Virginia Opioid Treatment-Emergency Department (VOT-ED)
Primary Purpose
Opioid Use Disorder
Status
Withdrawn
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
SUBLOCADE
Sponsored by
About this trial
This is an interventional treatment trial for Opioid Use Disorder focused on measuring Opioid use disorder, Opioid withdrawal, Emergency department, Treatment-seeking, Opioid agonist treatment, Sublocade
Eligibility Criteria
Inclusion criteria:
- Signed the informed consent form (ICF) and have the ability to comply with the requirements and restrictions listed therein.
- Age: ≥ 18 years at time of executing the ICF.
- Currently meets DSM-5 criteria for moderate to severe OUD.
- Is clinically stable (respiratory rate [RR] ≥ 12, pulse oximetry > 95%, Glasgow Coma Scale [GCS] score of 15) and suitable for the trial in investigator's or designee's judgement.
- Agrees not to take any buprenorphine products other than those administered during the current study throughout participation in the study.
- Negative urine pregnancy test for females.
- Vital signs (BP, HR, temperature) considered within normal limits or non-clinically significant elevation, as assessed by treating physician.
- Provide a urine drug screen positive for illicit opioids, excluding methadone.
- Have a COWS score ≥ 8.
- Is seeking medication-assisted treatment for OUD.
Exclusion Criteria:
- Current diagnosis, other than OUD, requiring chronic opioid treatment.
- Active suicidal ideation in opinion of the Investigator or designee.
- Female subject that is lactating, pregnant or planning to become pregnant during their participation in the study.
- Uncontrolled intercurrent illness including, but not limited to, psychiatric illness that would limit compliance with study requirements or compromise the ability of the subject to provide written informed consent.
- Known allergy or hypersensitivity to SUBOXONE or SUBLOCADE.
- Any condition that, in the opinion of the Investigator would interfere with interpretation of subject safety or study results.
- Currently receiving methadone, depot naltrexone, or Probuphine for OUD or received those treatments for OUD within 30 days prior to consent.
- Current or concurrent treatment with an investigational agent.
- Current or concurrent enrollment in another clinical study, or observational study that includes MAT.
- Treatment for OUD required by court order.
- Current or pending incarceration/legal action that could affect participation or compliance in the study.
- Subjects who are unable, in the opinion of the Investigator, to comply fully with the study requirements.
- Less than 48-72 hours since last use of long acting opioids (i.e., methadone), by self-report.
- Current intoxication with benzodiazepines or alcohol.
- Meet current DSM-5 diagnosis for severe Benzodiazepine or Alcohol Use Disorder or endorse benzodiazepine or alcohol withdrawal symptoms.
- Current illicit opioid users who endorse regular use of long acting opioids (i.e., methadone).
- Total bilirubin ≥ 1.5x the upper limit of normal (ULN), alanine aminotransferase (ALT) ≥3xULN, aspartate aminotransferase (AST) ≥ 3xULN, serum creatinine > 2xULN, international normalized ratio (INR) >1.5xULN. If these results are unable to be obtained prior to enrolling the subject, the investigator can make an initial determination about eligibility based on LFTs collected in the past 6 months from the subject's medical record.
- Patients with a history of Long QT Syndrome or an immediate family member with this condition or those taking Class lA antiarrhythmic medications (e.g., quinidine, procainamide, disopyramide) or Class Ill antiarrhythmic medications (e.g., sotalol, amiodarone) or other medications that prolong the QT interval.
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Opioid withdrawal patients
Arm Description
Subjects with opioid use disorder seeking treatment and/or experiencing symptoms of opioid withdrawal receive acute administration of SUBOXONE sublingual film followed by SUBLOCADE administration in the 1) ED, 2) Clinical Decision Unit or 3) Inpatient unit combined with 6 months of treatment with SUBLOCADE in the outpatient treatment clinic.
Outcomes
Primary Outcome Measures
Treatment engagement - 1 month
Treatment engagement as measured by percentage of participants who attend an outpatient clinic visit within 1 month of first injection.
Secondary Outcome Measures
Treatment engagement - 3 and 6 months
Treatment engagement as measured by percentage of participants who continue to attend outpatient clinic visits with SUBLOCADE injections (buprenorphine treatment) at 3 and 6 months.
Number of repeat ED visits
Number of repeat ED visits for any reason will be measured from electronic medical records and self-reported data.
Full Information
NCT ID
NCT04523792
First Posted
August 19, 2020
Last Updated
February 9, 2021
Sponsor
Virginia Commonwealth University
Collaborators
Indivior, PLC.
1. Study Identification
Unique Protocol Identification Number
NCT04523792
Brief Title
Virginia Opioid Treatment-Emergency Department
Acronym
VOT-ED
Official Title
Virginia Opioid Treatment-Emergency Department
Study Type
Interventional
2. Study Status
Record Verification Date
February 2021
Overall Recruitment Status
Withdrawn
Why Stopped
Funder has not approved protocol
Study Start Date
January 1, 2021 (Anticipated)
Primary Completion Date
December 31, 2021 (Anticipated)
Study Completion Date
December 31, 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Virginia Commonwealth University
Collaborators
Indivior, PLC.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
The current study seeks to test the feasibility of an alternative treatment for patients with opioid use disorder who present to the emergency department seeking treatment or with opioid withdrawal, which includes FDA approved long-acting medication for opioid misuse (SUBLOCADE) and rapid transfer of care to outpatient substance abuse treatment.
Detailed Description
This proof of concept study will provide feasibility data on whether rapid initiation of SUBLOCADE® (buprenorphine extended-release) injection for subcutaneous use CIII in the ED, Clinical Decision Unit, or inpatient unit and after administration of a test dose of SUBOXONE® (buprenorphine and naloxone) sublingual film, for sublingual or buccal use CIII among treatment-seeking adults with moderate or severe OUD increases subsequent outpatient treatment engagement as compared to a historical control cohort and concurrent controls who decline treatment participation. The study will also assess whether rapid initiation of SUBLOCADE® reduces subsequent ED visits for any reason. As a exploratory aim we will examine whether rapid initiation of Sublocade in this patient group reduces opioid overdose events compared to historical controls and patients who decline Sublocade.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Opioid Use Disorder
Keywords
Opioid use disorder, Opioid withdrawal, Emergency department, Treatment-seeking, Opioid agonist treatment, Sublocade
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Model Description
The study is designed to examine feasibility of SUBLOCADE on outpatient treatment engagement compared to historical and concurrent control groups.
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Opioid withdrawal patients
Arm Type
Experimental
Arm Description
Subjects with opioid use disorder seeking treatment and/or experiencing symptoms of opioid withdrawal receive acute administration of SUBOXONE sublingual film followed by SUBLOCADE administration in the 1) ED, 2) Clinical Decision Unit or 3) Inpatient unit combined with 6 months of treatment with SUBLOCADE in the outpatient treatment clinic.
Intervention Type
Drug
Intervention Name(s)
SUBLOCADE
Intervention Description
SUBLOCADE (buprenorphine extended-release) injection is a colorless to amber sterile solution for SC injection designed to deliver buprenorphine at doses of 100 mg or 300 mg at a controlled rate over a one-month period.
Primary Outcome Measure Information:
Title
Treatment engagement - 1 month
Description
Treatment engagement as measured by percentage of participants who attend an outpatient clinic visit within 1 month of first injection.
Time Frame
1 month
Secondary Outcome Measure Information:
Title
Treatment engagement - 3 and 6 months
Description
Treatment engagement as measured by percentage of participants who continue to attend outpatient clinic visits with SUBLOCADE injections (buprenorphine treatment) at 3 and 6 months.
Time Frame
3 and 6 months
Title
Number of repeat ED visits
Description
Number of repeat ED visits for any reason will be measured from electronic medical records and self-reported data.
Time Frame
6 months
Other Pre-specified Outcome Measures:
Title
Healthcare resource utilization
Description
Healthcare resource utilization (measured by number of outpatient clinic and emergency department visits, and number of inpatient admissions) as compared to the concurrent and historical control groups.
Time Frame
6 months
Title
Opioid craving
Description
Opioid craving in subjects as measured by Craving Visual Analog Scale (VAS), a 3-item scale in which individuals rate their cravings for opioids on a scale from 0 (NOT AT ALL) to 10 (EXTREMELY).
Time Frame
6 months
Title
Number of participants with a urine drug screen negative for illicit opioids.
Description
Illicit opioid use as measured by urine drug screen (UDS) results.
Time Frame
6 months
Title
Impulse control
Description
Time to decision in delay discounting task
Time Frame
6 months
Title
Opioid cravings
Description
Brief opioid demand task
Time Frame
6 months
Title
Number of non-fatal or fatal opioid-related overdoses
Description
Data on the number of opioid overdoses will be measured from electronic medical records and/or state death registries.
Time Frame
6 months
Title
Treatment effectiveness: Treatment Effectiveness Assessment (TEA)
Description
Treatment effectiveness as measured by Treatment Effectiveness Assessment (TEA), which measures on 4 domains (substance use, health, lifestyle, community involvement). Responses on each item range from 1 ("not better at all") to 10 ("very much better") with items summed for a total score of 4-40, and higher scores reflecting greater self-report of treatment effectiveness.
Time Frame
6 months
Title
Medication satisfaction: Medication Satisfaction Questionnaire (MSQ)
Description
Measured by the Medication Satisfaction Questionnaire (MSQ), a single item that asks participants to rate how satisfied they are with their current opioid dependence medication on a scale from 1 ("extremely dissatisfied") to 7 ("extremely satisfied"). Higher scores reflect greater satisfaction with the medication.
Time Frame
6 months
Title
Employment, presentism and absenteeism
Description
Assessed by the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP), which measures the effects of opioid use disorder on the ability to work and perform regular activities among participants. Items evaluate hours of work completed and hours of work missed in the past 7 days and ask participants to rate the impact on their work productivity and regular activities in the past 7 days on a scale of 0 ("problem had no effect on my work/regular activities") to 10 ("problem completely prevented me from working/regular activities"), with higher scores reflecting greater severity and worse outcomes on the measure.
Time Frame
6 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria:
Signed the informed consent form (ICF) and have the ability to comply with the requirements and restrictions listed therein.
Age: ≥ 18 years at time of executing the ICF.
Currently meets DSM-5 criteria for moderate to severe OUD.
Is clinically stable (respiratory rate [RR] ≥ 12, pulse oximetry > 95%, Glasgow Coma Scale [GCS] score of 15) and suitable for the trial in investigator's or designee's judgement.
Agrees not to take any buprenorphine products other than those administered during the current study throughout participation in the study.
Negative urine pregnancy test for females.
Vital signs (BP, HR, temperature) considered within normal limits or non-clinically significant elevation, as assessed by treating physician.
Provide a urine drug screen positive for illicit opioids, excluding methadone.
Have a COWS score ≥ 8.
Is seeking medication-assisted treatment for OUD.
Exclusion Criteria:
Current diagnosis, other than OUD, requiring chronic opioid treatment.
Active suicidal ideation in opinion of the Investigator or designee.
Female subject that is lactating, pregnant or planning to become pregnant during their participation in the study.
Uncontrolled intercurrent illness including, but not limited to, psychiatric illness that would limit compliance with study requirements or compromise the ability of the subject to provide written informed consent.
Known allergy or hypersensitivity to SUBOXONE or SUBLOCADE.
Any condition that, in the opinion of the Investigator would interfere with interpretation of subject safety or study results.
Currently receiving methadone, depot naltrexone, or Probuphine for OUD or received those treatments for OUD within 30 days prior to consent.
Current or concurrent treatment with an investigational agent.
Current or concurrent enrollment in another clinical study, or observational study that includes MAT.
Treatment for OUD required by court order.
Current or pending incarceration/legal action that could affect participation or compliance in the study.
Subjects who are unable, in the opinion of the Investigator, to comply fully with the study requirements.
Less than 48-72 hours since last use of long acting opioids (i.e., methadone), by self-report.
Current intoxication with benzodiazepines or alcohol.
Meet current DSM-5 diagnosis for severe Benzodiazepine or Alcohol Use Disorder or endorse benzodiazepine or alcohol withdrawal symptoms.
Current illicit opioid users who endorse regular use of long acting opioids (i.e., methadone).
Total bilirubin ≥ 1.5x the upper limit of normal (ULN), alanine aminotransferase (ALT) ≥3xULN, aspartate aminotransferase (AST) ≥ 3xULN, serum creatinine > 2xULN, international normalized ratio (INR) >1.5xULN. If these results are unable to be obtained prior to enrolling the subject, the investigator can make an initial determination about eligibility based on LFTs collected in the past 6 months from the subject's medical record.
Patients with a history of Long QT Syndrome or an immediate family member with this condition or those taking Class lA antiarrhythmic medications (e.g., quinidine, procainamide, disopyramide) or Class Ill antiarrhythmic medications (e.g., sotalol, amiodarone) or other medications that prolong the QT interval.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frederick G Moeller, MD
Organizational Affiliation
Virginia Commonwealth University
Official's Role
Principal Investigator
12. IPD Sharing Statement
Learn more about this trial
Virginia Opioid Treatment-Emergency Department
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