knives stabbed into your kidneys'. Sufferers may turn to opioids to deal with their discomfort.

 

[amanitadine]

I was one of the jokers in the nineties importing kgs from china (and then the freebase, which they didn't schedule until later, and then ketimine, which well, not allowed to discuss here) for dimes on the gram and thus went through periods of injecting up to a couple grams a day, for prolonged periods of time. I also became a "ketamine tourist" when I'd take my half year off and go to Mexico, India, etc, and do the same thing. Most PSYCHOLOGICALLY addictive drug I've enter encountered, including the scores of analogs, and I NEVER had any physical withdrawal symptoms. Psychological yes, to the point of burglary (blush, but I did leave cash for the K taken, and inflicted minimal if zero damage on the veterinary facilities. I can say, without doubt, that for ME, ketamine is not physiologically addictive.

BUT, I did say above ketamine did NOTHING for heroin withdrawal. But this was at high doses, maybe there is something to low dose. Far enough from heroin now to try again, but maybe we'll see how low dose MXE or 3-MeO PCP does for high dose kratom withdrawal. It's a lot worse than you'd think. And I'm talking plain leaf, 50g or so a day for over a year, no extracts involved

FWIW ketamine also never gave me bladder issues. Just a strong diuretic. YMMV

I'm totally willing to explore the NMDA antagonist effect on opiate withdrawal, with low dose. I'm just saying high dose ket did nothing for heroin withdrawal and has no subjective effect on the MOR.

 

[puffj]

It's been very well known anecdotally, and is just now becoming noticed in the scientific communities/medical communities (as is always the case they seem to play 60 year catch-up to what drug addicts know, for example just now developing nasal opioid sprays or opioid and benzo inhalers for faster onset) that NMDA antagonists can have dramatic effects on reducing withdrawal symptoms, reversing tolerance and eliminating cravings for not only opiates but almost all addictive drugs. Papers have been published (and I'm not going to make a long post with explanations so research yourself if you're interested) showing how certain NMDA antagonists such as ketamine, dxm, memantine, and ESPECIALLY gabapentin not only mitigate withdrawal symptoms by blocking the parasympathetic responses triggered during withdrawal and cutting calcium channel conduction, but they also have profound effects on the cholecystokinin hormonal receptors which are primarily responsible for the neuroadaptations that result from chronic use or cessation of use and thus the development and reversal of tolerance/dependence. Studies were conducted using gabapentin on post-operative patients who needed pain control through opiates. They had a control group a placebo group and a "test" group. All patients regardless of group were given opiates for acute post-surgical pain. All patients had no history of drug abuse and no opiate tolerance. All patients were started at the same dose. The control group was given nothing but the opiates, the placebo group the opiates and a placebo (obviously for the sake of the researchers conducting a double blind correctly) and the test group opiates and gabapentin in I believe 300mg doses TID. At the end of 14 days, the control group had built tolerance to the initial opiate dosage and had required increased opiate dosage to achieve the same level of pain relief. Ditto with the placebo group. But the group given gabapentin and an opiate not only required no dosage increase, but they had developed no tolerance and the same dosage that worked 14 days ago was still working. Some of the patients even needed reduced opiate dosages for pain because the gabapentin had made the standard dose too strong, not by acting synergistically, but by reducing the normal opiate naive individual's tolerance to a lower level than average. In other words people got the same effect after 7 days of gabapentin and opiate from 3mg of percocet as they had from 5mg 7 days earlier... at the end of the 14 days the gabapentin patients experienced no withdrawal and no residual pain... infact some stopped having pain after 7 days but had to stay in the study anyways... whereas the other groups both the control and placebo were all on high opiate doses for pain control.

It's really incredible stuff and if you can understand it the pharmacology behind NMDA antagonism on all addiction/dependence (as some NMDA antagonists seem to even eliminate psychological cravings entirely) is fascinating and has the potential to become very helpful to those who truely want to be rid of their addiction and dependence.

 

[jimhoo]

ketamine is a great anti depressant but i believe its main method action is nmda antagonism. i would doubt it would be all that effective for dealing with opiate withdrawel. if you wanted to ease withdrawel then weaker opiate agonists would be the way forward like kratom. where as more severe, dysphoric way to beat addiction is with k opoid agonists like salvia and ibogaine.

 

[Amberthefrog]

^ Whilst kratom is an extremely effective withdrawal aid, you are still substituting one mu agonist for another (actually several, though 7-HO-mitragynine seems by far the most significant). Kratom can instigate opiate withdrawal of surprising severity, though of course kratom addiction and withdrawal would remain massively preferable to (diacetyl)morphine and oxy/hydro-codone/morphone dependant.

IMO one of the main advantages kratom offers is it's half-life; much much shorter than the medically standard maintenance drugs, resulting in a much easier physical withdrawal. Loperamide, likewise has a pretty hefty half-life (also the ridiculous doses needed are neurotoxic). I also find kratom more useful than codeine for coming off of morphine (which is surprising considering what the later is metabolised into!); codeine (for myself at least) has a very short duration, it's 'ceiling dose' is also an issue - when i'm taking upwards of ~60mg oral morphine/ day codeine provides only minor and fleeting relief, with >100mg of morphine/ day codeine doesn't even grant that, in fact it does nothing at doses below 1 gram, and exceeding the gram barrier triggers some histamine release/agonism but little else. Kratom doesn't have that anal inhibitory metabolic feedback loop codeine has, nor a ceiling dose for any of reasons - it can be effective regardless of the type and size of your dependence. DHC runs it close though, having a much longer duration and only a partial (YMMV?) ceiling.

All that waffled, NMDA antagonists are in my experience a massive physical and psychological boon during opiate cessation. They (ketamine/DXM) almost immediately halt the dreaded leg thrashing. General aches and lethargy persist but you step away from them, feeling them somewhat less and caring a lot less. DXM in particular helps my body sort it's thermoregulation out, I've no idea which aspect of DXM's hideously complex and convoluted mode of operation is responsible for this. In summary you still feel physically abject, the pain is still there but you half cease to care, it almost belongs to someone else. It's possible to sit/stand still for more than half a minute. Sleep is still a problem, though it's now just insomnia as opposed to the hellish, climbing-up-the-fecking-walls, punching-thighs-to-deaden-them-whilst-writhing-around-your-sweat-soaked-bed fuckscape that is withdrawal insomnia. Over-hyphenation is under-rated.

As for which NMDA antagonist I'd say it's very subjective. Obviously the fleeting duration of ketamine is problematic when taken with it's sometimes ghastly price, it still can do the job well especially during the night - a three hour break from hell and trail off into surprisingly good REM sleep. Ketamine doesn't give me any nausea at all, ever, and feels more well-rounded and less psychologically messy than DXM.

DXM however has a very decent half life (or it's main metabolite does). It also has that handy SNRI ability which enhances energy levels, mood (and pupil size, if even possible!) a fair bit more than ket. The serotoninergic properties of DXM last (for me at least) several *days*, which really, really helps on the mental front. On the flip side DXM gives me a bit of nausea, even in <100mg dosages, when combined with withdrawal this becomes much worse. On balance it's still worth it though, for the 3 day long antidepressant affect alone. Be warned though, DXM + opiate withdrawal = unbelievable dinner plate pupils.

Also, what puffj said concerning tolerance (thanks for that btw, I was ignorant of the mechanism you described behind this)

Cheers

PS. Has anyone ever cracked out the nitrous during WD? One would assume it would be an excellent relief/distraction but would end up being canned due to it's brevity (something I lack)? Other NMDA antags' seem to massively extend the N2O during, perhaps cracking 1 canister/ hour on top of ketamine/DXM/x-MeO-PCP/Methoxetamine would be a useful technique?

pps. I'm aware of ibogaine's use in opiate addiction therapy (no personal experience) and I'm also aware of it's affinity for kappa, I was unaware that the k-opoid affinity of salvia could be utilised in a similar way? Kappa ligands and their respective effects and uses are something I'm a tad ignorant of; in what way could salvia be used to help addiction? Is the effect psychological? Physiological? Both? Would smoking a bowl of extract once a day during acute withdrawal be a feasible method? I'd guess that chewing the leaves may be preferable? I will UTFSE because I'm intrigued, any hints people can sling my way in addition would be much appreciated however.

Double cheers

 

[psilocyb.org]

People on about K withdrawal? What? Maybe psychological dependance, but nothing like a real physical withdrawal. MXE, however, I have noticed certain physical symptoms upon quitting use. Pretty mild, but still present.

Using MXE to quit anything is a bad idea. Especially opiates, as MXE has µ-opioid receptor affinity. Why continue to abuse the same receptors? Sounds like defeating the purpose to me...

 

[sekio]

MXE has µ-opioid receptor affinity

It doesn't? (see ACMD report)... the only significant bindings are at SERT and NMDA.

Even if it did bind, it is unlikely that it would be a fullagonist opioid like you would "expect".

 

[psilocyb.org]

True it's definitely not a full agonist, but I am pretty sure that in higher than normal doses it has at least minor affinity. Still, why risk using it when there's any question it could still effect the receptors you're trying to give a break?

Many people argue that K and MXE are not addictive because there's no physical withdrawal, but they still can be mentally addictive. Why use something that can hook you in to get unhooked? I still say it's defeating the purpose.

Just smoke weed yo

 

[sekio]

Many people argue that K and MXE are not addictive because there's no physical withdrawal, but they still can be mentally addictive.
Just smoke weed yo

... which has no physical withdrawal, but can still be mentally addicting?

I get what you mean, but still. Not everyone will find dissociatives immediately 'moreish'.

 

[g0to]

Works really well, can even help minimize/eliminate dreaded PAWS for people tapering down from Bupe or long term opiates usage. Just make sure not to binge on the K or MXE... (for some people its very moreish indeed). I was always IVing so the MXE was very strong and sometimes when didn't weigh my dosage out it got me way too fucked up for my own good (to the point of feeling physically malignant). There also seems to be a kind of reverse tolerance of sorts, to some of the effects. It's also good for cessating from (meth)amphetamine use. It's definitely resetting the dopamine pathways in the brain somehow [no citation] I will say that when all has been said and done though, it helped me to quit IV/smoked heroin and IV/smoked meth use and still have a positive outlook on life. Just now after stopping MXE I have some dopamine symptoms still, like really deep REM sleep and extremely vivid dreams etc.. that could have something to do with melatonin/valerian/Mg/Zn supplementation before bed as well as I stopped ingesting cannabinoids.

 

[Benjo Diazepine]

PS. Has anyone ever cracked out the nitrous during WD? One would assume it would be an excellent relief/distraction but would end up being canned due to it's brevity (something I lack)? Other NMDA antags' seem to massively extend the N2O during, perhaps cracking 1 canister/ hour on top of ketamine/DXM/x-MeO-PCP/Methoxetamine would be a useful technique?

I have tried it and noticed no real effects. I do think this is due to its brevity like you said.

How much DXM does one have to ingest for the NMDA antagonism effect to be felt or to reverse tolerance? Does it need to be a psychoactive dose? The idea of tripping on DXM kinda scares me.

 

[g0to]

I've had N2O before during acute opiate withdrawals, it helped for the duration of the experience but I must note the extreme brevity... perhaps if supplemented with cannabinoids/ethanol the effects would have been much more potent.

 

[bentruthaddict]

Keyamine does 100% work for opiate withdrawal. I am living testament And at request will explain.

 

[dopamimetic]

For lower doses of opioid tolerance, NMDA antagonists work for sure. 40-60mg of memantine worked at least once for me.

But it becomes problematic when one acquires tolerance them too.. I am not sure yet (but hope so) if it´s just a question of dosage and taking some days out on more dissociation will break it again..

At least for those who do not use dissociatives regularly and / or when dealing with opioid tolerances at the lower end, Ketamine and other NMDA antagonists are really overlooked.

 

[tantric]

here's my version of this with DXM, the relevant parts from my blog about doing this and living it.

the neurochemical vehicle

addiction is the normal state of life – it is the root of suffering. if you are wondering, you probably are an addict, even if its just to your massively unhealthy diet. or greed or ideals. DXM, dextromethrophan, AKA robotussin, is an OTC drug that inhibits addictions, like all other NMDA antagonists: ketamine and ibogaine in particular. you have to take it as you are withdrawing – 24 hours of rice, fruit juice and patience. by then you’ll be craving at least. take about 150mg of DXM. it’s good to have a trip sitter, but make sure you have alone space to go to. hear that? your gods are coming, and they want to have a serious talk with you. the combination of acute withdrawal and DXM results in a profound religious experience, which can be disorienting, to say the least, but it also CURES YOUR FUCKING ADDICTION. all of them. period. you don’t have to keep taking the drug after that, you probably shouldn’t. but you must eat low fat/low protein foods, peasant foods, like beans and rice, plantains, sweet potatoes, etc. this isn’t hard, as you can taste food again, and it’s *FANTASTIC*. you feel great, all the time. if you don’t have a philosophy to attach to this experience, like the one i’m offering, it can be very strange and you might even act a bit nutty. YMMV.

 

[adder]

DXM certainly does lower your tolerance to opioids but its wide spectrum of effects eliminates it as a potential candidate for practical use in the treatment of opioid addiction (perhaps a low dose of DXO would have less side effects). NMDA antagonists should be researched more as potential additives to the pharmacotherapy but a good candidate should be as selective for NMDA receptors as possible, it'd probably be very difficult to separate NMDA antagonistic properties from sigmaergic properties, but in my opinion potent serotonergic and noradrenergic properties of DXM are simply unacceptable in the long run. Keep in mind during opioid withdrawal there is a hyperactivity of adrenergic and noradrenergic systems, and this is responsible for a lot of symptoms, DXM potentially exacerbates anxiety associated with withdrawal. It's great as long as you're still taking some opioid but I bet it's too dirty to be used when you're completely off opioids. As for me even tramadol is too dirty to be used to attenuate opioid withdrawal, I know for some people it's a great aid, but it's hardly a universal aid.

That is not to say DXM is completely useless, I'm actually very interested how DXM binds to MOP receptors (I guess it's possible it binds in a similar manner as pethidine and related compounds do) and how some simple changes to the structure would affect its affinity. In case of DXM the affinity at MOP receptors is useless in my opinion, even though it's only 3-6 times lower than the affinity of DXO at NMDA receptors, it probably doesn't produce much opioid effects for the same reason PCP doesn't - there are many times more NMDA receptors than MOP receptors, so unless you saturate the former, an insignificant amount of the latter will be occupied.

On the other hand we already have methadone which is basically a MOP agonist with NMDA antagonistic properties.

 

[tantric]

DXM certainly does lower your tolerance to opioids but its wide spectrum of effects eliminates it as a potential candidate for practical use in the treatment of opioid addiction (perhaps a low dose of DXO would have less side effects). NMDA antagonists should be researched more as potential additives to the pharmacotherapy but a good candidate should be as selective for NMDA receptors as possible, it'd probably be very difficult to separate NMDA antagonistic properties from sigmaergic properties, but in my opinion potent serotonergic and noradrenergic properties of DXM are simply unacceptable in the long run. Keep in mind during opioid withdrawal there is a hyperactivity of adrenergic and noradrenergic systems, and this is responsible for a lot of symptoms, DXM potentially exacerbates anxiety associated with withdrawal. It's great as long as you're still taking some opioid but I bet it's too dirty to be used when you're completely off opioids. As for me even tramadol is too dirty to be used to attenuate opioid withdrawal, I know for some people it's a great aid, but it's hardly a universal aid.

That is not to say DXM is completely useless, I'm actually very interested how DXM binds to MOP receptors and how some simple changes to the structure would affect its affinity. In case of DXM the affinity at MOP receptors is useless in my opinion, even though it's only 3-6 times lower than the affinity of DXO at NMDA receptors, it probably doesn't produce much opioid effects for the same reason PCP doesn't - there are many times more NMDA receptors than MOP receptors, so unless you saturate the former, an insignificant amount of the latter will be occupied.

i've used DXM to kick morphine/methadone, cigs and meth. it works for me fine. i respect your scholarship, but you've misread me. when the brain is going through withdrawal, it isn't neurochemically 'normal'. the process i used involves about 150mg of DXM one time (less than a recreational dose) while in acute withdrawal. in other circumstances, it would do very little, but then, it creates a profound religious experience, unlike other DXM experiences. while i agree its not ideal, it is OTC right now, not off in some jungle in africa. isn't it worth trying? and huh, can't take DXM off opiods? of course you can, it's a fine trip. see, if i get tempted now or am in a sitch wherein i just have to imbide to be cool (and trusted), i just do it....then i go home and take 75mg and go on with life. i don't binge.

besides, it doesn't work if you don't understand addiction - you are not addicted to a drug or behavior, you're addicted to dopamine. the basic, primal addiction is to high fat/high protein foods - the dopamine rush evolved so we'll eat more of these foods, prefer them over others. then winning, competition, all those dopamine rushes, then drugs. its' not an accident that we have junk dope, junk food and junk stuff. most therapies don't work because the addict just switches drugs - like walking into an AA meeting and choking on cig smoke. you can't win like that - you have to get rid of *all* addiction and stay off it, meaning no junk food, no shopping sprees, etc. it sounds harsh, but when you live like this, you can feel other neurotransmitters very keenly. hell, i get washed over with bliss daily. so long as i follow my diet and regime, i have no cravings and i can use occasionally without binging or stupid shit. how many former morphine/methadone addicts do you know who can take pain meds as directed for a tooth ache? that shit has no power over me, because i know the riddle of addiction.

 

[adder]

I didn't mean to undervalue your experience, I used DXM myself to lower my tolerance to buprenorphine once. However, I repeat it's far from being ideal for everyone. The majority of people are not able to take a psychedelic/dissociative trip easy being unprepared, not to mention having a trip bordering with a profound religious experience on top of opioid withdrawal which may be frightening for some at the very least. Ibogaine treatment is already practised and it's rather considered a last resort. Also, the wide spectrum of DXM effects is hardly a recipe for correcting the neurochemical imbalance after long-term opioid dependence, it's actually quite easy to create an imbalance with DXM alone with no prior problems and I met such people for whom a few relatively light doses were enough to impact them for a very long time. I'm well aware how the addiction and dependence works too, I had more or less addiction problems with quite a few classes of drugs and at the moment I'm only dependent on buprenorphine and tobacco, and I do realise my dopamine deficit is a just a chemical process that doesn't shake the whole universe, yet it's strong enough to cause me so much discomfort that I can't take when I'm occupied by a ton of obligations and other problems. Leave aside the need for proper nutrition which is basically always necessary to sustain a healthy life. Cheers!

 

[tantric]

I didn't mean to undervalue your experience, I used DXM myself to lower my tolerance to buprenorphine once. However, I repeat it's far from being ideal for everyone. The majority of people are not able to take a psychedelic/dissociative trip easy being unprepared, not to mention having a trip bordering with a profound religious experience on top of opioid withdrawal which may be frightening for some at the very least. Ibogaine treatment is already practised and it's rather considered a last resort. Also, the wide spectrum of DXM effects is hardly a recipe for correcting the neurochemical imbalance after long-term opioid dependence, it's actually quite easy to create an imbalance with DXM alone with no prior problems and I met such people for whom a few relatively light doses were enough to impact them for a very long time. I'm well aware how the addiction and dependence works too, I had more or less addiction problems with quite a few classes of drugs and at the moment I'm only dependent on buprenorphine and tobacco, and I do realise my dopamine deficit is a just a chemical process that doesn't shake the whole universe, yet it's strong enough to cause me so much discomfort that I can't take when I'm occupied by a ton of obligations and other problems. Leave aside the need for proper nutrition which is basically always necessary to sustain a healthy life. Cheers!

my big question is simply which CYP2D6 group i belong to. the first time i took DXM, i remember hallucinating so hard i literally could not see. but that just doesn't happen now. IMO, DXM is the water of life, a poison that must be enzymatically changed into a drug that lets you see through time. does my body convert it almost instantly to DXO and thus the effect? i can't get anyone who might have the knowledge to comment.

i fully agree that the experience is not at all recreational - in fact, it's fucking terrifying. but i dont agree that its' not for everyone. addiction is SERIOUS. and bear in mind i'm a buddhist, a religion that fundamentally treats the origin of all suffering as an addiction to gross pleasures of samsara. thus addiction is a spiritual disease that requires a spiritual cure, AA/NA dogma. you have to learn that there's more to life than pleasure, you have to know joy and peace, that it's real and can be had. just detoxing you is useless, if you don't have a better option. what, quit smack and become a mass consumer of wal-mart junk instead? if you believe that pleasure and pain are all there is to life, it flat makes sense to be a junkie - why screw around when you can mainline it?