Low-dose Buccal Buprenorphine: Relative Abuse Potential and Analgesia

Purpose

The goal of this study is to compare the abuse potential of low-dose equianalgesic buccal buprenorphine to a commonly used full mu opioid receptor (MOR) agonist in a highly controlled experimental setting. This is a translational study in which healthy participants are phenotyped for psychosocial and Opioid-Use-Disorder-risk-related metrics. In a within-subjects crossover design, 60 participants will receive a standard postoperative oral oxycodone dose (10 mg), placebo, and 3 different doses of buccal buprenorphine across 5 separate sessions. Quantitative Sensory Testing (QST) will be used to evaluate alterations in pain responsiveness relative to placebo across buprenorphine doses and oxycodone, and will compare abuse potential (indexed by the standard FDA drug liking metric) following equianalgesic doses of the two drugs.

Conditions

  • Analgesia
  • Abuse Opioids
  • Pain

Eligibility

Eligible Ages
Between 18 Years and 65 Years
Eligible Genders
All
Accepts Healthy Volunteers
Yes

Inclusion Criteria

  • Intact cognitive status and ability to provide informed consent - Ability to read and write in English sufficiently to understand and complete study questionnaires - Age 18-65 - Opioid-naive status (defined as no use of full mu-opioid receptor (MOR) agonist, partial MOR agonist, or mixed agonist/antagonist medications for the prior 3 months by patient report

Exclusion Criteria

  • Liver/kidney disease - Chronic pain - Current/prior substance use disorder - Pregnancy (to avoid fetal drug exposure, with pregnancy tests conducted to confirm eligibility) - Seizure disorder - Certain psychiatric conditions (severe depression, bipolar disorder, psychotic disorders) - Recent use of medications that may interfere with study drug metabolism - Recent benzodiazepine or opioid use (confirmed via rapid urine screening prior to each lab session) - The presence of any medical conditions felt by the study physician to render participant unsafe - Prior allergic reaction or intolerance to oxycodone, buprenorphine, or their analogs

Study Design

Phase
Phase 4
Study Type
Interventional
Allocation
Randomized
Intervention Model
Crossover Assignment
Intervention Model Description
randomized, double blind, double-dummy, placebo-controlled, crossover
Primary Purpose
Other
Masking
Double (Participant, Investigator)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Buccal Buprenorphine 300mcg and oral Placebo
In randomized order (crossover) across 5 laboratory sessions approximately 5 days apart, participants will receive: 1) Buccal buprenorphine 300 mcg and oral placebo, 2) Buccal buprenorphine 450 mcg and oral placebo 3) Buccal buprenorphine 600 mcg and oral placebo, 4) Buccal buprenorphine 900 mg and oral placebo, 5) oral immediate-release oxycodone 10mg and oral placebo, or 6) buccal placebo and oral placebo.
  • Drug: Buccal Buprenorphine 300 mcg
    buprenorphine for 300mcg buccal administration
  • Drug: Oral Placebo
    Placebo for oral administration
Experimental
Buccal Buprenorphine 600mcg and oral Placebo
In randomized order (crossover) across 5 laboratory sessions approximately 5 days apart, participants will receive: 1) Buccal buprenorphine 300 mcg and oral placebo, 2) Buccal buprenorphine 450 mcg and oral placebo 3) Buccal buprenorphine 600 mcg and oral placebo, 4) Buccal buprenorphine 900 mg and oral placebo, 5) oral immediate-release oxycodone 10mg and oral placebo, or 6) buccal placebo and oral placebo.
  • Drug: Buccal Buprenorphine 600 mcg
    buprenorphine for 600mcg buccal administration
  • Drug: Oral Placebo
    Placebo for oral administration
Experimental
Buccal Buprenorphine 900mcg and oral Placebo
In randomized order (crossover) across 5 laboratory sessions approximately 5 days apart, participants will receive: 1) Buccal buprenorphine 300 mcg and oral placebo, 2) Buccal buprenorphine 450 mcg and oral placebo 3) Buccal buprenorphine 600 mcg and oral placebo, 4) Buccal buprenorphine 900 mg and oral placebo, 5) oral immediate-release oxycodone 10mg and oral placebo, or 6) buccal placebo and oral placebo.
  • Drug: Buccal Buprenorphine 900 mcg
    buprenorphine for 900mcg buccal administration. Note: This arm has been discontinued as of 06/25/2024 and has been replaced with the 450mcg buprenorphine buccal administration arm.
  • Drug: Oral Placebo
    Placebo for oral administration
Active Comparator
Oral immediate release oxycodone 10mg and buccal placebo
In randomized order (crossover) across 5 laboratory sessions approximately 5 days apart, participants will receive: 1) Buccal buprenorphine 300 mcg and oral placebo, 2) Buccal buprenorphine 450 mcg and oral placebo 3) Buccal buprenorphine 600 mcg and oral placebo, 4) Buccal buprenorphine 900 mg and oral placebo, 5) oral immediate-release oxycodone 10mg and oral placebo, or 6) buccal placebo and oral placebo.
  • Drug: Buccal Placebo
    Placebo for buccal administration
  • Drug: Oral immediate-release oxycodone 10mg
    Immediate-release oxycodone for 10 mg oral administration
Placebo Comparator
Oral placebo and buccal placebo
In randomized order (crossover) across 5 laboratory sessions approximately 5 days apart, participants will receive: 1) Buccal buprenorphine 300 mcg and oral placebo, 2) Buccal buprenorphine 450 mcg and oral placebo 3) Buccal buprenorphine 600 mcg and oral placebo, 4) Buccal buprenorphine 900 mg and oral placebo, 5) oral immediate-release oxycodone 10mg and oral placebo, or 6) buccal placebo and oral placebo.
  • Drug: Buccal Placebo
    Placebo for buccal administration
  • Drug: Oral Placebo
    Placebo for oral administration
Experimental
Buccal Buprenorphine 450mcg and oral Placebo
In randomized order (crossover) across 5 laboratory sessions approximately 5 days apart, participants will receive: 1) Buccal buprenorphine 300 mcg and oral placebo, 2) Buccal buprenorphine 450 mcg and oral placebo 3) Buccal buprenorphine 600 mcg and oral placebo, 4) Buccal buprenorphine 900 mg and oral placebo, 5) oral immediate-release oxycodone 10mg and oral placebo, or 6) buccal placebo and oral placebo.
  • Drug: Oral Placebo
    Placebo for oral administration
  • Drug: Buccal Buprenorphine 450mcg
    buprenorphine for 450mcg buccal administration. Note: This arm has been added to replace the 900mcg buprenorphine buccal administration arm.

Recruiting Locations

Vanderbilt University Medical Center
Nashville, Tennessee 37069
Contact:
Daniel Larach Larach, MD, MSTR, MA
615-322-6033
daniel.larach@vumc.org

More Details

Status
Recruiting
Sponsor
Vanderbilt University Medical Center

Study Contact

Daniel Larach, MD, MSTR, MA
615-322-6033
daniel.larach@vumc.org