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A Study to Evaluate the Abuse Potential of Oxymorphone Compared to Other Mu Opioid Agonists.

Primary Purpose

Opioid Use Disorder

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Intravenous Challenge Drug
Sponsored by
New York State Psychiatric Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Opioid Use Disorder

Eligibility Criteria

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

Inclusion Criteria:

  1. Able to understand and provide signed and dated written consent.
  2. Self-reported opioid use for nontherapeutic purposes on at least 21 days in the 30 days prior to screening, physical dependence on opioids, recent intravenous opioid use, and meeting DSM 5 criteria for moderate-severe opioid use disorder.
  3. Positive urine drug screen for opioids (those who are in a methadone or buprenorphine treatment program are ineligible; physical dependence on street methadone or buprenorphine are also exclusionary so participants must produce at least one methadone- or buprenorphine-negative urine during screening).
  4. ≥ 21 and ≤ 55 years of age.
  5. Body mass index (BMI) ≥ 18 and ≤ 35 kg/m2 and weight ≥ 50 kg (110 pounds).
  6. Otherwise healthy as determined by the investigator.
  7. Demonstrate understanding how to complete the self-administration tasks and VAS Questionnaire.
  8. Women of childbearing potential must not be pregnant or breastfeeding at screening.
  9. Willing and able to comply with all testing requirements defined in the protocol.

participation in the Study Treatment Phase:

  1. During the Study Qualification Phase, on the bipolar 100--mm Drug Liking VAS, the subject must provide Emax ≥ 40 mm and < 60 mm following placebo and, following morphine 56 mg/70 kg, i.v., Emax ≥ 60 mm and ≥ 15 mm closer to "Strong Liking" than the Emax to placebo.
  2. In the judgment of the investigator, the subject is able to tolerate the i.v., opioids administered in the study, including the ability to complete most pharmacodynamics assessments administered post--dose.
  3. In the judgment of the study staff, the subject's general behavior during the Study Qualification Phase suggests the ability to successfully complete the Study Treatment Phase.

Exclusion Criteria:

  1. History of a medical or psychiatric disorder that would prevent successful completion of the study.
  2. Current DSM-5 diagnosis of substance use disorders requiring medical management other than OUD.
  3. Suicidal ideation or intent with or without a plan at Screening or within 6 months prior to Screening (i.e., answering "Yes" to questions 4 and/or 5 on the Suicidal Ideation section of the Columbia Suicide Severity Rating Scale).
  4. Currently seeking or participating in treatment for substance use disorder.
  5. Physically dependent on drugs of abuse (other than opioids, nicotine, or caffeine) or alcohol.
  6. Medically important deviation from normal limits on physical examination, vital signs, screening laboratory tests, or 12--lead ECG.
  7. Significant cardiovascular, hepatic, renal, respiratory, gastrointestinal, endocrine, immunologic, dermatologic, hematologic, or neurologic disorder.
  8. Any surgical, or medical condition that may interfere with the absorption, distribution, metabolism, or excretion of the test drug.
  9. Family history of long QT syndrome and/or unexpected sudden cardiac death or is known to have QTc > 500 ms at screening.
  10. Used an investigational agent within 30 days or 5 therapeutic half-lives of that agent, whichever is longer, prior to the first dose of study drug.
  11. Hypersensitivity to opioids or any drug intended for use in this study.
  12. Acute gastrointestinal symptoms (e.g., nausea, vomiting, fever, or Diarrhea unrelated to opioid withdrawal) ≤ 7 days before Day 1.
  13. Any of the following values for laboratory tests at Screening:

    1. A positive pregnancy test in women of childbearing potential.
    2. Hemoglobin < 11 g/dL in males and < 10 gm/dL in females.
    3. Neutrophil count < 1.0 × 109/L.
    4. Platelet count < 75 × 109/L.
    5. Creatinine clearance < 50 ml/min per modified Cockcroft-Gault equation.
    6. Aspartate aminotransferase or alanine aminotransferase > 3.0x upper limit of normal.

Sites / Locations

  • University of Kentucky
  • New York State Psychiatric Institute in the Division on Substance Use Disorders

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

Intravenous Challenge Drug: Oxymorphone

Intravenous Challenge Drug: Oxycodone

Intravenous Challenge Drug: Hydromorphone

Intravenous Challenge Drug: Placebo

Arm Description

Intravenous (IV) Dose Range: 1.8, 3.2, 5.6, 10 mg/70kg of the participant's body weight

IV Dose Range: 10, 18, 32, 56 mg/70kg of the participant's body weight

IV Dose Range: 3.2, 5.6, 10, 18 mg/70kg of the participant's body weight

IV saline

Outcomes

Primary Outcome Measures

Positive Subjective Drug Effects (i.e., Drug "Liking").
The positive subjective effects of the most efficacious dose of the intravenous challenge drugs. These are measured using self-reported assessment by the participant in terms of drug "liking" rated on a visual analog scale of 0-100. Higher values indicate a greater drug effect.

Secondary Outcome Measures

Full Information

First Posted
December 19, 2017
Last Updated
August 11, 2023
Sponsor
New York State Psychiatric Institute
Collaborators
University of Kentucky
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1. Study Identification

Unique Protocol Identification Number
NCT03389750
Brief Title
A Study to Evaluate the Abuse Potential of Oxymorphone Compared to Other Mu Opioid Agonists.
Official Title
A Randomized, Double-Blind, Placebo- and Active-Controlled, Crossover Study to Evaluate the Abuse Potential of Oxymorphone Compared to Other Mu Opioid Agonists in Physically Dependent Opioid Users With Moderate-to-Severe Opioid Use Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Completed
Study Start Date
March 15, 2018 (Actual)
Primary Completion Date
June 15, 2022 (Actual)
Study Completion Date
June 28, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
New York State Psychiatric Institute
Collaborators
University of Kentucky

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Significant public health concerns have arisen from the intravenous misuse of oxymorphone, a potent mu-opioid pain medication. However, little is known about its abuse potential relative to other mu-opioid analgesics. The present study is designed to examine the abuse liability of intravenous oxymorphone compared to other mu opioid agonists (oxycodone, and hydromorphone) among physically dependent opioid abusers.
Detailed Description
Significant public health concerns have arisen from the misuse of oxymorphone, a potent mu-opioid pain medication approved by the Food and Drug Administration as Opana and Opana ER. However, little is known about its abuse potential relative to other mu opioid analgesics. The present study is designed to examine the abuse liability of intravenous oxymorphone compared to other mu opioid agonists (oxycodone and hydromorphone). Participants who are physically dependent on opioids and who meet DSM 5 criteria for Opioid Use Disorder will complete the study across 2 sites, New York State Psychiatric Institute (NYSPI) and the University of Kentucky; a total of 6 additional participants across 2 sites will complete a pilot phase of the study in order to establish comparable opioid dose-response functions based on subjective ratings of Drug Liking. All participants will reside in clinical inpatient units for the duration of the studies (both the 8- to 9-week main and 4- to 5-week pilot studies; please note that the pilot study is identical in design to the first 4-5 weeks of the main study). The study design is based on the 2017 FDA Assessment of Abuse Potential of Drugs: Guidance for Industry [Center for Drug Evaluation and Research (CDER), 2017], which suggests the use of a double-blind, positive- and placebo-controlled design that includes a qualification phase and VAS measure of Drug Liking. The proposed study also examines the reinforcing effects of oxymorphone and other mu opioid agonists using two different drug self-administration procedures, namely Drug versus Money and Drug versus Drug choice procedures.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Opioid Use Disorder

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
Intravenous Challenge Drug
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intravenous Challenge Drug: Oxymorphone
Arm Type
Active Comparator
Arm Description
Intravenous (IV) Dose Range: 1.8, 3.2, 5.6, 10 mg/70kg of the participant's body weight
Arm Title
Intravenous Challenge Drug: Oxycodone
Arm Type
Active Comparator
Arm Description
IV Dose Range: 10, 18, 32, 56 mg/70kg of the participant's body weight
Arm Title
Intravenous Challenge Drug: Hydromorphone
Arm Type
Active Comparator
Arm Description
IV Dose Range: 3.2, 5.6, 10, 18 mg/70kg of the participant's body weight
Arm Title
Intravenous Challenge Drug: Placebo
Arm Type
Placebo Comparator
Arm Description
IV saline
Intervention Type
Drug
Intervention Name(s)
Intravenous Challenge Drug
Other Intervention Name(s)
Oxycodone, Oxymorphone, Hydromorphone, or Placebo
Intervention Description
Intravenous administration of opioid drugs (oxycodone, oxymorphone, hydromorphone), for the purpose of comparison of their abuse potential among each other, and in comparison to placebo (saline).
Primary Outcome Measure Information:
Title
Positive Subjective Drug Effects (i.e., Drug "Liking").
Description
The positive subjective effects of the most efficacious dose of the intravenous challenge drugs. These are measured using self-reported assessment by the participant in terms of drug "liking" rated on a visual analog scale of 0-100. Higher values indicate a greater drug effect.
Time Frame
Throughout study enrollment period (8-9 weeks)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able to understand and provide signed and dated written consent. Self-reported opioid use for nontherapeutic purposes on at least 21 days in the 30 days prior to screening, physical dependence on opioids, recent intravenous opioid use, and meeting DSM 5 criteria for moderate-severe opioid use disorder. Positive urine drug screen for opioids (those who are in a methadone or buprenorphine treatment program are ineligible; physical dependence on street methadone or buprenorphine are also exclusionary so participants must produce at least one methadone- or buprenorphine-negative urine during screening). ≥ 21 and ≤ 55 years of age. Body mass index (BMI) ≥ 18 and ≤ 35 kg/m2 and weight ≥ 50 kg (110 pounds). Otherwise healthy as determined by the investigator. Demonstrate understanding how to complete the self-administration tasks and VAS Questionnaire. Women of childbearing potential must not be pregnant or breastfeeding at screening. Willing and able to comply with all testing requirements defined in the protocol. participation in the Study Treatment Phase: During the Study Qualification Phase, on the bipolar 100--mm Drug Liking VAS, the subject must provide Emax ≥ 40 mm and < 60 mm following placebo and, following morphine 56 mg/70 kg, i.v., Emax ≥ 60 mm and ≥ 15 mm closer to "Strong Liking" than the Emax to placebo. In the judgment of the investigator, the subject is able to tolerate the i.v., opioids administered in the study, including the ability to complete most pharmacodynamics assessments administered post--dose. In the judgment of the study staff, the subject's general behavior during the Study Qualification Phase suggests the ability to successfully complete the Study Treatment Phase. Exclusion Criteria: History of a medical or psychiatric disorder that would prevent successful completion of the study. Current DSM-5 diagnosis of substance use disorders requiring medical management other than OUD. Suicidal ideation or intent with or without a plan at Screening or within 6 months prior to Screening (i.e., answering "Yes" to questions 4 and/or 5 on the Suicidal Ideation section of the Columbia Suicide Severity Rating Scale). Currently seeking or participating in treatment for substance use disorder. Physically dependent on drugs of abuse (other than opioids, nicotine, or caffeine) or alcohol. Medically important deviation from normal limits on physical examination, vital signs, screening laboratory tests, or 12--lead ECG. Significant cardiovascular, hepatic, renal, respiratory, gastrointestinal, endocrine, immunologic, dermatologic, hematologic, or neurologic disorder. Any surgical, or medical condition that may interfere with the absorption, distribution, metabolism, or excretion of the test drug. Family history of long QT syndrome and/or unexpected sudden cardiac death or is known to have QTc > 500 ms at screening. Used an investigational agent within 30 days or 5 therapeutic half-lives of that agent, whichever is longer, prior to the first dose of study drug. Hypersensitivity to opioids or any drug intended for use in this study. Acute gastrointestinal symptoms (e.g., nausea, vomiting, fever, or Diarrhea unrelated to opioid withdrawal) ≤ 7 days before Day 1. Any of the following values for laboratory tests at Screening: A positive pregnancy test in women of childbearing potential. Hemoglobin < 11 g/dL in males and < 10 gm/dL in females. Neutrophil count < 1.0 × 109/L. Platelet count < 75 × 109/L. Creatinine clearance < 50 ml/min per modified Cockcroft-Gault equation. Aspartate aminotransferase or alanine aminotransferase > 3.0x upper limit of normal.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sandra D Comer, PhD
Organizational Affiliation
New York State Psychiatric Institute / Columbia University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Kentucky
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40508
Country
United States
Facility Name
New York State Psychiatric Institute in the Division on Substance Use Disorders
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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A Study to Evaluate the Abuse Potential of Oxymorphone Compared to Other Mu Opioid Agonists.

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