CASE REPORT article
Front. Psychiatry
Sec. Addictive Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1586945
Ketamine treatment for buprenorphine precipitated opioid withdrawal: A case report • Authors' full names, highest academic degrees, and affiliations
Provisionally accepted
- Brigham and Women's Hospital, Harvard Medical School, Boston, United States
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Background: The presence of fentanyl in the drug supply is thought to contribute to the incidence of buprenorphine precipitated opioid withdrawal (BPOW) during initiation. Long used as a surgical anesthetic and an analgesic, the utility of ketamine for psychiatric and substance use disorder indications continues to grow. We present a case of IV ketamine use on the general medical floor for the management of BPOW in a hospitalized patient.Case summaryA 72-year-old male presented to the emergency room with new onset hematuria and was admitted for urological intervention. Hematuria was successfully managed with continuous bladder irrigation over three days. Unfortunately, on hospital day two, the patient developed myalgias, restlessness and later revealed ongoing non-medical use of illicit opioids. The addiction consultation service was consulted on the second day of hospitalization and made a new diagnosis of severe opioid use disorder. Two separate attempts at buprenorphine/naloxone high-dose initiation to treat BPOW were not successful and the second was not responsive to standard symptomatic agents. IV ketamine 27mg bolus was then administered with initial improvement followed by subsequent emergence delirium which was addressed with IV haloperidol. The patient was eventually stabilized on buprenorphine/naloxone 8mg twice daily prior to discharge.Clinical significance:Ketamine may be an effective adjunctive agent in managing opioid withdrawal. Usually restricted to the intensive care unit and emergency department, this case report highlights both the potential and risks of IV ketamine on the general hospital floors. Further research is needed to better understand the safety of using ketamine to manage opioid withdrawal.
Keywords: Buprenorphine, Ketamine, Buprenorphine Opioid Withdrawal, Fentanyl, Buprenorphine initiation
Received: 03 Mar 2025; Accepted: 28 May 2025.
Copyright: © 2025 Gbujie, Vercollone and Suzuki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ezioma Gbujie, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
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