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Standardized Natural Psilocybin-assisted Psychotherapy for Tapering of Opioid Medication

Primary Purpose

Opioid Dependence, Chronic Pain

Status
Not yet recruiting
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Psilocybin-assisted Psychotherapy
Sponsored by
University of British Columbia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Opioid Dependence focused on measuring Opioid Tapering, Psilocybin, Psychotherapy, Chronic Pain, Hallucinogens, Opioid Use Disorder

Eligibility Criteria

19 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Must be 19 - 75 years of age.
  2. Have a diagnosed noncancer chronic pain condition including but not limited to neuropathic pain, fibromyalgia, chronic headaches/migraines, back pain, musculoskeletal pain.
  3. Currently on a stable dose of opioid therapy on short-acting, long-acting, or combination of opioid medication types, for a minimum duration of 90 consecutive days.
  4. History of at least one unsuccessful attempt to taper or discontinue long-term opioid therapy, and has expressed current interest in making another attempt to reduce or discontinue.
  5. Able to swallow capsules/tablets.
  6. If of childbearing potential, agree to practice an effective means of birth control throughout the duration of the study.

Exclusion Criteria:

  1. Have any of the following cardiovascular conditions: uncontrolled hypertension, coronary artery disease, congenital long QT syndrome, cardiac hypertrophy, greater than first degree AV block, cardiac ischemia, congestive heart failure, myocardial infarction, tachycardia, chronic bradycardia, artificial heart valve, a clinically significant screening ECG abnormality, or any other significant cardiovascular condition.
  2. Asthma
  3. Have moderate to severe hepatic impairment.
  4. Chronic pain is due to cancer.
  5. Women who are pregnant, who intend to become pregnant during the study, or who are currently breastfeeding.
  6. Have a history of stroke or Transient Ischemic Attack (TIA).
  7. Meet DSM-5 criteria for severe alcohol or drug use disorders (other than Opioid use Disorder).
  8. Nicotine dependence that would prevent the participant from remaining nicotine free for the duration of dosing sessions (i.e., 6-8 hours).
  9. Have Epilepsy.
  10. Clinically significant sleep disorders such as sleep apnoea not on appropriate treatment.
  11. Have Insulin-dependent diabetes.
  12. Participants who are or have been taking mood stabilizers (e.g. lithium), SSRIs/SNRIs (e.g. citalopram, venlafaxine, vortioxetine, duloxetine), herbal remedies with serotonin activity (e.g. 5-HTP, St. John's Wort), dopamine agonists (e.g. bupropion), tricyclic antidepressants (e.g. amitriptyline), antipsychotics (e.g. haloperidol), amphetamines (e.g. amphetamine/dextroamphetamine salts, methylphenidate, dextroamphetamine, lisdexamfetamine), monoamine oxidase inhibitors (e.g. isocarboxazid, phenelzine, selegiline, tranylcypromine), alcohol or aldehyde dehydrogenase inhibitors (e.g. disulfiram), and UDG modulators (i.e. UGT modulators such as phenytoin, regorafenib, eltrombopag) during the study or in the preceding 8 weeks.
  13. Hallucinogenic or psychedelic drug use within 12 months (i.e. any use of mescaline, 2C-B, psilocybin, LSD, 5-MeO-DMT, ibogaine ayahuasca, MDA, MDMA, ketamine or any related molecules).
  14. Meet DSM-5 criteria for schizophrenia spectrum or other psychotic disorders, including major depressive disorder with psychotic features, or Bipolar I or Bipolar II Disorder.
  15. Have a first degree relative with schizophrenia, Bipolar I or Bipolar II Disorder.
  16. Meet DSM-5 criteria for diagnosis of antisocial or borderline personality disorders.
  17. Participants with a history of a developmental disorder.
  18. Participants diagnosed with serious comorbidities that may or may not influence mental health in the opinion of the qualified investigator.

Sites / Locations

  • University of British Columbia - Okanagan Campus

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Psilocybin-assisted Psychotherapy

Arm Description

Participants will undergo a single-arm, 8-week therapeutic intervention using natural standardized psilocybin-assisted psychotherapy as a treatment for opioid tapering in chronic pain patients. Specifically, they will undergo one or two standardized natural psilocybin (PEX010) dosing sessions; 25mg at week 3 and 37.5mg at week 7.

Outcomes

Primary Outcome Measures

Feasibility of psilocybin administration
Percentage of participants who provide consent and complete the intervention.
Acceptability of psilocybin administration
Participant ratings of benefits and harms of the intervention.
Safety of psilocybin administration
Number and type of treatment-related adverse events and serious adverse events reported during the intervention.

Secondary Outcome Measures

Change in prescribed opioid dose at the 1-month visit compared to initial dose
Taper adherence rates will be assessed by categorizing participants as "adhering", or "non-adhering" based on percentage of the initial dose that they are using at the 1-month timepoint.
Change in prescribed opioid dose at the 3-month visit compared to initial dose
Taper adherence rates will be assessed by categorizing participants as "adhering", or "non-adhering" based on percentage of the initial dose that they are using at the 3-month timepoint.
Change in prescribed opioid dose at the 6-month visit compared to initial dose
At 6-month follow-up participants will be categorized as "successful" if they have discontinued opioid therapy, and "unsuccessful" if they have not.

Full Information

First Posted
October 14, 2022
Last Updated
August 30, 2023
Sponsor
University of British Columbia
Collaborators
Etheridge Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT05585229
Brief Title
Standardized Natural Psilocybin-assisted Psychotherapy for Tapering of Opioid Medication
Official Title
Standardized Natural Psilocybin-assisted Psychotherapy for Tapering of Opioid Medication in Patients With Chronic Pain: an Open-label Feasibility Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
November 1, 2023 (Anticipated)
Primary Completion Date
February 28, 2025 (Anticipated)
Study Completion Date
August 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of British Columbia
Collaborators
Etheridge Foundation

4. Oversight

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

5. Study Description

Brief Summary
This is an open-label pilot trial to assess the safety and feasibility of a novel 8-week psilocybin-assisted psychotherapy intervention to facilitate successful tapering/discontinuation of opioid pain medication in adult patients receiving long-term opioid therapy for chronic pain. Participation will last approximately 8 months and includes one or two psilocybin-assisted therapy sessions. The study will evaluate the incidence and severity of adverse events during and after treatment, the number of participants who drop out of the study for intervention-related reasons, and the self-reported benefits and harms of the intervention.
Detailed Description
The purpose of this pilot study is to establish the safety and tolerability of a therapeutic intervention using psilocybin-assisted psychotherapy as a novel treatment for opioid tapering in a sample of patients with chronic pain. Participants will be patients who have failed previous attempts to reduce their use of opioid medication and who have no medical or psychological contraindications for psilocybin administration. This pilot study involves an 8-week open-label, non-randomized therapeutic intervention and a 6-month follow-up period. To provide a supportive context for the drug experience, participants will receive preparatory and integrative sessions following an acceptance and commitment therapy model for psychedelic therapy. The physician-supervised opioid taper will begin following the first psilocybin dosing session (25mg) after an integration session with therapists, and a second optional psilocybin dosing session (37.5mg) will be facilitated one month later. Assessments will be completed at baseline, and at follow-up points at 1-month, 3-months and 6-months post-intervention to evaluate both acute and long-term effects of the intervention. Primary outcomes of interest are rates of adverse events, retention rates, and patient perceptions of intervention tolerability. Preliminary efficacy of the treatment will be evaluated by tracking opioid reduction rates and long-term maintenance of these reductions. Other measures of interest include qualities of the psychedelic experience, opioid cravings and withdrawal, chronic pain symptoms, and psychological mechanisms.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Opioid Dependence, Chronic Pain
Keywords
Opioid Tapering, Psilocybin, Psychotherapy, Chronic Pain, Hallucinogens, Opioid Use Disorder

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Psilocybin-assisted Psychotherapy
Arm Type
Experimental
Arm Description
Participants will undergo a single-arm, 8-week therapeutic intervention using natural standardized psilocybin-assisted psychotherapy as a treatment for opioid tapering in chronic pain patients. Specifically, they will undergo one or two standardized natural psilocybin (PEX010) dosing sessions; 25mg at week 3 and 37.5mg at week 7.
Intervention Type
Drug
Intervention Name(s)
Psilocybin-assisted Psychotherapy
Other Intervention Name(s)
PEX010
Intervention Description
Participants will complete a 8-week structured psychotherapeutic intervention involving administration of 25mg and 37.5mg PEX010 on two separate occasions.
Primary Outcome Measure Information:
Title
Feasibility of psilocybin administration
Description
Percentage of participants who provide consent and complete the intervention.
Time Frame
Week 31
Title
Acceptability of psilocybin administration
Description
Participant ratings of benefits and harms of the intervention.
Time Frame
Week 31
Title
Safety of psilocybin administration
Description
Number and type of treatment-related adverse events and serious adverse events reported during the intervention.
Time Frame
Up to 33 Weeks
Secondary Outcome Measure Information:
Title
Change in prescribed opioid dose at the 1-month visit compared to initial dose
Description
Taper adherence rates will be assessed by categorizing participants as "adhering", or "non-adhering" based on percentage of the initial dose that they are using at the 1-month timepoint.
Time Frame
Week 11
Title
Change in prescribed opioid dose at the 3-month visit compared to initial dose
Description
Taper adherence rates will be assessed by categorizing participants as "adhering", or "non-adhering" based on percentage of the initial dose that they are using at the 3-month timepoint.
Time Frame
Week 19
Title
Change in prescribed opioid dose at the 6-month visit compared to initial dose
Description
At 6-month follow-up participants will be categorized as "successful" if they have discontinued opioid therapy, and "unsuccessful" if they have not.
Time Frame
Week 31

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must be 19 - 75 years of age. Have a diagnosed noncancer chronic pain condition including but not limited to neuropathic pain, fibromyalgia, chronic headaches/migraines, back pain, musculoskeletal pain. Currently on a stable dose of opioid therapy on short-acting, long-acting, or combination of opioid medication types, for a minimum duration of 90 consecutive days. History of at least one unsuccessful attempt to taper or discontinue long-term opioid therapy, and has expressed current interest in making another attempt to reduce or discontinue. Able to swallow capsules/tablets. If of childbearing potential, agree to practice an effective means of birth control throughout the duration of the study. Exclusion Criteria: Have any of the following cardiovascular conditions: uncontrolled hypertension, coronary artery disease, congenital long QT syndrome, cardiac hypertrophy, greater than first degree AV block, cardiac ischemia, congestive heart failure, myocardial infarction, tachycardia, chronic bradycardia, artificial heart valve, a clinically significant screening ECG abnormality, or any other significant cardiovascular condition. Asthma Have moderate to severe hepatic impairment. Chronic pain is due to cancer. Women who are pregnant, who intend to become pregnant during the study, or who are currently breastfeeding. Have a history of stroke or Transient Ischemic Attack (TIA). Meet DSM-5 criteria for severe alcohol or drug use disorders (other than Opioid use Disorder). Nicotine dependence that would prevent the participant from remaining nicotine free for the duration of dosing sessions (i.e., 6-8 hours). Have Epilepsy. Clinically significant sleep disorders such as sleep apnoea not on appropriate treatment. Have Insulin-dependent diabetes. Participants who are or have been taking mood stabilizers (e.g. lithium), SSRIs/SNRIs (e.g. citalopram, venlafaxine, vortioxetine, duloxetine), herbal remedies with serotonin activity (e.g. 5-HTP, St. John's Wort), dopamine agonists (e.g. bupropion), tricyclic antidepressants (e.g. amitriptyline), antipsychotics (e.g. haloperidol), amphetamines (e.g. amphetamine/dextroamphetamine salts, methylphenidate, dextroamphetamine, lisdexamfetamine), monoamine oxidase inhibitors (e.g. isocarboxazid, phenelzine, selegiline, tranylcypromine), alcohol or aldehyde dehydrogenase inhibitors (e.g. disulfiram), and UDG modulators (i.e. UGT modulators such as phenytoin, regorafenib, eltrombopag) during the study or in the preceding 8 weeks. Hallucinogenic or psychedelic drug use within 12 months (i.e. any use of mescaline, 2C-B, psilocybin, LSD, 5-MeO-DMT, ibogaine ayahuasca, MDA, MDMA, ketamine or any related molecules). Meet DSM-5 criteria for schizophrenia spectrum or other psychotic disorders, including major depressive disorder with psychotic features, or Bipolar I or Bipolar II Disorder. Have a first degree relative with schizophrenia, Bipolar I or Bipolar II Disorder. Meet DSM-5 criteria for diagnosis of antisocial or borderline personality disorders. Participants with a history of a developmental disorder. Participants diagnosed with serious comorbidities that may or may not influence mental health in the opinion of the qualified investigator.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
W. Francois Louw, MD
Phone
250-860-9754
Email
doclouw@mail.ubc.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
W. Francois Louw, MD
Organizational Affiliation
University of British Columbia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of British Columbia - Okanagan Campus
City
Kelowna
State/Province
British Columbia
ZIP/Postal Code
V1V 1V7
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
W. Francois Louw, MD
Phone
250-860-9754
Email
doclouw@mail.ubc.ca

12. IPD Sharing Statement

Plan to Share IPD
No

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Standardized Natural Psilocybin-assisted Psychotherapy for Tapering of Opioid Medication

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