Ketamine infusion as an adjunct therapy to aid opioid rotation to buprenorphine: A case series.

BACKGROUND: There are increasing rates of opioid prescriptions for chronic pain worldwide. Long-term opioid use for chronic noncancer pain is reported to be associated with problematic use and dependence. An effective way of improving patients' safety who are on high doses of potent opioids is utilizing buprenorphine rotation. Opioid rotation can be challenging due to the risk of precipitated withdrawals, which require mild-to-moderate opioid withdrawal symptoms. This can be highly stressful for patients and often leads to failure of the transition attempt. Ketamine is a short-acting N-methyl-D-aspartate antagonist analgesic with opioid-sparing properties. It can help mitigate opioid withdrawal symptoms and manage severe pain in individuals with opioid dependence. CASE SERIES: This case series presents four patients with noncancer chronic pain with comorbid opioid dependency, all of whom have failed outpatient attempts at opioid rotation to buprenorphine. These patients were admitted as inpatients, and ketamine infusion was utilized as an adjunct therapy in the facilitation of opioid rotation to buprenorphine/naloxone. All patients were successful in their opioid rotations. On follow-up, these patients had subjectively improved functioning without further aberrant behaviors pertaining to their opioids. All had either remained or reduced on the buprenorphine dose with follow-up. CONCLUSION: Ketamine infusion can be an effective adjunct therapy in facilitating opioid rotation for patients with chronic noncancer pain.