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

Background: The number of medical marijuana patients is increasing. This increase raises important concerns about how medical marijuana use may affect parenting. Methods: Thirty-two adult medical marijuana patients participated in focus groups. The focus groups were audio-recorded and transcribed. The transcriptions were coded by a team that met regularly to resolve coding differences. Codes related to parenting were used to develop a conceptual model for this manuscript. Results: Six of 11 participants who identified being parents reported that using marijuana helped them to be calmer with their children and to manage difficult emotions related to parenting. At the same time, most medical marijuana patients did not want their children to use marijuana. Their concerns about their children led to different strategies related to storing medical marijuana securely and how to communicate with children about medical marijuana use. Conclusions: These findings show that many medical marijuana patients are concerned about their children using marijuana and may be open to strategies to addressing this issue with their children. These findings also show that some medical marijuana patients may benefit from alternative strategies for managing difficult emotions related to parenting.