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Ketamine and esketamine are efficacious for treatment-resistant depression. Unlike other antidepressants, ketamine lacks a therapeutic delay and decreases the risk for suicide. This cross-sectional study geographically characterized ketamine and esketamine prescribing to United States (US) Medicaid patients. Ketamine and esketamine prescription rates and spending per state were obtained. Between 2009 and 2020, ketamine prescribing rates peaked in 2013 followed by a general decline. For ketamine and esketamine in 2019, Montana (967/million enrollees) and Indiana (425) showed significantly higher prescription rates, respectively, relative to the national average. A total of 21 states prescribed neither ketamine nor esketamine in 2019. There was a 121.3% increase in esketamine prescriptions from 2019 to 2020. North Dakota (1,423) and North Carolina (1,094) were significantly elevated relative to the average state for esketamine in 2020. Ten states prescribed neither ketamine nor esketamine in 2020. Medicaid programs in 2020 spent 72.7-fold more for esketamine ($25.3 million) than on ketamine (0.3 million). Despite the effectiveness of ketamine and esketamine for treatment-resistant depression and anti-suicidal properties, their use among Medicaid patients was limited and highly variable in many areas of the US. Further research to better understand the origins of this state-level variation is needed.

Many patients have reported that they decrease their use of opioids after starting medical cannabis (MC) but less is known for alcohol. The objective of this exploratory study was to identify any factors which differentiate alcohol abaters from those that do not modify their alcohol use after starting MC (non-abaters). Comparisons were made to identify any demographic, dosing, or health history characteristics which differentiated alcohol abaters (N = 47) from non-abaters (N = 65). Respondents selected from among a list of 37 diseases/health conditions (e.g. diabetes, sleep disorders). Abaters and non-abaters were indistinguishable in terms of sex, age, or prior drug history. A greater percentage of abaters (59.6%) than non-abaters (40.6%, p < .05) reported using MC two or more times per day. Abaters were more likely to be employed (68.1%) than non-abaters (51.1%, p < .05). Abaters also reported having significantly more health conditions and diseases (3.3 ± 2.0) than non-abaters (2.4 ± 1.4, p < .05). This small study offers some insights into the profile of patients whose self-reported alcohol intake decreased following initiation of MC. Additional prospective or controlled research into the alcohol abatement phenomenon following MC may be warranted.

Medical marijuana patients often believe that specific strains are more efficacious at treating their conditions. The goals of this investigation were to determine: (1) how many strains of cannabis are there; (2) which strains are used by medical cannabis (MC) patients; and (3) are there any differences in the strains used by patient condition? Study I involved quantifying the number of strains listed in the online database leafly.com and categorizing these by whether the strain name included a gustatory component. MC patients (N = 455) from New England completed an anonymous online survey about their medical history and strain preferences in Study II. There were 1,987 strains listed. Hybrids were significantly more likely than Cannabis indica strains to have a gustatory title. Strain preferences were highly state/dispensary specific with one-fifth of MC patients in Maine preferring Mother of Berries (M.O.B., 21.5%). Many respondents mentioned that they had developed a time-dependent pattern with sativa use during the day and an indica for nighttime use and for improving sleep. There is some general consistency across dispensaries in that hybrid strains and C. indica were most common. Further longitudinal and controlled investigations are necessary to identify the strains that are most efficacious for specific conditions.