Evaluation of Medical Cannabis and Prescription Opioid Taper Support for Reduction of Pain and Opioid Dose in Patients With Chronic Non-Cancer Pain

Pain Clinical Trial

Official title:

Evaluation of Medical Cannabis and Prescription Opioid Taper Support for Reduction of Pain and Opioid Dose in Patients With Chronic Non-Cancer Pain

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04827992
• Other study ID #: 2021P000871
• Status: Recruiting
• Phase: N/A
• Start date: August 23, 2021
• Est. completion date: June 30, 2025

Study information

• Verified date: May 2024
• Source: Massachusetts General Hospital
• Contact: Jodi Gilman, PhD
• Phone: 6176437293
• Email: jgilman1[@]mgh.harvard.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study will use a randomized controlled design to test whether medical marijuana use by adults on high-dose chronic opioid therapy (COT) for chronic non-cancer pain is associated with reduced opioid dose and improved pain intensity and interference when added to a 24-week behavioral intervention (POTS).

Description:

This trial is a randomized, six-month study of medical marijuana (MM) on opioid use that will: (1) evaluate whether adults with chronic, non-cancer pain on COT assigned to MM+POTS, compared with those assigned to WL+POTS, have greater reduction in opioid dose and/or pain intensity and interference, (2) assess whether participants assigned to MM+POTS, compared with those assigned to WL+POTS, have improved quality of life, depression, and anxiety; and reduced self-reported opioid dose, (3) evaluate whether those assigned to MM+POTS develop symptoms of CUD and have a reduced number of OUD symptoms over the 24-week intervention, as well as at the 12-month time point.

Participants will be randomly assigned to either an active MM arm (n = 125), or to a waitlist control arm (WLC) (n = 125). Participants will be assessed at baseline, every 4 weeks for 6 months, and at a 12-month follow-up for opioid use, development of CUD, development or resolution of OUD, and neurocognitive performance. Urine collected will be assessed with quantitative assays.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 250
• Est. completion date: June 30, 2025
• Est. primary completion date: June 30, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

1. Men and women aged 18-75, inclusive.

2. Endorsing > 6 months of chronic, non-cancer pain.

3. On stable prescription opioid doses of 25 MME or greater for >90 days, verified by the Prescription Monitoring Program.

4. Either no prior use or current light cannabis use (weekly or less in the past 12 months).

5. Plans to use medical cannabis for pain to control pain and/or reduce opioid dose.

6. Competent and willing to provide written informed consent in English.

7. Potential participants of childbearing potential must not be pregnent at enrollment. They will be asked to self-report pregnancy status and the start date of their most recent menstrual period and agree to use effective contraception: abstinence; hormonal contraception; intra-uterine device, sterilization; or double barrier contraception, during the study.

Exclusion Criteria:

1. Current cannabis use (including inhaled or ingested CBD products) of greater than weekly on average in the past 12 months, assessed via self-report (no more than 10 times in the past 90 days).

2. Current cannabis use disorder; current moderate to severe substance use disorder for any substance by structured interview, EXCEPT nicotine and opioids (OUD).

3. Current uncontrolled major medical illness, such as cancer, symptomatic hypothyroidism/hyperthyroidism or severe respiratory compromise.

4. Use of non-prescribed opioids, by self-report.

5. Dose change or initiation of medications with significant analgesic effects (e.g., tricyclic antidepressants, SSRIs, gabapentin, NSAIDs) in the past 4 weeks.

6. Concomitant medications will be discussed at each study visit, and any medications that may interact with cannabinoids (e.g., warfarin) will be discussed with a study clinician prior to enrollment or continued participation.

7. Actively suicidal and/or suicide attempt or psychiatric hospitalization in past year, or current suicidal ideation with specific plan or intent.

8. History of intellectual disability (e.g., Down's syndrome) or other severe developmental disorder or IQ < 70.

9. Current diagnosis of delirium, dementia, amnestic, or other cognitive disorder; current diagnosis of bipolar II disorder; lifetime diagnosis of bipolar I disorder, schizophrenia spectrum, or other psychotic disorder.

10. Surgery within the past month or planned during the next 6 months.

11. Pregnant or trying to get pregnant or breastfeeding.

12. In the opinion of the investigator or study physicians, not able to complete study procedures or safely participate in this study.

Related Conditions & MeSH terms

• Marijuana Abuse
• Marijuana Use
• Opioid Use
• Pain

Intervention

Drug:
• Medical Marijuana
Patients in this group can choose what type, how much, and when to use medical marijuana to use.

Behavioral:
• Prescription Opioid Taper Support (POTS)
Prescription Opioid Taper Support (POTS), a manualized behavioral prescription opioid taper support intervention developed by consultant, will be offered weekly to all participants to support behavioral self-management of pain and structured, voluntary taper of COT dose.

Locations

Country	Name	City	State
United States	Massachusetts General Hospital	Boston	Massachusetts
United States	Cambridge Health Alliance	Cambridge	Massachusetts
United States	Maine Medical Center	Portland	Maine

Sponsors (3)

Lead Sponsor	Collaborator
Massachusetts General Hospital	Cambridge Health Alliance, MaineHealth

Country where clinical trial is conducted

United States, 

References & Publications (1)

Jashinski J, Grossman E, Quaye A, Cather C, Potter K, Schoenfeld DA, Evins AE, Gilman JM. Randomised, pragmatic, waitlist controlled trial of cannabis added to prescription opioid support on opioid dose reduction and pain in adults with chronic non-cancer pain: study protocol. BMJ Open. 2022 Jun 9;12(6):e064457. doi: 10.1136/bmjopen-2022-064457. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Mean Difference in Prescription Monitoring Program verified opioid dose at baseline and week 24	Opioid dose verified by the Prescription Monitoring Program, in morphine milligram equivalents (MME) per day. If participants decide to reduce dose at week 24, we will use the reduced dose even if the new dose cannot be immediately implemented (e.g., due to delays in refilling prescription) to ensure accurate representation of change.	Baseline and week 24
Primary	Mean Difference in Pain, Enjoyment, General Activity (PEG) Scale Summed Score over post-baseline to week 24 interval	The Pain, Enjoyment, General Activity (PEG) scale will assess pain intensity and interference. The scale ranges from 0-30, with a higher score indicating greater pain intensity and interference. Collected daily by a self-reported online survey.	Every post-baseline day until week 24
Secondary	Mean Difference in Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form Summed Score at weeks 4, 8, 12, 16, 20, 24	Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form will assess changes in quality of life measures. The scale ranges from 14 - 70, with a lower score indicating greater dissatisfaction with life.	Week 4, week 8, week 12, week 16, week 20, week 24
Secondary	Mean Difference in PROMIS-29 Depression Subscale Summed Score at weeks 4, 8, 12, 16, 20, 24	The 8-item depression subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS)-29 will be used to assess depression symptoms. The scale uses a t-score metric (mean of 50, SD of 10). Higher scores indicate worse depression.	Week 4, week 8, week 12, week 16, week 20, week 24
Secondary	Mean Difference in PROMIS-29 Anxiety Subscale Summed Score at weeks 4, 8, 12, 16, 20, 24	The 7-item anxiety subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS)-29 will be used to assess anxiety symptoms. The scale uses a t-score metric (mean of 50, SD of 10). Higher scores indicate worse anxiety.	Week 4, week 8, week 12, week 16, week 20, week 24
Secondary	Mean Difference in Opioid Use Disorder Symptoms at weeks 4, 8, 12, 16, 20, 24	The DSM-5 Opioid Use Disorder Checklist will evaluate symptoms of Opioid Use Disorder (number of symptoms). The scale ranges from 0 - 11, with a higher score indicating more severe Opioid Use Disorder.	Week 4, week 8, week 12, week 16, week 20, week 24
Secondary	Mean Difference in Cannabis Use Disorder Symptoms at weeks 4, 8, 12, 16, 20, 24	The DSM-5 Cannabis Use Disorder Checklist will evaluate symptoms of Cannabis Use Disorder (number of symptoms). The scale ranges from 0 - 11, with a higher score indicating more severe Cannabis Use Disorder.	Week 4, week 8, week 12, week 16, week 20, week 24
Secondary	Mean Difference in Self-Reported Opioid Dose at weeks 4, 8, 12, 16, 20, 24	Self-reported opioid dose in morphine milligram equivalents (MME) per day. This is collected daily by a self-reported online survey and averaged over each 4-week interval.	Week 4, week 8, week 12, week 16, week 20, week 24