Adjunctive Effects of Psilocybin and Buprenorphine

• ClinicalTrials.gov Identifier: NCT04161066
• Recruitment Status: Recruiting
• First Posted: November 13, 2019
• Last Update Posted: June 3, 2022
• Sponsor: University of Wisconsin, Madison
• Collaborator: Heffter Research Institute
• Information provided by (Responsible Party): University of Wisconsin, Madison

Study Description

Brief Summary:

Primary Aim: In participants with OUD in early or sustained full recovery on buprenorphine/naloxone therapy, to characterize adverse events associated with adding two psilocybin doses to a stable buprenorphine/naloxone regimen.

Secondary Aim: To evaluate the effect of psilocybin treatment on the effectiveness of buprenorphine/naloxone maintenance therapy.

Secondary Aim: To evaluate the effect of concurrent buprenorphine/naloxone use on the effects of psilocybin therapy.

Descriptive Aim: To describe any changes in self-efficacy, quality of life, pain.

Condition or disease	Intervention/treatment	Phase
Opioid Use Disorder	Drug: Psilocybin with guided counseling	Phase 1

Detailed Description:

The primary objective of this clinical trial is to determine the safety of psilocybin in adult patients with opioid use disorder concurrently taking buprenorphine/naloxone (Suboxone®).

Eligible participants will be adults with opioid use disorder (OUD) who have been demonstrated to be stable on a daily buprenorphine/naloxone dose. Recovery status will be verified by the participant's community-based prescriber. After psychological screening and at least 6 hours of preparatory counseling and preparation for the psilocybin dosing, set, and setting, each participant will ingest 1 oral dose of psilocybin. All dosing sessions will be attended by 2 specially trained guides, in a dedicated Clinical Research Facility. After eight hours of observation in the dosing room, the participant will be kept overnight in the hospital Clinical Research Unit, and complete an integration session with a psychologist before discharge to home. Approximately 4 weeks after the first dose, the participant will receive a second oral dose of psilocybin, with the same length of observation.

Participants who have been administered the first dose but decline to receive the second dose will remain evaluable. At study termination, their active study participation will end, but completion of the 28 day post-dose follow up will be requested.

The primary endpoint is the assessment of the safety of concurrent administration of buprenorphine and naloxone (eg., Suboxone®) and psilocybin as determined by physiological measures (ECG, respiratory rate, blood pressure, body temperature, and blood oxygen saturation) and validated clinical and self-report measures (Clinical Opiate Withdrawal Scale (COWS), Opioid Craving Scale (OCS), Timeline Follow-Back (TLFB)).

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 10 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Intervention Model Description: open-label pilot study
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• Official Title: Phase I Study of the Safety and Adjunctive Effects of Psilocybin in Adults With Opioid Use Disorder Maintained on Buprenorphine/Naloxone
• Actual Study Start Date: January 13, 2021
• Estimated Primary Completion Date: August 2022
• Estimated Study Completion Date: August 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Open-label; Psilocybin with guided counseling: Psilocybin will be administered in the form of capsules, taken orally with water. Each participant will receive 2 doses, approximately 4 weeks apart.	Drug: Psilocybin with guided counseling; open-label pilot study

Outcome Measures

Primary Outcome Measures :

1. Safety Measured by Incidence and Severity of Adverse Events 24 hrs post-dose [ Time Frame: approximately Week 1 ]
   In participants with OUD in early or sustained full recovery on buprenorphine/naloxone therapy, the safety of this intervention will be assessed by characterize adverse events associated with adding two psilocybin doses to a stable buprenorphine/naloxone regimen.
2. Safety Measured by Incidence and Severity of Adverse Events 24 hrs post-dose [ Time Frame: approximately Week 5 ]
   In participants with OUD in early or sustained full recovery on buprenorphine/naloxone therapy, the safety of this intervention will be assessed by characterize adverse events associated with adding two psilocybin doses to a stable buprenorphine/naloxone regimen.
3. Mean Change in Symptoms of Opioid Withdrawal Measured by COWS Instrument [ Time Frame: up to 5 weeks ]
   It is hypothesized that co-administration of oral psilocybin with buprenorphine/naloxone will not cause signs and symptoms of opioid withdrawal. This will be measured by the Clinical Opiate Withdrawal Scale (COWS) instrument, an 11-item scale administered by the clinician where total score of: 5- 12 = mild withdrawal; 13-24 = moderate withdrawal; 25-36 = moderately severe withdrawal; and more than 36 = severe withdrawal. Administered before the dose and again 8 hours after the dose.
4. Mean Change in Peripheral Capillary Oxygen [ Time Frame: up to 5 weeks ]
   It is hypothesized that co-administration of oral psilocybin with buprenorphine/naloxone will not cause opioid intoxication. Opioid intoxication will be determined by drops peripheral capillary oxygen saturation (SpO2) before and after dosing.
5. Mean Change in ECG [ Time Frame: up to 5 weeks ]
   It is hypothesized that co-administration of oral psilocybin with buprenorphine/naloxone will not cause a clinically significant increase in the QTc interval. The QTc interval will be measured by electrocardiogram (ECG) before and after dosing. ECGs will be collected using the CardioCard PC computer-based system, once before the dose, and again at 1, 2, 3, 4, 6, and 8 hours after the dose. If a QTc(F), calculated by the CardioCard system exceeds 470msec, a study physician will be contacted immediately for further monitoring and treatment recommendations.

Secondary Outcome Measures :

1. Change in Opioid Craving Scale (OCS) from baseline through end of study [ Time Frame: Baseline, Week 1, Week 5, and Week 9 ]
   To evaluate the effect of psilocybin treatment on the effectiveness of buprenorphine/naloxone maintenance therapy. The hypothesis is that co-administration of oral psilocybin with buprenorphine/naloxone will not cause an increase in opioid craving, as measured by the OCS at baseline, week 1, week 5, and week 9. The OCS is a 3-item visual analog scale to measure the frequency and intensity of opioid craving. Total score ranges from 0-30 where the higher the number, the higher the craving.
2. Mystical Effects Questionnaire (MEQ) after each dose [ Time Frame: approximately Week 1 and Week 5 ]
   To evaluate the effect of concurrent buprenorphine/naloxone use on the effects of psilocybin with guided counseling. The hypothesis is that co-administration of buprenorphine/naloxone with oral psilocybin will not be associated with a change in the effects of psilocybin, as measured by adverse events (Primary Outcome Measure), and the MEQ. The MEQ is a 30-item assessment used to characterize the consciousness-altering effects of psilocybin. Total possible range of scores is 0-150 where the higher the number the higher the consciousness-altering effects.
3. Mean Number of Days of Participant Opioid Use via Time Line Follow Back (TLFB) [ Time Frame: up to 9 weeks ]
   It is hypothesized that co-administration of oral psilocybin with buprenorphine/naloxone will not be associated with an increase in self-reported illicit opioid use. This will be measured by Time Line Follow-Back calendar method for up to the 28 days following the last dosing session. Participants will be asked to recall the previous 28 days of substance use at the first in-person visit.

Eligibility Criteria

• Ages Eligible for Study: 21 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Aged 21 to 65 years
• Able to read, speak, and understand spoken and written English

• Diagnosis of opioid use disorder (OUD) receiving a prescribed buprenorphine formulation for OUD treatment

  1. In the clinical judgment of the prescribing provider, the participant has been stable in treatment for OUD for at least 6 months; AND
  2. The total daily dose of buprenorphine did not exceed 20mg in the 10 days prior to screening
• Females of childbearing potential must agree to practice an effective means of contraception throughout their participation in the study, beginning at screening and throughout follow-up
• Ability and willingness to adhere to study requirements, including attending all study visits, preparatory and follow-up sessions, and evaluations
• Healthy kidney function
• Able to provide contact information for a local support person. This person must be available during both of the 24-hour treatment and observation periods, and willing to provide the participant transportation from the site after each treatment and observation period.

Exclusion Criteria:

• Current participation in a drug treatment court program or other legal supervision. Individuals who are under legal supervision will be advised that participating in this study could potentially violate terms of probation, parole, or extended supervision.
• Inadequately treated hypertension
• Current acute coronary syndrome or angina
• Evidence of ischemic disease, cardiac conduction defects, and/or ventricular arrhythmias on screening ECG
• History of heart transplant
• Current insulin dependence, due to Type I or Type II diabetes
• Current use of intramuscular naltrexone
• Urine drug test containing non-prescribed drugs of abuse
• Any finding(s), based on the screening process, that the PI feels makes the study unsuitable for the participant

Contacts and Locations

Contacts

Contact: David Horton, MS; 608-444-2397; protea.research@mailplus.wisc.edu

Locations

United States, Wisconsin

University of Wisconsin; Recruiting

Madison, Wisconsin, United States, 53705

Contact: David Horton, MS 608-444-2397 protea.research@mailplus.wisc.edu

Principal Investigator: Randall Brown, MD PhD

Sponsors and Collaborators

University of Wisconsin, Madison

Heffter Research Institute

Investigators

• Principal Investigator: Randall Brown, MD PhD; University of Wisconsin, Madison

More Information

• Responsible Party: University of Wisconsin, Madison
• ClinicalTrials.gov Identifier: NCT04161066
• Other Study ID Numbers: 2019-0187; A532007 ( Other Identifier: UW Madison ); SMPH/FAMILY MEDICINE ( Other Identifier: UW Madison ); Protocol Version 9/22/2021 ( Other Identifier: UW Madison )
• First Posted: November 13, 2019
• Last Update Posted: June 3, 2022
• Last Verified: June 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No
• Plan Description: No individual participant data sharing is planned

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by University of Wisconsin, Madison:

Suboxone; Buprenorphine

Additional relevant MeSH terms:

Opioid-Related Disorders; Narcotic-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders; Psilocybin; Hallucinogens; Physiological Effects of Drugs; Psychotropic Drugs