Background: Ketamine and esketamine are efficacious for treatment resistant depression. Unlike other antidepressants, ketamine and esketamine lack a therapeutic delay and do not increase risk for suicidal thoughts and behaviors in adolescents and young-adults. Esketamine gained FDA approval in March of 2019.Objective: This cross-sectional study aimed to geographically characterize ketamine and esketamine prescribing to US Medicaid patients.Methods: Ketamine and esketamine prescription rate and spending per state were obtained from the Medicaid State Drug Utilization Database. States outside of a 95% Confidence Interval were considered statistically significant.Results: Between 2009-2020, 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. Since its approval, esketamine prescriptions have surpassed those of ketamine. 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 for esketamine in 2020. Ten states prescribed neither ketamine nor esketamine in 2020. State Medicaid programs in 2020 spent 72.7 fold more for esketamine ($25.3 million) than on ketamine (0.3 million) prescriptions. Conclusion:Despite the effectiveness of ketamine and esketamine for treatment resistant depression, their use among Medicaid patients was limited and variable in many areas of the US.
Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians’ attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.
BackgroundKetamine, and its isomer esketamine are useful for treatment resistant depression (depression not responsive to traditional antidepressants). Compared to other antidepressants, ketamine and esketamine lack a therapeutic delay and do not increase risk of suicidality in adolescents. Esketamine gained FDA approval in March of 2019.ObjectiveThis study aimed to geographically characterize ketamine and esketamine prescriptions in the United States among Medicaid patients.MethodsKetamine and esketamine prescription rate data per state per quarter were obtained from the Medicaid State Drug Utilization Database for 2019-2020. Total prescription rates per year for ketamine and esketamine were obtained for 2009-2020.ResultsBetween 2009-2020, ketamine prescribing rates peaked in 2013 followed by a general decline. For ketamine and esketamine prescriptions in 2019, Montana and Indiana showed significantly higher prescription rates, respectively, relative to the national average. A total of 21 states prescribed neither ketamine or esketamine in 2019. Since its approval, esketamine prescriptions have surpassed those of ketamine. There was a 121.3% increase in esketamine prescriptions from 2019 to 2020. Ten states prescribed neither ketamine or esketamine in 2020.ConclusionDespite the effectiveness of ketamine and esketamine for treatment resistant depression, their use among Medicaid patients was limited and variable in many areas of the US.
Background and aims. Chronic pain is a major part of the disease burden in Charcot-Marie-Tooth (CMT) disease. Current pharmacotherapies to manage symptoms of CMT disease, particularly pain, are inadequate. This exploratory study examined the patient reported efficacy of medical cannabis among CMT patients. Methods. Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundations Global Registry for Inherited Neuropathies. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results. When asked about how much relief they experience from using cannabis as a method of symptom relief, respondents reported an average of 69.6% (SEM + 2.6). Women were more likely to report experiencing pain than men (p < .05). Participants who perceived support from their providers were more likely to inform them of their cannabis use (p < .05). Interpretation. Patients reported that cannabis was effective to manage symptoms. More prospective and controlled research needs to be conducted to better serve and optimize the potential use of cannabis to treat CMT.
Background. Antibiotic resistance is a persistent and growing concern. Our objective was to analyze antibiotic prescribing data in the United States (US) to identify trends in the Medical Expenditure Panel System (MEPS) and any state-level disparities to Medicaid patients. Methods. We obtained total MEPS prescriptions for eight antibiotics from 2013 to 2020. We extracted prescribing rates per 1,000 Medicaid enrollees for two years, 2018 and 2019, for four broad spectrum (azithromycin, ciprofloxacin, levofloxacin, and moxifloxacin) and four narrow spectrum (amoxicillin, cephalexin, doxycycline, and trimethoprim/sulfamethoxazole) antibiotics. Results. Antibiotics in MEPS decreased from 2013 to 2020 by -38.7% with a larger decline for broad (-53.7%) than narrow spectrum (-23.5%). Antibiotic prescriptions decreased from 2018 to 2019 and by -6.7% when correcting for the number of Medicaid enrollees. Amoxicillin was the predominant antibiotic followed by azithromycin, cephalexin, trimethoprim/sulfamethoxazole, doxycycline, ciprofloxacin, levofloxacin, and moxifloxacin. Substantial geographic variation in antibiotic prescribing existed with 2.8-fold between the highest (Kentucky = 855/1,000) and lowest (Oregon = 299) states. The South prescribed 52.2% more antibiotics (580/1,000) than the West (381/1,000). There were significant correlations across states in antibiotic prescribing. Conclusions & Relevance. This study identified sizable disparities by geography in prescribing rates of eight antibiotics with over three-fold state level differences. The South had the highest prescribing rates among all the regions. Areas with high antibiotic prescribing rates, particularly for outpatients, may benefit from programs to reduce potentially unnecessary prescribing. Further analysis of state level Medicaid or prescribing policies is needed to identify reasons for the variation in prescribing rates.
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