Even as prescription
opioid dispensing rates have begun to decrease, the use of illicit
opioids such as
heroin and
fentanyl has increased. Thus, the end of the opioid epidemic is not in sight, and treating patients that are addicted to
opioids remains of utmost importance. Currently, the primary
pharmacotherapies used to treat
opioid addiction over the long term are the
opioid antagonist naltrexone, the partial-agonist
buprenorphine, and the full agonist
methadone.
Naloxone is an antagonist used to rapidly reverse
opioid overdose. While these treatments are well-established and used regularly, the gravity of the opioid epidemic necessitates that all possible avenues of treatment be explored. Therefore, in this narrative review, we analyze current literature regarding use of the alternative medications
ketamine,
noribogaine, and
cannabinoids in treating patients suffering from
opioid use disorder. Beyond its use as an
anesthetic,
ketamine has been shown to have many applications in several medical specialties. Of particular interest to the subject at hand,
ketamine is promising in treating individuals addicted to
opioids, alcohol, and
cocaine. Therapeutically administered
cannabinoids have been proposed for the treatment of multiple illnesses. These include, but are not limited to
epilepsy,
Parkinson's disease,
multiple sclerosis,
chronic pain conditions,
anxiety disorders, and addiction. The
cannabinoid dronabinol has been seen to have varying effects. High doses appear to reduce
withdrawal symptoms but this comes at the expense of increased adverse side effects such as sedation and
tachycardia.
Noribogaine is a weak MOR antagonist and relatively potent KOR agonist, which may explain the clinical anti-addictive effects. More research should be done to assess the viability of these medications for the treatment of OUD and withdrawal.