Single-dose intravenous ketamine or intramuscular naltrexone for high-utilization inpatients with alcohol use disorder: pilot trial feasibility and readmission rates.

BACKGROUND: Alcohol use disorder (AUD) accounts for millions of acute care encounters annually in the United States. Hospitalization represents a vital opportunity to intervene pharmacologically, but low medication adherence is a significant barrier. Two single-dose, adherence-independent interventions are well suited for pre-discharge administration: intravenous (IV) ketamine and intramuscular (IM) naltrexone. Their feasibility and readmission-reducing efficacy in hospital settings are not well-established. METHODS: A 3-arm, open-label randomized trial was conducted at our safety-net medical hospital among high-utilization inpatients with severe AUD. Consented adults (age 18-65) were randomized to (1) IV ketamine (KET) 0.5 mg/kg over 40 min, (2) IM naltrexone (NTX) 380 mg once, or (3) linkage alone (LA). The primary clinical outcome was 30-day all-cause hospital readmission rate. All were provided enhanced linkage to outpatient addiction clinic. RESULTS: We consented and randomized 44 participants (n = 13, 14, 17 for KET, NTX, LA, respectively), with a mean of 3.2 past-year hospitalizations. Compared to the LA arm, both the KET arm (RR 0.37, p = 0.17) and NTX arm (RR 0.52, p = 0.27) had a lower 30-day readmission rate, though the differences were nonsignificant. Immediate acceptability ratings of KET and NTX were 9.50 and 9.17 out of 10, respectively. No serious adverse events or illicit ketamine use was reported. CONCLUSIONS: Both interventions are feasible and showed promise in reducing readmissions for high-utilization AUD inpatients. Despite randomization, baseline characteristics may have differed in ways that biased against the control arm. Additional pragmatic studies-with larger sample size, blinding, and robust follow-up data collection-are needed to verify findings and better understand mediating factors. CLINICALTRIALS: gov Identifier NCT04562779. Registered 24 September 2020. https://clinicaltrials.gov/ct2/show/NCT04562779.

Adolescent US Poison Center Exposure Calls During the COVID-19 Pandemic.

PURPOSE: The objective of this study was to evaluate trends and characteristics in adolescent poison center (PC) exposure calls before and during the COVID-19 pandemic. METHODS: A retrospective review of PC calls for adolescents aged 13-17 years from January 1, 2018 through June 30, 2021. RESULTS: During the pandemic, US PCs had a higher proportion of adolescent exposure calls managed in a healthcare facility (71.9% vs. 67.4%) and hospital admissions (27.2% vs. 25.7%) than prior to the pandemic. There was a higher proportion with suicide intent (55.8% vs. 48.8%), moderate/major clinical effects (22.8% vs. 20.1%), and deaths (0.07% vs. 0.05%). Monthly calls significantly increased from 30 calls/month to 204 calls/month (p < .001). The slope of hospital admissions significantly increased (0.19% per month, p < .001) during the pandemic. DISCUSSION: During the COVID-19 pandemic, US PCs observed an increase in adolescent suicidal intent exposure calls with more severe outcomes, hospitalizations, and deaths.