Using THC and CBD to treat chronic pain and opioid cravings

Combination of THC and CBD as Novel Treatment for Co-Occurring Opioid Use Disorder and Chronic Pain

This study is testing if a mix of THC and CBD can help people with chronic pain and opioid cravings feel better while they are on methadone.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 147 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: Yale University (Academic / other)
• Locations: 1 site (New Haven, Connecticut)
• Trial ID: NCT06544291 on ClinicalTrials.gov

What this trial studies

This phase 2 study investigates the effects of combined delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on alleviating pain and opioid cravings in individuals with co-occurring opioid use disorder (OUD) and chronic pain who are on methadone therapy. The study employs a double-blind, placebo-controlled, crossover design with 147 participants randomized into three groups receiving varying doses of THC and CBD. The central hypothesis is that the combination of THC and CBD will be more effective than either drug alone in reducing pain and cravings. Additionally, the study will examine whether sex influences the response to these cannabinoids.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18-65 with co-occurring opioid use disorder and chronic pain who are compliant with methadone therapy.

Not a fit: Patients without a history of opioid use disorder or chronic pain, or those not on methadone therapy, may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could provide a novel dual-action therapy for managing chronic pain and reducing opioid cravings in patients with OUD.

How similar studies have performed: While the combination of THC and CBD is a relatively novel approach, preliminary studies suggest potential benefits in similar contexts, though further research is needed.

Eligibility criteria

Inclusion Criteria:

1. Provision of signed and dated informed consent form.
2. Stated willingness to comply with all study procedures and availability for the duration of the study.
3. Male or female aged 18-65 years.
4. Co-occurring OUD (meeting DSM-5 criteria) and chronic pain (uniformly operationalized as high-impact \[occurring most days, limiting life or work activities\] non-cancer low back pain for ≥ 3 months).
5. Prior exposure to cannabis or its constituent cannabinoids at least once in the last 10 years, 1-10 times in the last 20 years, or more than 20 times in lifetime.
6. Adherence to their clinically prescribed methadone therapy, on a stable dose (30-150 mg/day ≥ 3 weeks).
7. For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation and for an additional 2 weeks after the last test session.
8. For males of reproductive potential: use of condoms or other methods to ensure effective contraception with partner.

Exclusion Criteria:

1. Meeting DSM-5 criteria for cannabis use disorder and/or substance use disorders (SUDs) within the last 3 months. Participants meeting DSM-5 criteria for OUD and/or tobacco use disorder, either currently or within the last 3 months, will not be excluded per this criterion.
2. Clinically significant medical disorders as noted by the participant or through study screening procedures (e.g. liver dysfunction, as indicated by ALT and/or AST \> 1.5 times the normal limit).
3. Neurological conditions that may change the response to nociceptive stimuli (e.g., stroke, neuropathy), or that lead to loss of balance, evidenced by a neuro-sensory exam during screening.
4. Contraindications for exposure to nociceptive stimuli, such as untreated hypertension, verbally noted by participant or verified during screening procedures.
5. Abnormal screening EKG (QTc interval \>450 ms), arrythmia, or vasospastic disease.
6. Positive urine pregnancy test, or lack of birth control measures in women of childbearing potential. For males of reproductive potential refusal to use condoms or other methods to ensure effective contraception with partner.
7. Currently lactating.
8. Male participants who plan to donate sperm starting at screening and through 90 days after final study drug administration.
9. Females who plan to donate ova starting at screening through 28 days after final study drug administration.
10. History of primary psychotic disorders or mood disorders with psychotic features.
11. Current suicidal ideation or related behavior.
12. A physician will carefully evaluate participants for use of over-the-counter or prescription psychoactive drugs known to affect pain threshold or pain tolerance (including NSAIDS, serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g. venlafaxine, duloxetine), gabapentinoids, tricyclic antidepressants (e.g., nortriptyline, amitriptyline), anticonvulsant medications (e.g., topiramate, carbamazepine). Only participants who are on stable doses (i.e., consistent daily administration of the medication for at least three months at the same dose following the last dose change, either increase or decrease) of these medications, and whose dosing schedules allow participation in the study visits, thus excluding instances of single-dose or temporary dosing of the medication, will be eligible as determined by the sponsor-investigator. If possible, the morning dose will be administered after the study visit.
13. Current, regular use of benzodiazepines, other prescription opioids, or platelet inhibitors (e.g., clopidogrel, apixaban, ticagrelor).
14. Allergy or serious adverse reaction to cannabis or its constituent cannabinoid.
15. Allergy or serious adverse reaction to sesame oil or seeds.
16. Allergy or serious adverse reaction to Butylated Hydroxytoluene (BHT).
17. Unable to swallow or have difficulty swallowing capsules.
18. Prior to receiving the study medication on the first test session, participants' cannabinoid use will be assessed using a quantitative point-of-care urine 11-nor-9-carboxy-THC concentration test with a cut-off of ≤ 150 mg/mL. If a participant tests greater than ≤ 150 mg/mL, they will be asked to abstain for an additional 7 to 14 days. If 14 days after their initial THC concentration test the participant continues to test positive, they will not be allowed to participate in the study.

Where this trial is running

New Haven, Connecticut

• Connecticut Mental Health Center — New Haven, Connecticut, United States (Recruiting)

Study contacts

• Principal investigator: Joao P. De Aquino, M.D. — Yale University
• Study coordinator: Julia V. Meyerovich, M.S.

Conditions Chronic Pain; Opioid Use Disorder; Delta-9-Tetrahydrocannabinol; Cannabidiol; Cannabinoid; Methadone; Opioid Addiction; Pain