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Aprepitant Effects in Intravenous Heroin Dependence

Primary Purpose

Opioid Dependence

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Aprepitant
Placebo pill
Sponsored by
NYU Langone Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Opioid Dependence focused on measuring Aprepitant, Intravenous heroin dependence

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male and female subjects ranging in age from 18-55 years who are currently opioid dependent based on meeting DSM-IV criteria for dependence on heroin and who are either treatment or non-treatment seeking individuals.
  2. Use of intravenous heroin daily for a minimum of 45 days prior to study entry.
  3. Urine sample (+) for opioids and prior experience with i.v. drug injection.
  4. Female subjects who are not of childbearing potential, (i.e. post-hysterectomy, or two years post-menopausal) or who are of childbearing potential but will either abstain from heterosexual intercourse and/or practice a medically accepted form of contraception for the study duration.
  5. Subjects who have experienced significant opioid withdrawal and are familiar with its effects.
  6. Subjects who are willing to follow the protocol requirements, including methadone and study medication schedules, as evidenced by written informed consent and an ability to read, understand, and complete the study questionnaires.

Exclusion Criteria:

  1. Subjects with any significant current axis-1 psychiatric problems, other than those related to drug abuse and opioid dependence, based on a structured psychiatric interview, SCID or MINI, during the screening process.
  2. Subjects undergoing active treatment for any illness other than chronic stable medical conditions (Patients with HIV and/or taking anti-viral HIV medication without a manifestation of AIDS symptoms are allowed).
  3. Subjects with clinically significant abnormal findings as determined by medical history, physical examination, vital signs (blood pressure, heart rate, and respiration rate), 02 saturation measure,12-lead ECG, clinical laboratory tests (CBC, chemistry panel), urine drug screen, alcohol breath test, and urine pregnancy test (for females of childbearing potential only).
  4. Subjects who have any acute organ dysfunction or serious unstable disease states including symptomatic heart, renal or liver disease, COPD, sleep apnea, or encephalitis.
  5. Subjects with 02 saturation below 90% at screening.
  6. Subjects taking any concomitant medications (prescription and over-the-counter therapy) including psychotropic medications for the treatment of current major depression, schizophrenia, or mood disorders, as well as medications contraindicated for use with morphine, naltrexone, aprepitant, or methadone.
  7. Subjects who have received any investigational drug or treatment within the thirty (30) days preceding administration of study medication.
  8. Females who are nursing, pregnant (as confirmed by a positive urine pregnancy test), or at risk of becoming pregnant.
  9. Subjects allergic or intolerant to morphine, methadone, naloxone, or aprepitant.

Sites / Locations

  • Bellevue Hospital Center & the NYU School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Aprepitant 125 mg

Placebo

Arm Description

Day Number Dose Procedure Day 0 Aprepitant 125mg Admitting Medication Treatment Day 1 Aprepitant 125mg Saline-Saline Day 2 Aprepitant 125mg Morphine-Morphine Day 3 Aprepitant 125mg Saline-Morphine Day 4 Aprepitant 125mg Naloxone-Morphine and Discharge

Day Number Dose Procedure Day 0 placebo Admitting Medication Treatment Day 1 placebo Saline-Saline Day 2 placebo Morphine-Morphine Day 3 placebo Saline-Morphine Day 4 placebo Naloxone-Morphine and Discharge

Outcomes

Primary Outcome Measures

Opioid Withdrawal
On the 4 dosing days, opioid withdrawal will be measured using the Clinical Opiate Withdrawal Scale (COWS) and the Subjective Opioid Withdrawal Scale (SOWS) at the following time points: 30 minutes pre-medication, 150 minutes post medication, 15 minutes post-challenge drug administration, 1 hour post- challenge drug administration, 2 hours post challenge drug administration and 3.5 hours post challenge drug administration

Secondary Outcome Measures

Opioid Intoxication
On the 4 dosing days, opioid intoxication will be measured using the Visual Anaglog Scale (VAS)at the following time points: 30 minutes pre-medication, 150 minutes post medication, 15 minutes post-challenge drug administration, 1 hour post- challenge drug administration, 2 hours post challenge drug administration and 3.5 hours post challenge drug administration
Neuro-economic Choice Procedure
A neuro-economics collaborative team will perform a neuro-economic choice paradigm procedure at 45 minutes post challenge drug dosing to determine the relative proportion and amount of a further dose of drug at 3.5 hours post challenge drug administration versus receipt of a variable amount of money

Full Information

First Posted
January 9, 2012
Last Updated
August 17, 2021
Sponsor
NYU Langone Health
Collaborators
National Institute on Drug Abuse (NIDA)
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1. Study Identification

Unique Protocol Identification Number
NCT01527994
Brief Title
Aprepitant Effects in Intravenous Heroin Dependence
Official Title
Clinical Laboratory Evaluations of Aprepitant for the Treatment of Opioid Dependence: Inpatient Test
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
January 2012 (undefined)
Primary Completion Date
June 2014 (Actual)
Study Completion Date
February 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NYU Langone Health
Collaborators
National Institute on Drug Abuse (NIDA)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Current treatments for opioid addiction would benefit by the addition of a non-opioid based treatment medication. Recent behavioral studies have shown that the neurokinin-1 (NK1) receptor is involved in opioid reward and withdrawal. This study proposes to study a potential non-opioid treatment, the clinically available, FDA approved, NK1 antagonist aprepitant, in opioid addicted patients. Based on the unique behavioral and pharmacological characteristics of opioid addiction, and what is known of the currently employed treatments, the investigators propose that the therapeutic mechanism of any potential opioid addiction treatment medication must include the ability to reduce opioid withdrawal. This is of particular importance during treatment initiation (eg. detoxification). In addition, for long-term treatment and relapse prevention, it is important to manage drug craving and inhibit the rewarding effects of opioids if patients do experience a slip. Therefore, the investigators propose to study aprepitant using human models of opioid withdrawal, craving and acute opioid reward and reinforcement. The investigators will also include a neuro-economics choice procedure paradigm.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Opioid Dependence
Keywords
Aprepitant, Intravenous heroin dependence

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
64 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Aprepitant 125 mg
Arm Type
Experimental
Arm Description
Day Number Dose Procedure Day 0 Aprepitant 125mg Admitting Medication Treatment Day 1 Aprepitant 125mg Saline-Saline Day 2 Aprepitant 125mg Morphine-Morphine Day 3 Aprepitant 125mg Saline-Morphine Day 4 Aprepitant 125mg Naloxone-Morphine and Discharge
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Day Number Dose Procedure Day 0 placebo Admitting Medication Treatment Day 1 placebo Saline-Saline Day 2 placebo Morphine-Morphine Day 3 placebo Saline-Morphine Day 4 placebo Naloxone-Morphine and Discharge
Intervention Type
Drug
Intervention Name(s)
Aprepitant
Other Intervention Name(s)
Brand name: Emend
Intervention Description
Aprepitant 125 mg oral tablets
Intervention Type
Drug
Intervention Name(s)
Placebo pill
Intervention Description
Placebo oral pill- inactive compound
Primary Outcome Measure Information:
Title
Opioid Withdrawal
Description
On the 4 dosing days, opioid withdrawal will be measured using the Clinical Opiate Withdrawal Scale (COWS) and the Subjective Opioid Withdrawal Scale (SOWS) at the following time points: 30 minutes pre-medication, 150 minutes post medication, 15 minutes post-challenge drug administration, 1 hour post- challenge drug administration, 2 hours post challenge drug administration and 3.5 hours post challenge drug administration
Time Frame
30 minutes pre-medication, 150 minutes post medication, 15 minutes post-challenge drug administration, 1 hour post- challenge drug administration, 2 hours post challenge drug administration and 3.5 hours post challenge drug administration
Secondary Outcome Measure Information:
Title
Opioid Intoxication
Description
On the 4 dosing days, opioid intoxication will be measured using the Visual Anaglog Scale (VAS)at the following time points: 30 minutes pre-medication, 150 minutes post medication, 15 minutes post-challenge drug administration, 1 hour post- challenge drug administration, 2 hours post challenge drug administration and 3.5 hours post challenge drug administration
Time Frame
30 minutes pre-medication, 150 minutes post medication, 15 minutes post-challenge drug administration, 1 hour post- challenge drug administration, 2 hours post challenge drug administration and 3.5 hours post challenge drug administration
Title
Neuro-economic Choice Procedure
Description
A neuro-economics collaborative team will perform a neuro-economic choice paradigm procedure at 45 minutes post challenge drug dosing to determine the relative proportion and amount of a further dose of drug at 3.5 hours post challenge drug administration versus receipt of a variable amount of money
Time Frame
45 minutes post challenge drug dosing

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female subjects ranging in age from 18-55 years who are currently opioid dependent based on meeting DSM-IV criteria for dependence on heroin and who are either treatment or non-treatment seeking individuals. Use of intravenous heroin daily for a minimum of 45 days prior to study entry. Urine sample (+) for opioids and prior experience with i.v. drug injection. Female subjects who are not of childbearing potential, (i.e. post-hysterectomy, or two years post-menopausal) or who are of childbearing potential but will either abstain from heterosexual intercourse and/or practice a medically accepted form of contraception for the study duration. Subjects who have experienced significant opioid withdrawal and are familiar with its effects. Subjects who are willing to follow the protocol requirements, including methadone and study medication schedules, as evidenced by written informed consent and an ability to read, understand, and complete the study questionnaires. Exclusion Criteria: Subjects with any significant current axis-1 psychiatric problems, other than those related to drug abuse and opioid dependence, based on a structured psychiatric interview, SCID or MINI, during the screening process. Subjects undergoing active treatment for any illness other than chronic stable medical conditions (Patients with HIV and/or taking anti-viral HIV medication without a manifestation of AIDS symptoms are allowed). Subjects with clinically significant abnormal findings as determined by medical history, physical examination, vital signs (blood pressure, heart rate, and respiration rate), 02 saturation measure,12-lead ECG, clinical laboratory tests (CBC, chemistry panel), urine drug screen, alcohol breath test, and urine pregnancy test (for females of childbearing potential only). Subjects who have any acute organ dysfunction or serious unstable disease states including symptomatic heart, renal or liver disease, COPD, sleep apnea, or encephalitis. Subjects with 02 saturation below 90% at screening. Subjects taking any concomitant medications (prescription and over-the-counter therapy) including psychotropic medications for the treatment of current major depression, schizophrenia, or mood disorders, as well as medications contraindicated for use with morphine, naltrexone, aprepitant, or methadone. Subjects who have received any investigational drug or treatment within the thirty (30) days preceding administration of study medication. Females who are nursing, pregnant (as confirmed by a positive urine pregnancy test), or at risk of becoming pregnant. Subjects allergic or intolerant to morphine, methadone, naloxone, or aprepitant.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stephen Ross, MD
Organizational Affiliation
NYU School of Medicine & Bellevue Hospital Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Bellevue Hospital Center & the NYU School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States

12. IPD Sharing Statement

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Aprepitant Effects in Intravenous Heroin Dependence

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