Office-based Methadone Versus Buprenorphine to Address Retention in Medication for Opioid Use Disorder Treatment.

Opioid Use Disorder Clinical Trial

Official title:

Office-based Methadone Versus Buprenorphine to Address Retention in Medication for Opioid Use Disorder Treatment - A Pragmatic Hybrid Effectiveness/Implementation Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06323824
• Other study ID #: 2000033271
• Secondary ID: CTN-01315UG1DA01
• Status: Recruiting
• Phase: Phase 4
• Start date: June 4, 2024
• Est. completion date: May 2029

Study information

• Verified date: June 2024
• Source: Yale University
• Contact: Jessica Research Associate
• Phone: 203-785-6821
• Email: j.mckenzie[@]yale.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this clinical trial is to compare the effectiveness of office-based methadone with pharmacy administration and/or dispensing to office-based buprenorphine for the treatment of opioid use disorder. This study will also examine factors influencing the implementation of office-based methadone.

Description:

This study is a randomized, pragmatic hybrid type 1 effectiveness/implementation multisite (approximately 6 sites) trial to determine whether office-based methadone with pharmacy administration and/or dispensing or buprenorphine (BUP) results in greater treatment retention in approximately 600 patients with opioid use disorder (OUD). This trial will also identify implementation barriers, facilitators and acceptability at the patient, provider and health-systems level for office-based methadone with pharmacy administration and/or dispensing.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 600
• Est. completion date: May 2029
• Est. primary completion date: December 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 99 Years

Eligibility

Inclusion Criteria

• 18 years of age or older;

• Meet Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for OUD;

• Are initiating a new MOUD treatment episode

Exclusion Criteria

• Have been prescribed (and ingested) or been administered more than 72 hours of MOUD in the 7 days prior to randomization as a "bridge" to the new OUD treatment episode. Such MOUD may include prescribed (and ingested) or administered medically managed withdrawal (aka detoxification).

• Known contraindication to methadone or BUP

• Unwilling to pursue or continue pre-natal care or pregnancy counseling if determined pregnant by urine human chorionic gonadotropin (hCG) testing at the screening assessment

• Be actively suicidal or severely cognitively impaired (e.g., dementia, untreated psychosis) precluding informed consent as determined by site clinician

• Current severe comorbid substance use disorder requiring residential or inpatient treatment services as determined by site clinician

• Be unable or unwilling to provide reliable locator information including 2 or more contacts in addition to themselves

• Be unwilling to follow study procedures (e.g., unwilling to receive treatment from site clinician, use the study pharmacy, unwilling to be randomized to BUP or methadone, or will be unavailable for the follow-up assessments) including allowing the researchers to access their record in the EMR and state's prescription drug monitoring program

• Have previously enrolled in CTN-0131

• Currently enrolled in another research study which will conflict with study procedures

• Are currently in jail, prison or other overnight facility as required by a court of law or have pending legal action that could prevent participation in study activities

• Unable to conduct research assessments in English as determined by Site PI or their designee.

Related Conditions & MeSH terms

• Opioid Use Disorder
• Opioid-Related Disorders
• Substance-Related Disorders

Intervention

Drug:
• Methadone
Drug: Methadone Possible formulations: 10 and 40 mg tablets
• Buprenorphine (BUP)
Drug: Buprenorphine (BUP) Possible formulations: A. Buprenorphine 225 mcg to 24 mg 225 mcg to 32 mg per day B. Buprenorphine (Extended release) 300 mg q 28 days (Sublocade) 100 mg q 28 days (Sublocade) 8 mg q 7 days (Brixadi) 16 mg q 7 days (Brixadi) 24 mg q 7 days (Brixadi) 32 mg q 7 days (Brixadi) 64 mg q 7 28 days (Brixadi) 96 mg q 7 28 days (Brixadi) 128 mg q 7 28 days (Brixadi)

Locations

Country	Name	City	State
United States	Officed Based Addiction Treatment Program, Boston Medical Center	Boston	Massachusetts
United States	Rapid Start Clinic, Kaiser Permanente Colorado	Denver	Colorado
United States	Marshall University Division of Addiction Sciences P.R.O.A.C.T	Huntington	West Virginia
United States	Hennepin Healthcare Addiction Medicine	Minneapolis	Minnesota
United States	Highland Hospital Bridge Clinic at Alameda Health System	Oakland	California
United States	Outpatient Buprenorphine Induction Clinic, University of California, San Francisco	San Francisco	California

Sponsors (10)

Lead Sponsor	Collaborator
Yale University	Alameda Health System, Boston Medical Center (BMC), Hennepin Healthcare Research Institute, Kaiser Permanente, Marshall Health, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), The Emmes Company, LLC, University of California, San Francisco

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of days of continuous treatment with study site clinician-prescribed methadone or buprenorphine, as randomized, during the 168 days post-randomization among RCT participants.	MOUD dispensed to the participant including medication, duration of prescription and daily dose prescribed data will be extracted from the state prescription drug monitoring program (PDMP) or the electronic medical record (EMR).	up to Day 168
Secondary	Number of self-reported days in any FDA-approved formulation of MOUD treatment (e.g., buprenorphine, methadone or naltrexone) during the 168 days post-randomization.	The MOUD Calendar Based Recall (Self-Report) form is used to collect self-reported prescribed medications for OUD.	up to Day 168
Secondary	Number of self-reported days in formal OUD treatment, according to American Society of Addiction Medicine (ASAM) levels of care 1-4, during the 168 days post-randomization.	This information will be obtained from one or more of the following: Health Services Utilization instrument, a brief structured interview regarding health care utilization (inpatient and outpatient) collecting information on the type and amount of services received, Timeline Followback Medications, MOUD Calendar Based Recall, and Treatment Dates instruments.	up to Day 168
Secondary	Number of days prescribed any FDA-approved MOUD formulation during the 168 days post-randomization.	MOUD dispensed to the participant including medication, duration of prescription and daily dose prescribed data will be extracted from the state prescription drug monitoring program (PDMP) or the electronic medical record (EMR).	up to Day 168
Secondary	Number of days of self-reported non-prescribed opioid use per month.	The Opioid Use Calendar Based Recall instrument is used to collect self-reported non-prescribed opioid use.	up to Day 168
Secondary	Number of days of self-reported non-prescribed stimulant use per month.	The Timeline Followback instrument collects self-reported drug and alcohol use.	up to Day 168
Secondary	Number of days of self-reported non-prescribed benzodiazepine use per month.	The Timeline Followback instrument collects self-reported drug and alcohol use.	up to Day 168
Secondary	Urine toxicology	Number of monthly urines negative for non-prescribed opioids during the 168 days post-randomization. Non-prescribed opioids will be determined using the Opioid Use Calendar Based Recall self-report.	up to Day 168
Secondary	Participant satisfaction with MOUD	Proportion of RCT participants who report at the assessment scheduled to be collected on day 28 that the medication they received was at least "Somewhat helpful" on the Satisfaction with MOUD Provider Scale instrument.	up to Day 168
Secondary	Total number of self-reported overdose events per total number of participant days at risk.	The Overdose Calendar Recall instrument collects overdose events.	up to Day 168
Secondary	Total number of self-reported injection drug use related events per total number of participant days at risk.	Assessment of Infectious or Other Complications of Injection Drug Use assess for self-report of skin or soft-tissue infections, osteoarticular infections (septic arthritis, osteomyelitis, epidural abscess), endovascular infections including endocarditis, or new injection-related viral infections.	Up to Day 168
Secondary	Pain measured using PEG-3: "Pain average," "interference with Enjoyment of life," and "interference with General activity."	Mean scores on the PEG-3 screening instrument over time. Total score range is 0-10; the highest being the worse pain.	Up to Day 168
Secondary	Number of self-reported days with acute care utilization (ED or hospitalization) events during the 168 days post-randomization per month.	The Health Services Utilization instrument is a brief, structured interview regarding health care utilization (inpatient and outpatient) collecting information on the type and amount of services received. This includes ED visits, hospitalizations, primary medical care visits (excluding those for BUP treatment) and self-help sources of support (e.g., NA). Also assessed are receipt of formal and informal addiction and mental health treatment services RCT participants might have received outside the study interventions.	Up to Day 168