D-LUCS: Combined Pharmacotherapy for Cannabis Dependency
Study Details
Study Description
Brief Summary
The purpose of this study is to see if Lofexidine in combination with Marinol is superior to placebo in achieving abstinence, reducing cannabis use and reducing withdrawal in cannabis-dependent patients seeking treatment for their marijuana use.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2/Phase 3 |
Detailed Description
Cannabis use disorders remain the most common illicit drug use disorder and options for treatment remain limited. Compared to other abusable substances, there has been little investigation of pharmacotherapies for cannabis dependence and no effective pharmacotherapy for cannabis dependence has yet to been developed. The development of effective cannabis dependence pharmacotherapy is an important unmet public health need. Agonist pharmacotherapy strategies have been effective for other substance use disorders (e.g., opioid and nicotine use disorders) and the endocannabinoid system represents a promising target for agonist pharmacotherapy with dronabinol. Lofexidine, a noradrenergic system suppressant, is effective in treating opioid withdrawal and shows promise as a cannabis use disorder pharmacotherapy. Haney et al. (2008) found that the combination of lofexidine and dronabinol (Lofex-Dro) was superior to placebo, lofexidine alone, or dronabinol alone in improving sleep and other cannabis withdrawal symptoms. Further, reduction in craving and relapse was greater for this combined pharmacotherapy relative to either medication alone or placebo. The proposed protocol is a 2 group, double blind, placebo-controlled outpatient study of the safety and efficacy of the combination of dronabinol and lofexidine for the treatment of cannabis dependence. We plan to enroll 180 subjects in a 12-week trial. The primary hypothesis is that dronabinol will act as an agonist treatment while lofexidine will suppress craving- and cue-induced related stress such that the combination will act in a complementary manner to induce prolonged abstinence from marijuana.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Lofexidine and Dronabinol Maintained at 1.8mg/day Lofex. and 60 mg/day of Dronabinol |
Drug: Dronabinol
Dronabinol: 20 mg/TID
Other Names:
Drug: Lofexidine
Lofex: .6 mg/ TID
|
| Placebo Comparator: Placebo Lofex. matched placebo Dronabinol placebo |
Drug: Placebo
Placebo control
|
Outcome Measures
Primary Outcome Measures
- 21 Days of Consecutive Abstinence as Measured by the Time-line Followback. [reported daily for 12 weeks/ or study participation]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Men and women between the ages of 18-60 who meet DSM-IV criteria for current marijuana dependence
-
Individuals must report using marijuana at least 5 days a week and have a positive urine test for THC on the day of study entry.
-
Individual must describe marijuana as their primary drug of abuse.
-
Individuals must be capable of giving informed consent and capable of complying with study procedures.
Exclusion Criteria:
-
Meets DSM-IV-TR criteria for schizophrenia, schizoaffective illness, psychotic disorder other than transient psychosis due to drug abuse, major depression, bipolar illness or psychiatric disorders (other than substance abuse) which require psychiatric intervention.
-
Individuals who are medically unstable based on laboratory tests, electrocardiogram, medical history, physical examination that would make participation hazardous
-
Individuals with liver enzyme function tests greater than three times normal
-
Individuals with a history of seizure disorder
-
Individuals with current suicidal risk.
-
Individuals who are cognitively impaired
-
Bradycardia (< 50 beats/minute), hypotension (sitting or standing BP < 90/50), or symptoms attributable to low BP (i.e. lightheadedness or dizziness on standing).
-
Nursing mothers and pregnant women. Women of child bearing age will be included in the study provided that they are not pregnant, based on the results of a blood pregnancy test drawn at the time of screening. They must also agree to use a method of contraception with proven efficacy and agree not to become pregnant during the study. To confirm this, urine pregnancy tests will be repeated monthly. Women will be provided a full explanation of the potential dangers of pregnancy while on the study medication. If a woman becomes pregnant, the study medication will be discontinued.
-
Individuals who are physiologically dependent on any other drugs (excluding nicotine) that would require a medical intervention
-
Individuals with known sensitivity to dronabinol or lofexidine
-
Individuals with coronary vascular disease as indicated by history or suspected by abnormal ECG or history of cardiac symptoms
-
Individuals currently being treated with an alpha-2 agonist antihypertensive medication
-
Individuals currently being prescribed a psychotropic medication (including sleep medication). However, medication for depression is allowed if stable for at least 1 month.
-
Individuals who have a job that even mild intoxication would be hazardous (e.g., firefighter, bus driver)
-
Individuals who are court-mandated to treatment.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | New York State Psychiatric Institute | New York | New York | United States | 10032 |
Sponsors and Collaborators
- New York State Psychiatric Institute
- National Institute on Drug Abuse (NIDA)
Investigators
- Principal Investigator: Frances R Levin, M.D., Columbia University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- #6015
- P50DA009236-16
Study Results
Participant Flow
| Recruitment Details | Participants were treated at the Substance Treatment and Research Service (STARS) of Columbia University/ New York State Psychiatric Institute (NYSPI). Study enrollment occurred from January 2010 through May 2014 with study completion in September 2014. |
|---|---|
| Pre-assignment Detail | The study included a one-week placebo lead-in phase. Participants were randomized at the end of the placebo lead-in phase and those who reported marijuana use less than once a week during the lead-in phase were considered placebo responders and were not randomized. A total of 34 participants discontinued prior to randomization for various reasons. |
| Arm/Group Title | Placebo | Lofexidine and Dronabinol |
|---|---|---|
| Arm/Group Description | Lofex. matched placebo Dronabinol placebo Placebo: Placebo control | Maintained at 1.8mg/day Lofex. and 60 mg/day of Dronabinol Lofexidine and Dronabinol: Lofex: .6 mg/ TID Dronabinol: 20 mg/TID |
| Period Title: Overall Study | ||
| STARTED | 61 | 61 |
| COMPLETED | 35 | 32 |
| NOT COMPLETED | 26 | 29 |
Baseline Characteristics
| Arm/Group Title | Placebo | Lofexidine and Dronabinol | Total |
|---|---|---|---|
| Arm/Group Description | Lofex. matched placebo Dronabinol placebo Placebo: Placebo control | Maintained at 1.8mg/day Lofex. and 60 mg/day of Dronabinol Lofexidine and Dronabinol: Lofex: .6 mg/ TID Dronabinol: 20 mg/TID | Total of all reporting groups |
| Overall Participants | 61 | 61 | 122 |
| Age (years) [Mean (Standard Deviation) ] | |||
| Mean (Standard Deviation) [years] |
35.4
(10.8)
|
34.8
(11.2)
|
35.2
(10.9)
|
| Sex: Female, Male (Count of Participants) | |||
| Female |
16
26.2%
|
22
36.1%
|
38
31.1%
|
| Male |
45
73.8%
|
39
63.9%
|
84
68.9%
|
| Race/Ethnicity, Customized (participants) [Number] | |||
| Hispanic |
15
24.6%
|
17
27.9%
|
32
26.2%
|
| Black |
17
27.9%
|
18
29.5%
|
35
28.7%
|
| White |
26
42.6%
|
21
34.4%
|
47
38.5%
|
| Other |
3
4.9%
|
5
8.2%
|
8
6.6%
|
Outcome Measures
| Title | 21 Days of Consecutive Abstinence as Measured by the Time-line Followback. |
|---|---|
| Description | |
| Time Frame | reported daily for 12 weeks/ or study participation |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Placebo | Lofexidine and Dronabinol |
|---|---|---|
| Arm/Group Description | Lofex. matched placebo Dronabinol placebo Placebo: Placebo control | Maintained at 1.8mg/day Lofex. and 60 mg/day of Dronabinol Lofexidine and Dronabinol: Lofex: .6 mg/ TID Dronabinol: 20 mg/TID |
| Measure Participants | 61 | 61 |
| Number [participants] |
18
29.5%
|
17
27.9%
|
Adverse Events
| Time Frame | 12 weeks of trial or participants length of participation | |||
|---|---|---|---|---|
| Adverse Event Reporting Description | ||||
| Arm/Group Title | Placebo | Lofexidine and Dronabinol | ||
| Arm/Group Description | Lofex. matched placebo Dronabinol placebo Placebo: Placebo control | Maintained at 1.8mg/day Lofex. and 60 mg/day of Dronabinol Lofexidine and Dronabinol: Lofex: .6 mg/ TID Dronabinol: 20 mg/TID | ||
All Cause Mortality |
||||
| Placebo | Lofexidine and Dronabinol | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | / (NaN) | / (NaN) | ||
Serious Adverse Events |
||||
| Placebo | Lofexidine and Dronabinol | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 1/61 (1.6%) | 1/61 (1.6%) | ||
| Gastrointestinal disorders | ||||
| abdominal pain | 0/61 (0%) | 0 | 1/61 (1.6%) | 1 |
| Psychiatric disorders | ||||
| detoxification | 1/61 (1.6%) | 1 | 0/61 (0%) | 0 |
Other (Not Including Serious) Adverse Events |
||||
| Placebo | Lofexidine and Dronabinol | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 46/61 (75.4%) | 47/61 (77%) | ||
| Gastrointestinal disorders | ||||
| nausea | 5/61 (8.2%) | 5 | 6/61 (9.8%) | 6 |
| stomache upset | 5/61 (8.2%) | 5 | 2/61 (3.3%) | 2 |
| diarrhea | 4/61 (6.6%) | 4 | 2/61 (3.3%) | 2 |
| vomitting | 4/61 (6.6%) | 4 | 2/61 (3.3%) | 2 |
| gas | 1/61 (1.6%) | 1 | 3/61 (4.9%) | 3 |
| General disorders | ||||
| dry mouth | 6/61 (9.8%) | 6 | 27/61 (44.3%) | 27 |
| fatigue | 15/61 (24.6%) | 15 | 26/61 (42.6%) | 26 |
| dizzy | 12/61 (19.7%) | 12 | 21/61 (34.4%) | 21 |
| insomnia | 13/61 (21.3%) | 13 | 13/61 (21.3%) | 13 |
| intoxication | 2/61 (3.3%) | 2 | 13/61 (21.3%) | 13 |
| headache | 12/61 (19.7%) | 12 | 10/61 (16.4%) | 10 |
| drowsiness | 4/61 (6.6%) | 4 | 9/61 (14.8%) | 9 |
| irritability | 6/61 (9.8%) | 6 | 3/61 (4.9%) | 3 |
| fever | 4/61 (6.6%) | 4 | 1/61 (1.6%) | 1 |
| sore throat | 3/61 (4.9%) | 3 | 2/61 (3.3%) | 2 |
| Metabolism and nutrition disorders | ||||
| decreased appetite | 6/61 (9.8%) | 6 | 2/61 (3.3%) | 2 |
| Nervous system disorders | ||||
| confusion | 1/61 (1.6%) | 1 | 3/61 (4.9%) | 3 |
| Psychiatric disorders | ||||
| anxiety | 11/61 (18%) | 11 | 3/61 (4.9%) | 3 |
| depression | 5/61 (8.2%) | 5 | 3/61 (4.9%) | 3 |
| Respiratory, thoracic and mediastinal disorders | ||||
| upper respiratory infection | 8/61 (13.1%) | 8 | 2/61 (3.3%) | 2 |
| Skin and subcutaneous tissue disorders | ||||
| sweating | 5/61 (8.2%) | 5 | 5/61 (8.2%) | 5 |
| rash | 3/61 (4.9%) | 3 | 0/61 (0%) | 0 |
| Vascular disorders | ||||
| hypotension | 1/61 (1.6%) | 1 | 10/61 (16.4%) | 10 |
| orthostasis | 1/61 (1.6%) | 1 | 4/61 (6.6%) | 4 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Daniel Brooks |
|---|---|
| Organization | New York State Psychiatric Institute |
| Phone | 646-774-6171 |
| brooksd@nyspi.columbia.edu |
- #6015
- P50DA009236-16