Study of Four Different Potencies of Smoked Marijuana in 76 Veterans With PTSD

• ClinicalTrials.gov Identifier: NCT02759185
• Recruitment Status: Completed
• First Posted: May 3, 2016
• Last Update Posted: January 31, 2019
• Sponsor: Multidisciplinary Association for Psychedelic Studies
• Information provided by (Responsible Party): Multidisciplinary Association for Psychedelic Studies

Study Description

Brief Summary:

Posttraumatic stress disorder (PTSD) is a debilitating disorder experienced by a subset of individuals following life-threatening trauma, such as sexual and physical assault, natural disasters, and military combat. Despite there being a number of treatments for PTSD, there is a need to help people who have PTSD and do not benefit from these treatments as many individuals continue to experience marked PTSD symptoms following treatment. In response to overwhelming demand, several U.S. states have passed laws allowing the medical use of cannabis (marijuana) by individuals with PTSD. Unfortunately, there has been very little scientific evidence on suitability of cannabis as an alternative therapy for PTSD. The purpose of this study is to find out if cannabis can reduce PTSD symptoms in 76 military veterans with PTSD. Four different types of smoked cannabis will be evaluated using a "triple-blind" cross-over placebo controlled design. After screening and meeting study requirements, participants will be randomly assigned to receive one of four types of cannabis that vary based on THC and CBD content. During the study, each participant will smoke two of the four types of cannabis, up to 1.8 grams per day, for a 3-week period. Participants can smoke their daily 1.8g cannabis at any time, using as much as they need. After each 3-week cannabis use period, they will stop smoking marijuana/cannabis for two weeks where no cannabis use will be allowed. Study findings will help researchers better understand the risks and benefits associated with cannabis use among veterans with PTSD, information that can be used to aid in shared decision-making among people with PTSD and their doctors or therapists.

Condition or disease	Intervention/treatment	Phase
Posttraumatic Stress Disorder	Drug: High THC Marijuana; Drug: High CBD Marijuana; Drug: High THC/high CBD marijuana; Drug: Placebo marijuana	Phase 2

Detailed Description:

Posttraumatic Stress Disorder (PTSD), characterized by an inability to recover from a stress reaction to a traumatic event, is a widely prevalent disorder within the U.S. and across the world. Currently, several psychotherapies are empirically-supported for the treatment of PTSD. However, because of treatment refusal due to treatment type, non-response, and dropout, many individuals continue to experience severe symptoms and meet criteria for PTSD following treatment.

Emerging observational and early clinical evidence suggest that cannabis (marijuana) may have the potential to reduce or ameliorate a number of symptoms experienced by those with PTSD, including sleep difficulty and anxiety. Indeed, some evidence has suggested that delta-9-tetrahydrocannabinol (THC) may serve to reduce nightmares among those with PTSD, while other studies have shown anxiolytic effects of cannabidiol (CBD). However, there have been no randomized controlled trials of cannabis, in any form, for PTSD.

The present triple-blind, randomized, placebo-controlled crossover trial aims to examine the safety and efficacy of four types of cannabis (i.e., high THC, low CBD; high CBD, low THC; equal ratio THC/CBD; and placebo) among 76 military veterans with PTSD of at least six months' duration. Participants will be recruited from one study site, the Scottsdale Research Institute (Phoenix, AZ).

After giving written informed consent, participants will undergo screening for initial eligibility. Potential participants will be required to stop using non-study medical cannabis for two weeks during screening, and for the duration of the study if enrolled. After the two-week washout, a blinded independent rater will administer the Clinician-Administered PTSD Scale (CAPS-5) to assess presence and severity of PTSD symptoms. Self-report measures will also be completed. Eligible participants will then be enrolled and randomized. In the active portion of the study, participants will receive two of four different types of cannabis during two stages (Stage 1 and Stage 2), each lasting three weeks, with crossover and re-randomization at Stage 2. Prior to each stage, participants will complete two introductory sessions where they will be trained on cannabis self-administration. During each stage, participants will be provided 1.8 grams of cannabis daily to smoke ad libitum. Each stage will be followed by a two-week cessation. To reduce the risk of diversion, after the second cessation period, participants will have the option to complete a third stage of the study where they can request the remaining unused cannabis from either Stage 1 or 2.

Study outcomes will be assessed objectively, behaviorally, via self-report, and by a third-party rater. Specifically, blood and urine will be collected to confirm cannabis use status throughout the study, participants will be required to video record self-administration of cannabis, and any unused cannabis from each weekly allotment will be returned to the investigator or designee to be weighed and accounted for prior to dispensing of the next weekly supply. Sleep will be measured via self-report and tracked with actigraphy, clinical interviews will be conducted by blinded independent raters will provide an independent rating of participant behavior.

Participant suicidal ideation will be assessed weekly with the C-SSRS, and daily if results indicate development of suicidal ideation. Weekly evaluations will include measures of symptoms of PTSD, depression, anxiety, sleep quality, general functioning, and responses to cannabis. During each evaluation, actigraph data will also be downloaded and a urine-dip EtG test will be performed. Analysis of blood/urine cannabinoids will be conducted after cessation periods, in addition to weekly urine drug screening for substances other than cannabis. At Baseline and end of Stage 1, Cessation 1 and end of Stage 2, additional blood samples will be collected for analysis of inflammation markers. At the end of Stage 1 and 2, endpoint measures will be administered; an independent rater will evaluate symptoms of PTSD on the CAPS-5 via telemedicine, and self-reported symptoms of anxiety, depression, withdrawal, sleep quality, and psychosocial functioning will be assessed.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 80 participants
• Allocation: Randomized
• Intervention Model: Crossover Assignment
• Masking: Triple (Participant, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Placebo-Controlled, Triple-Blind, Randomized Crossover Pilot Study of the Safety and Efficacy of Four Different Potencies of Smoked Marijuana in 76 Veterans With Posttraumatic Stress Disorder (PTSD)
• Actual Study Start Date: January 2, 2017
• Actual Primary Completion Date: January 2019
• Actual Study Completion Date: January 2019

Arms and Interventions

Arm	Intervention/treatment
Experimental: High THC marijuana; Provided with up to 1.8 g of marijuana with more tetrahydrocannabinol than cannabidiol	Drug: High THC Marijuana; Three weeks of smoking marijuana containing more THC than CBD, with amount smoked limited to no more than 1.8 g per day.; Other Names: Tetrahydrocannabinol; cannabis
Experimental: High CBD marijuana; Provided with up to 1.8 g of marijuana per day of marijuana with more cannabidiol than tetrahydrocannabinol	Drug: High CBD Marijuana; Three weeks of smoking marijuana containing more CBD than THC, with amount smoked limited to no more than 1.8 g per day.; Other Names: cannabidiol; cannabis
Experimental: High THC/high CBD marijuana; Provided with up to 1.8 g per day of marijuana with an approximately equal amount of tetrahydrocannabinol and cannabidiol	Drug: High THC/high CBD marijuana; Three weeks of smoking marijuana containing equal amounts of THC and CBD, with smoking limited to no more than 1.8 g per day.; Other Names: tetrahydrocannabinol; cannabidiol; cannabis
Placebo Comparator: Placebo marijuana; Provided with 1.8 per day of marijuana with very low levels of tetrahydrocannabinol and cannabidiol	Drug: Placebo marijuana; Three weeks of smoking marijuana with low levels of THC and CBD, with smoking limited to no more than 1.8 per day.; Other Name: cannabis

Outcome Measures

Primary Outcome Measures :

1. Change in CAPS Global Severity Score from baseline to primary endpoint [ Time Frame: Baseline, 3 weeks after randomization ]
   Clinician-Administered PTSD Scale, a measure of PTSD symptom severity

Secondary Outcome Measures :

1. Change in CAPS Global Severity Score from baseline to secondary endpoint [ Time Frame: Baseline and eight weeks after study randomization ]
   Clinician-Administered PTSD Scale, a measure of PTSD symptom severity

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Have PTSD of at least six months duration.
• Have PTSD of at least moderate severity at the time of baseline assessment.
• Be a military veteran with PTSD.
• Be at least 18 years old.
• Be willing to commit to medication dosing and delivery method, to completing evaluation instruments, and attending all study visits.
• Agree to use only marijuana provided by site staff and agree to required cessation periods for the duration of the study.
• Report no current hazardous marijuana use and completely abstain from marijuana during the 2-week baseline assessment period (verified via urine and/or blood cannabinoid concentrations).
• Agree to video record all marijuana administrations and provide video to the site staff for review during study participation.
• Agree to keep all marijuana provided by site staff securely stored in the provided lock box and not to share/distribute marijuana to any other individual.
• Be stable on any pre-study medications and/or psychotherapy regimen for PTSD prior to study entry, agree to notify their physician/clinician about participation in the study, and agree to report any changes in medication or psychotherapy treatment regimen during the study, to site staff.
• If female and of childbearing potential, agree to use an effective form of birth control during study participation and may only be allowed to enroll and continue in the study based on a negative pregnancy test.
• Be proficient in reading and writing in English and able to effectively communicate with site staff.
• Agree not to participate in any other interventional clinical trials during the study

Exclusion Criteria:

• Upon review of medical or psychiatric history must not have any current or past diagnosis that would be considered a risk to participation in the study.
• Have any allergies to marijuana or contraindication for smoking of marijuana.
• Are abusing illegal drugs;
• Are not able to give adequate informed consent.
• Are not able to attend face-to-face visits or those who plan to move out of the area within the treatment period.
• Are pregnant or nursing, or if a woman who can have children, those who are not practicing an effective means of birth control;

Contacts and Locations

Locations

United States, Arizona

Scottsdale Research Institute

Phoenix, Arizona, United States, 85027

Sponsors and Collaborators

Multidisciplinary Association for Psychedelic Studies

More Information

Additional Information:

Study recruitment website 

• Responsible Party: Multidisciplinary Association for Psychedelic Studies
• ClinicalTrials.gov Identifier: NCT02759185
• Other Study ID Numbers: MJP-1
• First Posted: May 3, 2016
• Last Update Posted: January 31, 2019
• Last Verified: November 2018

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

Keywords provided by Multidisciplinary Association for Psychedelic Studies:

PTSD; marijuana; cannabis; sleep; THC; CBD

Additional relevant MeSH terms:

Marijuana Abuse; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Trauma and Stressor Related Disorders; Mental Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Dronabinol; Epidiolex; Hallucinogens; Physiological Effects of Drugs; Psychotropic Drugs; Analgesics, Non-Narcotic; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Cannabinoid Receptor Agonists; Cannabinoid Receptor Modulators; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Anticonvulsants