Personalized adaptive deep brain stimulation for severe opioid use disorder

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

Adults with severe, treatment-resistant opioid use disorder will be implanted with investigational deep brain stimulation devices. Investigators will perform invasive brain mapping to customize adaptive stimulation settings for each participant. Safety, craving levels, and opioid use will be tracked through regular follow-up visits and outcome measures. Device recordings will also be analyzed to improve understanding of the brain mechanisms involved in opioid use disorder.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Adults (all genders) 22 to 75 years old.
* Current diagnosis of severe primary opioid use disorder (OUD) (\>= 6 on DSM-5 OUD criteria) (any form of opioid use).
* History of opioid use for more than 5 years.
* Participants are seeking treatment for their OUD.
* Participants have insight into their opioid use disorder (score \> 26 on the recognition subscale of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES V.8))
* OUD is treatment refractory: unable to achieve sustained remission over the past 5 years, despite at least three treatment attempts (outpatient, residential, inpatient), with at least one treatment attempt involving taking a first-line medication for OUD (MOUD) such as buprenorphine, methadone, or extended-release naltrexone. Treatment failure is defined as continued opioid use or relapse during or after completion of treatment. Sustained remission is defined per DSM-5 as not meeting any OUD criteria except craving for \> 12 months. Documented adherence: participants must have documented adherence to the failed first-line MOUD for at least 8 weeks (PMID: 29083570).
* Stated willingness to comply with all study procedures and availability for the duration of the study.
* Social support system and stable living arrangement to provide assurances that the subject will adhere to study requirements: family or friends who live with or near the subject, and can provide collateral information, monitor the subject's behavior, support, and encourage the subject to participate in follow-up visits and evaluations.
* For individuals of reproductive potential: use of highly effective contraception for at least 4 weeks prior to sEEG surgery and agreement to use such a method during study participation.

Exclusion Criteria:

* Pregnancy or lactation.
* Non-English speaking.
* Participants are not willing to start MOUD treatment with buprenorphine or to switch MOUD to buprenorphine if they are already on other MOUD, for the duration of the study.
* OUD treatment with another investigational drug or other intervention within 3 months.
* History of primary psychosis or Bipolar I disorder per the medical interview.
* History of severe personality disorder that could interfere with study participation (e.g., antisocial personality disorder) per the medical interview.
* History of traumatic brain injury with loss of consciousness greater than 5 minutes.
* Clinically significant cognitive impairment per neuropsychological testing.
* History of suicidal attempts in the past 3 years or current suicidal thoughts per psychiatric evaluation.
* Coagulopathy: INR \> 1.4, aPTT \> 40 s, platelets \< 100,000.
* Current clinically significant medical or neurologic disease that affects brain function (e.g., recent stroke, myocardial infarction, seizures not due to alcohol withdrawal).
* Clinically significant abnormality on structural brain MRI scan.
* Life expectancy less than 24 months per the clinical judgment of study investigators (e.g., terminal cancers).
* Any labeled DBS contraindication or inability to have brain MRI: certain pacemakers, metal in body, inability to undergo awake operation, significant cardiac or other medical risk factors for surgery, infection, and coagulopathy.
* Exclusion for early remission: participants who achieve early remission after initiating buprenorphine during the screening phase (prior to the sEEG phase) will be excluded from the study.

Where it's running

• University of California, San Francisco
  San Francisco, California, United States Recruiting

Study contacts

• Principal investigator: Khaled Moussawi, MD, PhD — University of California, San Francisco
• Study coordinator: Catherine Borror, BS
• Email: TN2Lab@ucsf.edu
• Phone: 415-514-6551

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.