Cannabidiol Pharmacotherapy for Comorbid Opioid Addiction and Chronic Pain

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PROJECT SUMMARY/ABSTRACT This proposal seeks to investigate the analgesic and anti-craving efficacy of Cannabidiol (CBD) for comorbid opioid use disorder (OUD) and chronic pain. Chronic pain afflicts approximately 70% of people with OUD. Opioid agonist treatment effectively reduces opioid use overdose deaths, but does not alleviate chronic pain. Convergent preclinical studies have shown that cannabinoids reduce pain sensitivity and opioid-seeking behavior, suggesting they could be leveraged for treatment. Yet, the therapeutic efficacy of cannabinoids for comorbid OUD and chronic pain remains unknown. Given CBD’s lack of hedonic properties and established analgesic and anti-craving effects, it holds particular therapeutic promise for this population. Quantitative Sensory Testing (QST) is a computerized pain assessment method used to reliably measure antinociception and predict the pain treatment response. QST pain biomarkers can be integrated with behavioral paradigms to investigate the two-pronged efficacy of CBD for alleviating pain sensitivity and cue- induced opioid craving. The objective of this proposal is to apply behavioral pharmacology, multimodal pain research and clinical trial methods to study the safety and therapeutic efficacy of CBD for people with comorbid OUD and chronic pain. This will have a significant impact for this patient population, by (i) determining the safety of acute CBD administration (Aim 1); (ii) determining the dose of CBD required to reduce pain sensitivity and cue-induced opioid craving (Aim 2); (iii) understanding the safety of long-term CBD co-administration with opioid agonist maintenance (Aim 3), and (iv) providing preliminary data on the efficacy of CBD to reduce pain severity/interference and opioid craving in the clinical setting (Aim 4). Aims 1 and 2 will be carried out through human laboratory study, and Aims 3 and 4 will be executed through a pilot clinical trial. These studies will serve as the basis for novel treatments and therapeutic biomarkers for comorbid OUD and chronic pain. This proposal will integrate state-of-the-art facilities at Yale and at the VA Connecticut, with established collaborations with local opioid treatment programs. The applicant has assembled a renowned team of expert mentors in the fields of opioid, cannabinoid and pain research. This proposal builds on preliminary work on cannabinoid modulation of pain sensitivity in humans with comorbid OUD and chronic pain. Formal didactics, symposia and national scientific meetings will support the applicant’s training. Specific training goals include developing exceptional skills in (i) behavioral pharmacology of addiction (ii) multimodal assessment of pain, (iii) clinical trials and advanced biostatistics, (iv) grant writing, and (v) responsible conduct of research. Finally, this application leverages the applicant’s robust clinical foundation as a board-certified addiction psychiatrist. The vital support from this K23 award will allow the applicant’s scientific development, leading to an independent research program that timely combines interdisciplinary methods towards developing novel therapeutics for OUD and chronic pain.