Opioid Use Disorder
Conditions
Brief summary
Medication is the most efficacious treatment of an opioid use disorder, including methadone, buprenorphine, and naltrexone. However, many patients experience withdrawal symptoms, which prevents them from being successfully inducted onto medication for opioid use disorder. This study is a pilot study investigating whether blocking the SPG helps reduce withdrawal symptoms in OUD. This study does not involve treatment or induction onto medications. It is a proof of principal study only. We will recruit non-treatment seeking subjects with OUD who are admitted to the research unit for all procedures.
Detailed description
The sphenopalatine ganglion (SPG) is a collection of neurons involved in autonomic regulation (which refers to bodily processes that are automatic like heart rate and blood pressure). Blocking the SPG is used to treat disorders, such as migraines or cluster headaches (short, severe headaches that occur together). The procedure will be performed by a doctor (specialized in ear, nose throat surgery) and would first involve the application of numbing nasal spray to both nostrils, which lasts about two hours and might reduce smell during that time. This is followed by an injection of a stronger numbing agent (similar to the type used by dentists) to the nerve bundles in the back of the nasal passages (one side at a time) via a tool, known as an endoscope which is a rigid tube with a camera on the end. The procedure is not painful. Previous studies have shown that clonidine, which inhibits the autonomic nervous system, is helpful for reducing the symptoms of opioid withdrawal. However, the dosing of clonidine is limited by side effects (lowered blood pressure and heart rate) and compliance. Furthermore, withdrawal is among the most significant barriers to substance treatment and ultimately overcoming a substance use disorder. Thus, we would like to explore whether a more targeted intervention would improve rates of successful acute detoxification while overcoming the aforementioned challenges of systemic side effects and compliance issues observed with the use of oral agents.
Interventions
PROCEDUREsphenopalatine ganglion block
The sphenopalatine ganglion will be blocked with bupivacaine for this study
Sponsors
New York State Psychiatric Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
open label single group
Eligibility
Sex/Gender
ALL
Age
22 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Opioid Use Disorder, moderate to severe * Ages 22 to 50 * Lives in New York City, able to travel for visits * Willing to be admitted to an inpatient unit
Exclusion criteria
* Medical disorder, for who study participation could be deleterious (neurologic, cardiac, renal or infectious disease * Hypertension: BP \> 150/100 * Elevated liver function tests (AST, ALT) \> 3x normal * Having a painful medical illness for which opioids are needed (including upcoming surgery).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| enrollment: percent screened subjects who enroll | 4 weeks | We will measure the percent of screened participants who agree to enroll as part of the feasibility study |
| retention: percent enrolled subjects who complete | 4 weeks | We will measure the percent of enrolled participants who complete the study as part of the feasibility study |
| tolerability: percent adverse events, if any | 4 weeks | We will measure the percent of adverse events in this feasibility study, if any measured with the CTCAE grading system (rate 0 to 5) |
Countries
United States
Outcome results
None listed