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| ID | Type | Description | Link |
|---|---|---|---|
| R21DA047520 | U.S. NIH Grant/Contract | View source |
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The COVID-19 Pandemic prevented us from meeting target goals.
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| Name | Class |
|---|---|
| Johns Hopkins University | OTHER |
| National Institute on Drug Abuse (NIDA) | NIH |
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The epidemic of opioid overdose deaths continues to rise, killing more persons in 2017 than HIV/AIDS at the height of that epidemic. Medication assisted treatment, including methadone and buprenorphine, is the standard of care for the treatment of opioid use disorder (OUD). However, chronic pain can reduce treatment efficacy during medication assisted treatment and is associated with illicit substance relapse, dropout, and subsequent overdose. Mechanisms by which chronic pain may influence the impulsive decision making (e.g., drug relapse) in persons with OUD have not been well characterized. A better understanding is needed of decision-making in this population. Two factors that can influence decisions to use drugs are impulsivity and acute opioid withdrawal. This proposal will test how chronic pain is associated with increases in impulsive decision making in OUD, whether impulsive decision making is greater when undergoing opioid withdrawal, and how catastrophizing may modify the association between withdrawal and impulsive decision making in patients with chronic pain and OUD. An ideal population for this developmental research project are methadone maintained patients, who show high treatment attendance rates and will therefore assure study efficiency and reliable completion.
This is an outpatient Phase 1 clinical trial investigating the effect of naloxone precipitated withdrawal on delay discounting. Eligible participants will undergo two experimental sessions presented in random order. One session will involve the measurement of delay discounting 30 minutes after double-blind intramuscular (IM) administration of placebo (normal saline) and the other will have the exact same procedures performed after double-blind IM administration of naloxone (0.1 mg). Injections will occur 2 hours after methadone dosing (peak levels). Study sessions will last 2 hours and involve pain and opioid withdrawal measures assessed at baseline and 15 minute intervals after injections. The participant should be back to baseline and free of withdrawal by the end of the study session. Sessions will occur at least 48 hours apart.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pain Group | Experimental | Patients with chronic pain who are maintained on methadone for opioid use disorder |
|
| No Pain Group | Placebo Comparator | Patients who are maintained on methadone for opioid use disorder but who do not have chronic pain. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Naloxone Hydrochloride | Drug | An intramuscular (IM) injection of naloxone will be given. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Delay Discounting of Money Rate (k) | Delay discounting is the relative preference for smaller sooner over larger later rewards, an aspect of impulsivity. Most individuals would prefer an immediate $100 over $100 delayed by 1 year. However, when faced with the choice between receiving $95 now versus $100 in 1 year, preferences for the delayed reward may increase. By assessing such choices across multiple delays, delay discounting quantifies the devaluation of rewards over time, which allows for an index of overall discounting rate (k). Delay Discounting of money rate has no units and values can go from 0-infinity. A larger discount rate indicates that a future reward is devalued more, and is associated with more impulsive behavior. | k will be calculated from the same series of discounting questions that will be asked once each session at approximately 30 minutes after study medication administration. |
| Measure | Description | Time Frame |
|---|---|---|
| Study Session Peak Pain Visual Analog Scale (VAS) | Current pain level rated on 0-100 VAS. This is the validated pain scale typically used by clinicians in an outpatient or inpatient clinical visit to represent current level of pain. Higher ratings indicate worse pain severity. | Peak Pain VAS will be the highest rating during each 2 hour study session. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| D. Andrew Tompkins, MD | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zuckerberg San Francisco General Hospital | San Francisco | California | 94110 | United States |
Data will be made available to the public through presentation at scientific meetings and research publications in peer-reviewed journals. I have routinely kept an open policy to share data with the scientific and medical community upon request, and this policy will be continued with the present project.
Data will become available after publication of the main study results.
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We began study recruitment in January 2020 (Q2) after IRB approval was received. The first study participant screening session was on January 21, 2020. UCSF halted all non-essential clinical research in March 2020 and we were unable to conduct research activities on a full 5 day a week schedule until one year later, with some periods during winter surges when we had to again shut down all research activities.
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| ID | Title | Description |
|---|---|---|
| FG000 | Pain Group | Patients with chronic pain who are maintained on methadone for opioid use disorder Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. Placebo: An IM injection of 0.9% normal saline will be given. |
| FG001 | No Pain Group | Patients who are maintained on methadone for opioid use disorder but who do not have chronic pain. Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. Placebo: An IM injection of 0.9% normal saline will be given. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Pain Group | Patients with chronic pain who are maintained on methadone for opioid use disorder Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. Placebo: An IM injection of 0.9% normal saline will be given. |
| BG001 | No Pain Group |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Delay Discounting of Money Rate (k) | Delay discounting is the relative preference for smaller sooner over larger later rewards, an aspect of impulsivity. Most individuals would prefer an immediate $100 over $100 delayed by 1 year. However, when faced with the choice between receiving $95 now versus $100 in 1 year, preferences for the delayed reward may increase. By assessing such choices across multiple delays, delay discounting quantifies the devaluation of rewards over time, which allows for an index of overall discounting rate (k). Delay Discounting of money rate has no units and values can go from 0-infinity. A larger discount rate indicates that a future reward is devalued more, and is associated with more impulsive behavior. | Posted | Mean | Standard Deviation | k-value | k will be calculated from the same series of discounting questions that will be asked once each session at approximately 30 minutes after study medication administration. |
|
2 sessions were held approximately 1 week apart. Adverse events were collected after receiving the first injection of study medication until 24 hours after the last session. This was approximately 8 days for participants assuming sessions were held one week apart.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Pain Group, Placebo Session | Patients with chronic pain who are maintained on methadone for opioid use disorder. Placebo: An IM injection of 0.9% normal saline will be given. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Dizziness | Nervous system disorders | MedDRA (Unspecified) | Non-systematic Assessment |
COVID-19 Public Health Emergency caused almost complete stoppage of research activities for over half of the grant time. We only had 10% of the proposed number of completers. Therefore, the decision was made to halt the study.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| David Andrew Tompkins, MD, MHS | University of California, San Francisco | 628-206-3645 | david.tompkins@ucsf.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Dec 9, 2020 | Jan 5, 2024 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Nov 2, 2021 | Jan 5, 2024 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D009293 | Opioid-Related Disorders |
| D007175 | Impulsive Behavior |
| ID | Term |
|---|---|
| D000079524 | Narcotic-Related Disorders |
| D019966 | Substance-Related Disorders |
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D009270 | Naloxone |
| ID | Term |
|---|---|
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
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This proposal is a randomized double-blind placebo controlled Phase 1 clinical trial / human laboratory study
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The participant, investigator, medical personnel administering study drug, and outcomes assessor will be blinded to drug being administered.
| Placebo | Drug | An IM injection of 0.9% normal saline will be given. |
|
| Peak Clinical Opiate Withdrawal Scale (COWS) Rating | The COWS is an 11-item validated clinician administered scale that quantifies level of opioid withdrawal. The range of scores is 0-48, with higher scores indicating greater withdrawal severity. The peak COWS rating will be the highest measurement in the session after study drug administration. | Peak COWS rating will be the highest rating during each 2 hour study session. |
| Peak Subjective Opiate Withdrawal Scale (SOWS) Rating | The SOWS is a 16 item validated self-administered scale for grading opioid withdrawal symptoms. The range of scores is 0-64, with higher scores indicating greater withdrawal severity. The peak SOWS rating will be the highest measurement in the session after study drug administration. | Peak SOWS rating will be the highest rating during each 2 hour study session. |
| Peak Increase From Baseline Pupil Diameter | Pupil diameter (mm) will be measured via digital pupillometer in standard room lighting at baseline and then throughout the study session after study drug administration. The peak increase from baseline value will be the largest increase from baseline pupil diameter measured after study drug administration. | Peak increase from baseline pupil diameter will be the largest increase from baseline pupil diameter measured during each 2 hour study session. |
Patients who are maintained on methadone for opioid use disorder but who do not have chronic pain. Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. Placebo: An IM injection of 0.9% normal saline will be given. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Patients with chronic pain who are maintained on methadone for opioid use disorder
Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given.
Placebo: An IM injection of 0.9% normal saline will be given.
| OG001 | No Pain Group | Patients who are maintained on methadone for opioid use disorder but who do not have chronic pain. Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. Placebo: An IM injection of 0.9% normal saline will be given. |
|
|
| Secondary | Study Session Peak Pain Visual Analog Scale (VAS) | Current pain level rated on 0-100 VAS. This is the validated pain scale typically used by clinicians in an outpatient or inpatient clinical visit to represent current level of pain. Higher ratings indicate worse pain severity. | There was missing data for one participant with chronic pain in the placebo session. | Posted | Mean | Standard Deviation | score on a scale | Peak Pain VAS will be the highest rating during each 2 hour study session. |
|
|
|
| Secondary | Peak Clinical Opiate Withdrawal Scale (COWS) Rating | The COWS is an 11-item validated clinician administered scale that quantifies level of opioid withdrawal. The range of scores is 0-48, with higher scores indicating greater withdrawal severity. The peak COWS rating will be the highest measurement in the session after study drug administration. | Posted | Mean | Standard Deviation | score on a scale | Peak COWS rating will be the highest rating during each 2 hour study session. |
|
|
|
| Secondary | Peak Subjective Opiate Withdrawal Scale (SOWS) Rating | The SOWS is a 16 item validated self-administered scale for grading opioid withdrawal symptoms. The range of scores is 0-64, with higher scores indicating greater withdrawal severity. The peak SOWS rating will be the highest measurement in the session after study drug administration. | Posted | Mean | Standard Deviation | score on a scale | Peak SOWS rating will be the highest rating during each 2 hour study session. |
|
|
|
| Secondary | Peak Increase From Baseline Pupil Diameter | Pupil diameter (mm) will be measured via digital pupillometer in standard room lighting at baseline and then throughout the study session after study drug administration. The peak increase from baseline value will be the largest increase from baseline pupil diameter measured after study drug administration. | Posted | Mean | Standard Deviation | millimeters | Peak increase from baseline pupil diameter will be the largest increase from baseline pupil diameter measured during each 2 hour study session. |
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|
| 0 |
| 6 |
| 0 |
| 6 |
| 1 |
| 6 |
| EG001 | Pain Group, Naloxone Session | Patients with chronic pain who are maintained on methadone for opioid use disorder. Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. | 0 | 6 | 0 | 6 | 2 | 6 |
| EG002 | No Pain Group, Placebo Session | Patients who are maintained on methadone for opioid use disorder but who do not have chronic pain. Naloxone Hydrochloride: An intramuscular (IM) injection of naloxone will be given. | 0 | 4 | 0 | 4 | 1 | 4 |
| EG003 | No Pain Group, Naloxone Session | Patients who are maintained on methadone for opioid use disorder but who do not have chronic pain. Placebo: An IM injection of 0.9% normal saline will be given. | 0 | 4 | 0 | 4 | 0 | 4 |
| Tunnel Vision | Eye disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Paranoia | Nervous system disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Eye Irritation | Eye disorders | MedDRA (Unspecified) | Non-systematic Assessment |
|
| Somnolence | Nervous system disorders | MedDRA (Unspecified) | Non-systematic Assessment |
|
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| D001519 | Behavior |
| D006572 |
| Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |
| Naloxone |
|
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