The drug liking and craving questionnaire (DLCQ) to evaluate addiction risk for ketamine and esketamine

Wang, Jay; Khullar, Atul; McIntyre, Roger S.; Swainson, Jennifer

doi:10.1016/j.psycom.2021.100018

Cited by 8 publications

(9 citation statements)

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“…Another potential negative effect of IN esketamine treatment is the potential for abuse/craving, which will be assessed with the LCQ. 30 Finally, our exploratory qualitative outcome will include expert commentary by the attending physicians at each of the collaborating research centres, and the assessment of the primary and secondary outcomes. Though it is important to note that due to the sparsity of healthcare coverage to access IN esketamine, we foresee that this treatment may be less feasible for the average person suffering with TRD.…”

Section: Discussionmentioning

confidence: 99%

“…Tolerability will be determined by tracking the side effects of IN esketamine treatment, using a checklist of common side effects27 and the CADSS-628 for dissociation symptoms. Another potential negative effect of IN esketamine treatment is the potential for abuse/craving, which will be assessed with the LCQ 30. Finally, our exploratory qualitative outcome will include expert commentary by the attending physicians at each of the collaborating research centres, and the assessment of the primary and secondary outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Changes in the severity of depressive symptoms (using the MADRS 22 ) and the tracking of side effects (using a checklist of common side effects of ketamine treatment 27 and the simplified 6-Item Clinician Administered Dissociative Symptom Scale (CADSS-6) 28 for dissociation) will be recorded. Since the FDA and Health Canada both list IN esketamine as having potential for misuse and abuse, 25 29 we will include a measure of abuse potential using a Likeability and Craving Questionnaire (LCQ) developed by Dr Jennifer Swainson and Dr Jay Wang (University of Alberta, Edmonton) 30 to better contextualise real world risks. The Queen’s University Health Sciences and the Affiliated Teaching Hospitals Research Ethics Board approved this protocol.…”

Section: Methodsmentioning

confidence: 99%

“…We will use the side effects checklist (online supplemental appendix 1) 27 and the CADSS-6 for symptoms of dissociation (a common side effect of ketamine treatment) 28 up to 24 hours after the first, second, fourth, sixth and eighth sessions. Potential for addiction will be determined using a LCQ (online Open access supplemental appendix 2) 30 up to 24 hours after the first and eighth sessions. Please refer to figure 1 for an overview of the study design and the application of each of the mentioned scales through the treatment course.…”

Section: In Esketamine Treatmentmentioning

confidence: 99%

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Association of intranasal esketamine, a novel ‘standard of care’ treatment and outcomes in the management of patients with treatment-resistant depression: protocol of a prospective cohort observational study of naturalistic clinical practice

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IntroductionEsketamine is the S-enantiomer of racemic ketamine and has been approved by the Food and Drug Administration for the management of treatment resistant depression, demonstrating effective and long-lasting benefits. The objective of this observational study is to elucidate the association of intranasal (IN) esketamine with beneficial and negative outcomes in the management of treatment resistant major depressive disorder.Methods and analysisThis is a multicentre prospective cohort observational study of naturalistic clinical practice. We expect to recruit 10 patients per research centre (6 centres, total 60 subjects). After approval to receive IN esketamine as part of their standard of care management of moderate to severe treatment resistant depression, patients will be invited to participate in this study. Association of esketamine treatment with outcomes in the management of depression will be assessed by measuring the severity of depression symptoms using the Montgomery-Åsberg Depression Rating Scale (MADRS), and tolerability by systematically tracking common side effects of ketamine treatment, dissociation using the simplified 6-Item Clinician Administered Dissociative Symptom Scale and potential for abuse using the Likeability and Craving Questionnaire (LCQ). Change in depressive symptoms (MADRS total scores) over time will be evaluated by within-subject repeated measures analysis of variance. We will calculate the relative risk associated with the beneficial (reduction in total scores for depression) outcomes, and the side effect and dropout rates (tolerability) of adding IN esketamine to patients’ current pharmacological treatments. Covariate analysis will assess the impact of site and demographic variables on treatment outcomes.Ethics and disseminationApproval to perform this study was obtained through the Health Sciences Research Ethics Board at Queen’s University. Findings will be shared among collaborators, through departmental meetings, presented on different academic venues and publishing our manuscript.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: In Esketamine Treatmentmentioning

confidence: 99%

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Association of intranasal esketamine, a novel ‘standard of care’ treatment and outcomes in the management of patients with treatment-resistant depression: protocol of a prospective cohort observational study of naturalistic clinical practice

et al. 2022

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“…The participant survey was informed by a drug liking and craving questionnaire (DLCQ), which has been previously described and is available online ( 31 ). In the absence of a validated tool to assess addiction potential for ketamine in the psychiatric population, the DLCQ was created, based on review of the literature and recommendations for assessing abuse potential from the United States Federal Drug Administration ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

A survey of drug liking and cravings in patients using sublingual or intranasal ketamine for treatment resistant depression: A preliminary evaluation of real world addictive potential

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Ketamine has gained rapid popularity as a treatment option for treatment resistant depression (TRD). Though seen only in limited contexts, ketamine is a potential drug of abuse, addiction and diversion. Clinical ketamine studies to date have not systematically evaluated factors relevant to addiction risk in patients with TRD, but in treating patients with ketamine, risks of potential harms related to addiction must be considered. As clinical access to intravenous ketamine programs is limited in much of Canada, these considerations become even more important for clinicians who elect to offer patients less supervised, non-parenteral forms of ketamine treatment. This study explores factors relevant to addiction risk in a real-world sample of 33 patients with TRD currently or previously treated with sublingual (SL) or intranasal (IN) ketamine in the community. First, patients were surveyed using a Drug Liking and Craving Questionnaire (DLCQ) to assess their level of drug liking and craving for ketamine, and to screen for symptoms of a ketamine use disorder. Second, the pharmacy records of these patients were reviewed for red flags for addiction such as dose escalation or early refills. Third, surveys were administered to the treating psychiatrists of patients who had discontinued ketamine to determine if abuse concerns contributed to reason for discontinuation. Though limited to a small sample, results indicate that ketamine is not a universally liked or craved substance in patients with TRD. Prescribers of non-parenteral ketamine should monitor patients and prescribe cautiously. Factors related to addiction (as in the DLCQ) should be explored for clinicians to consider individual risk/benefit for judicious use of ketamine in patients with TRD.

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Non-parenteral Ketamine for Depression: A Practical Discussion on Addiction Potential and Recommendations for Judicious Prescribing

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Intravenous (IV) ketamine is increasingly used off-label at subanesthetic doses for its rapid antidepressant effect, and intranasal (IN) esketamine has been recently approved in several countries for treating depression. The clinical utility of these treatments is limited by a paucity of publicly funded IV ketamine and IN esketamine programs and cost barriers to private treatment programs, as well as the drug cost for IN esketamine itself, which makes generic ketamine alternatives an attractive option. Though evidence is limited, use of non-parenteral racemic ketamine formulations (oral, sublingual, and IN) may offer more realistic access in less rigidly supervised settings, both for acute and maintenance treatment in select cases. However, the psychiatric literature has repeatedly cautioned on the addictive potential of ketamine and raised caution for both less supervised and longer-term use of ketamine. To date, these concerns have not been discussed in view of available evidence, nor have they been discussed within a broader clinical context. This paper examines the available relevant literature and suggests that ketamine misuse risks appear not dissimilar to those of other well-established and commonly prescribed agents with abuse potential, such as stimulants or benzodiazepines. As such, ketamine prescribing should be considered in a similar risk/benefit context to balance patient access and need for treatment with concern for potential substance misuse. Our consortium of mood disorder specialists with significant ketamine prescribing experience considers prescribing of non-parenteral ketamine a reasonable clinical treatment option in select cases of treatment-resistant depression. This paper outlines where this may be appropriate and makes practical recommendations for clinicians in judicious prescribing of non-parenteral ketamine.

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The drug liking and craving questionnaire (DLCQ) to evaluate addiction risk for ketamine and esketamine

Cited by 8 publications

References 9 publications

Association of intranasal esketamine, a novel ‘standard of care’ treatment and outcomes in the management of patients with treatment-resistant depression: protocol of a prospective cohort observational study of naturalistic clinical practice

Association of intranasal esketamine, a novel ‘standard of care’ treatment and outcomes in the management of patients with treatment-resistant depression: protocol of a prospective cohort observational study of naturalistic clinical practice

A survey of drug liking and cravings in patients using sublingual or intranasal ketamine for treatment resistant depression: A preliminary evaluation of real world addictive potential

Non-parenteral Ketamine for Depression: A Practical Discussion on Addiction Potential and Recommendations for Judicious Prescribing

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