Cannabis Modulation of Outcomes Related to Opioid Use Disorder: Opioid Withdrawal, Opioid Abuse Potential and Opioid Safety

摘要 阿片类药物和大麻类药物是使用最广泛和滥用最多的两类药物。在世界范围内， 据估计，有5300万人滥用阿片类药物。在美国，260万人符合阿片类药物使用标准 2019年，有近4.7万人死于阿片类药物过量。与此同时，全球大麻 (例如，大麻)的使用量也达到了创纪录的水平--2018年，美国有4350万人报告了过去一年的情况 吸食大麻。尽管合法和非法使用这些药物的比率很高，但没有受控数据。 关于大麻对最高风险群体之一--阿片类药物使用障碍个人的影响。因此， 目前的项目旨在探索急性(研究1)和重复(研究2)大麻注射是如何 影响1)阿片类药物滥用潜力，2)阿片类药物戒断严重程度，3)阿片类药物安全/生理影响。二 在这个为期4年的项目中，将进行独立的住院研究，每个研究都将利用随机、 受试者内、双盲、安慰剂对照设计，将招募中度至 严重的阿片类药物使用障碍(目前有身体依赖)和过去一个月有限的大麻使用。研究1 将检查7种急性大麻剂量的影响，包括6倍剂量范围的THC(5，10，20，30毫克)， THC/CBD剂量范围为3倍(10：10毫克；30：30毫克THC：CBD)和匹配的安慰剂 结果与1)在急性阿片类药物挑战期间阿片类药物滥用责任(即高评级，喜欢药物)有关， 2)戒断严重程度(在阿片类药物急性戒断期间)，以及3)安全/生理效应(例如， 呼吸驱动)的药物条件和组合。研究2将探索反复吸入的影响。 大麻(连续6.5天，每天3次)，跨越三个随机剂量组(两个活性大麻 剂量，匹配的安慰剂)，以确定重复服用大麻的模型如何影响与1)相关的结果 在一次急性阿片类药物挑战期间评估的阿片类药物滥用潜力(即喜欢药物的高评级)；2) 戒断严重程度(在阿片类药物戒断的急性情况下测量)，3)安全/生理影响 (4)对大麻的耐受性和戒断。 还将探讨大麻对急性阿片类药物戒断期间睡眠质量的调节作用。两者都有 研究将采用完整的药效学结果，包括主观的和观察者评级的 措施，以及与安全和精神运动有关的一整套生理和精神运动结果 因此，毒品和犯罪问题办公室有必要全面评估大麻的潜在风险/益处概况。总体而言，这些及时和 创新研究将首次提供吸入性大麻对阿片类药物依赖者影响的经验数据 人口。这些研究将提供有关与临床相关的潜在相互作用的新的受控信息 执业、处方和公共安全。

Abstract Opioids and cannabinoids are the two most widely used and misused drug classes. Worldwide, an estimated 53 million people misuse opioids. In the US, 2.6 million individuals meet criteria for opioid use disorder and nearly 47,000 people died in 2019 due to opioid overdose. At the same time, global cannabis (i.e., marijuana) use is also at record high levels - in 2018, 43.5 million individuals in the US reported past-year cannabis use. Despite high rates of both licit and illicit use of these drug classes, there are no controlled data on the effects of cannabis in one of the most high-risk groups – individuals with opioid use disorder. Thus, the current project aims to explore how both acute (Study 1) and repeated (Study 2) cannabis administration impacts 1) opioid abuse potential, 2) opioid withdrawal severity, and 3) opioid safety/physiological effects. Two independent inpatient studies will be conducted during this 4-year project and each will utilize a randomized, within-subject, double-blind, placebo-controlled design and will enroll samples of participants with moderate to severe opioid use disorder (with current physical dependence) and limited past-month cannabis use. Study 1 will examine the effects of 7 acute cannabis doses, including a 6-fold dose range of THC (5, 10, 20, 30 mg), THC/CBD doses across a 3-fold dose range (10:10 mg; 30:30 mg THC:CBD) and matched placebo on outcomes related to 1) opioid abuse liability (i.e., ratings of high, drug liking) during an acute opioid challenge, 2) withdrawal severity (during acute instances of opioid withdrawal), and 3) safety/physiological effects (e.g., respiratory drive) of the drug conditions and combinations. Study 2 will explore the effects of repeated inhaled cannabis (3 times/day for 6.5 consecutive days), across three randomized dosing blocks (two active cannabis doses, matched placebo), to determine how a repeated cannabis dosing model impacts outcomes related to 1) opioid abuse potential (i.e., ratings of high, drug liking) assessed during an acute opioid challenge; 2) withdrawal severity (measured during acute instances of opioid withdrawal), 3) safety/physiological effects (e.g., respiratory drive) of the drug conditions and combinations; and 4) cannabis tolerance and withdrawal. Cannabis modulation of sleep quality during bouts of acute opioid withdrawal will also be explored. Both studies will employ a full complement of pharmacodynamic outcomes, including subjective and observer-rated measures, as well as a full battery of physiological and psychomotor outcomes related to safety and impairment to fully assess the potential risk/benefit profile of cannabis in OUD. Overall, these timely and innovative studies will provide the first empirical data on the effects of inhaled cannabis in an opioid-dependent population. These studies will provide new controlled information on potential interactions relevant to clinical practice, prescribing, and public safety.