6-week trial of oxytocin for co-occurring cocaine and opioid use disorders

与普通人群相比，退伍军人的物质使用障碍发生率较高 很大程度上受到心理社会因素的影响--例如难以重新融入 因回避重要支持系统而导致的平民生活--导致不成比例的 提高了未得到满足的成瘾治疗需求。那些同时使用可卡因和海洛因的人 死亡率是一般人口的14.3倍。30%-60%的患者接受 美沙酮维持疗法(MMT)针对阿片类药物使用障碍，积极使用可卡因。 目前还没有批准的可卡因使用的精神药理治疗。 MMT项目和重要的心理社会治疗的失调率和辍学率 吸食可卡因的人高达80%。此外，与其他药物相比，可卡因的使用 尤其是在社会压力的驱动下，可卡因与人的高反应性有关 下丘脑-垂体-肾上腺(HPA)轴。临床前和试点临床研究结果表明 催产素是一种哺乳动物神经肽，它的给药可能有多种 直接的抗成瘾作用，提高心理社会治疗的参与度，以及 减轻可卡因使用障碍患者HPA轴的高反应性。这是一个 50名积极使用可卡因的退伍军人的双盲、安慰剂对照临床试验 精神障碍，也在阿片类药物治疗计划中接受MMT，随机接受 催产素40IU或安慰剂滴鼻，每天两次，持续六周。初级阶段 结果衡量标准将是催产素在减少可卡因使用方面的有效性，通过 每周尿样中可卡因代谢物苯甲酰ecGonine的定量水平。 治疗反应的潜在机制将通过测量催产素来评估 A)改善与治疗提供者的治疗联盟(工作 联盟清单、客户和治疗师表格)和现有诊所运营的就诊情况 治疗组成部分和b)通过测量自我应激反应来减弱社会应激-反应性 报告的可卡因渴求、心理生理应激措施和唾液皮质醇 对特里尔社会压力测试的反应。总之，退伍军人和退伍军人之间的差异 成瘾流行率、严重性和成功干预的平民在很大程度上受到推动 退伍军人中较高的社交回避和创伤后应激症状。 这项研究将独特地结合精神药理学和循证医学 旨在减少可卡因使用、改善治疗的心理社会干预措施 参与，并防止与压力有关的可卡因在退伍军人中使用 发生可卡因和阿片类药物使用障碍接受MMT。

High rates of substance use disorders in Veterans compared to the general population are heavily influenced by psychosocial factors – such as difficulty reintegrating into civilian life due to avoidance of vital support systems – leading to disproportionately elevated unmet addiction treatment needs. Those using both cocaine and heroin have mortality rates 14.3 times higher than the general population. 30-60% of patients receiving methadone maintenance therapy (MMT) for opioid use disorder actively use cocaine. There are currently no approved psychopharmacological treatments for cocaine use disorder, and drop-out rates from MMT programs and vital psychosocial treatments are as high as 80% for cocaine users. What’s more, cocaine use, compared to other drugs, is particularly driven by social stress, and cocaine is associated with hyperreactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Preclinical and pilot clinical findings suggest that administration of oxytocin, a mammalian neuropeptide, may have a multitude of direct anti-addiction effects, improve engagement in psychosocial treatments, and attenuate hyperreactivity of the HPA axis in patients with cocaine use disorder. This is a double-blinded, placebo-controlled, clinical trial of fifty Veterans with active cocaine use disorder, also receiving MMT in an opioid treatment program, randomized to receive either oxytocin 40 IU or placebo intranasally twice daily for six weeks. The primary outcome measure will be oxytocin’s effectiveness at reducing cocaine use as measured by quantitative levels of the cocaine metabolite, benzoylecgonine, in weekly urine samples. Potential mechanisms of treatment response will be evaluated by measuring oxytocin’s effectiveness at a) improving therapeutic alliance with treatment providers (Working Alliance Inventory, client and therapist forms) and attendance in existing clinic-run treatment components and b) attenuating social stress-reactivity by measuring self- reported cocaine craving, psychophysiological stress measures, and salivary cortisol in response to a Trier Social Stress Test. In sum, discrepancies between Veterans and civilians in addiction prevalence, severity, and successful intervention are largely driven by higher rates of social avoidance and posttraumatic stress symptoms among Veterans. This study will uniquely combine psychopharmacological and evidence-based psychosocial interventions targeted at reducing cocaine use, improving treatment engagement, and preventing stress-related cocaine use among Veterans with co- occurring cocaine and opioid use disorders receiving MMT.