Over the last several years, opioid addiction has become a major issue. Despite efforts to combat this drug epidemic, 2019 saw over 50,000 deaths because of this issue. Likewise, over 40 percent of these deaths were related to pharmaceuticals like oxycontin. As has been the case over time, what was once hailed to be a remedy turned out to be a contributor. Today, new drugs are also being touted as having potential for treating opioid addiction as well as pain. Ketamine, perhaps better known as Special K on the streets, is one such drug. But finding a way to administer this treatment safely has been an issue.
For the most part, ketamine is given to those with opioid addiction or chronic pain in a hospital setting. The drug can be given as an injection in the muscle or vein, or it can be given intranasally. But close supervision is required, and as a result, the administration can be in the thousands of dollars. This has prompted companies to explore different options of administration that are potentially less costly and less cumbersome. Specifically, some are looking to administer ketamine subcutaneously through wearable devices. Without a doubt, these wearable technologies are exciting and promising. And many hope these wearable devices might be a solution that better addresses the opioid problems our society face.
“In the midst of a pandemic health crisis and evidence of increasing opioid addiction and overdoses, there has never been a greater need for effective non-opioid pain management.” -Gregg Peterson, Co-Founder and CEO, Bexson Biomedical
A Little Background Regarding Ketamine
Ketamine has been in use for many decades, however, its use for opioid addiction and chronic pain is relatively recent. The drug has been used in anesthesia since the 1960s, but ketamine was noted to have analgesic properties as well. Scientists have more recently noted that ketamine blocks NMDA receptors, which are involved in pain pathways. With this realization, ketamine has since been used to curb opioid addiction and to treat refractory pain syndromes. However, its use has been restricted to in-facility administration with close monitoring. Only as of late have intranasal and wearable devices been considered.
Ketamine has not only been found to be effective in pain states but also in other conditions as well. Research has shown that it can treat 70 percent of refractory depression conditions. Apparently, ketamine has effects on other brain receptors that include serotonin and dopamine. It is this effect that many scientists believe account for its benefits for depression as well as PTSD. But these are off-label uses that are just now being more aggressively explored. Ketamine remains primarily a drug used in pain states and for opioid addiction.
“[Ketamine] is considered by no means a panacea; it does not work for all pain, and it needs to be carefully dosed and the patients carefully chosen by a specialist. Even in that case, there are some patients that it works brilliantly in and in others it does not have any effect at all.” – Charles F. von Gunten, MD, PhD, VP of Medical Affairs for Palliative and Hospice Medicine, Ohio Health, Columbus, OH
Ketamine and Wearable Devices
Given the costs and challenges with in-facility ketamine administration, new approaches are being explored. Wearable devices are one such exploration. The Stevanato Group, one of the world’s largest drug delivery system makers, has partnered with Bexson Biomedical in this regard. Bexson has a unique formulation of ketamine called BB106 that is less acidic and has lower salt content. This makes is less irritating after administration. Together, these companies have created a wearable device that provides slow-release subcutaneous injections of BB106.
Wearable devices like this one works like an insulin pump. A tiny needle gives low doses of ketamine into the fatty tissue just beneath the skin. This means it provides a more gradual and consistent response over time without the highs and lows. The cartridge in the device lasts for 24 hours, and it can be titrated to the desired dosage. Not only does this make it easier to treat post-operative pain conditions in the hospital. But it also makes outpatient opioid addiction treatment with ketamine more manageable as well. This is why significant excitement is associated with this new technology.
“Pain is very challenging to treat and saying this is the solution that can address the opiate crisis is very simplistic. It’s much more complex than that.” Nora Volkow, MD, PhD., Director of the National Institute on Drug Abuse
Skepticism in Treating Opioid Addiction
Despite this enthusiasm, many are skeptical that ketamine wearable devices are the answer to opioid addiction. Oxycontin was believed to initially be non-addictive when it was first introduced for pain management. Likewise, cannabis now has been touted as an all-encompassing pain management drug by some. Neither are true. Therefore, many question whether ketamine will follow in these same footsteps. Ketamine is noted to have risks for renal and cardiac side effects. Likewise, it does increase dopamine levels known to be associated with addiction states. Thus, experts are encouraging tremendous caution with its use in opioid addiction and pain patients.
Understanding this, the manufacturers of these wearable devices for ketamine are still optimistic. They see that these transformative technologies allow better monitoring and control of administration. Likewise, they are regulated by Bluetooth technology which allows additional opportunities for oversight. These benefits, combined with lower costs, support the development these types of technologies. And because ketamine does not appear to accelerate patients to chronic pain states, it could become a preferred analgesic agent.
More Unknown Than Known
The management of the opioid crisis has been challenged, and little progress has been made. Much remains unknown about the mechanisms by which addiction, pain, and mood interact. This has made it challenging to identify effective therapies that don’t add insult to injury. But progress, despite its slow nature, is steady. The ability to utilize technologies for both diagnostic and therapeutic purposes will be important in the years to come. Wearable devices like Bexson’s therefore offer promise. And while its anticipated date of FDA approval isn’t until 2026, many look forward to its arrival.