Opioid Use Disorder, Severe, Amphetamine Use Disorder
Conditions
Brief summary
The goal of this clinical trial is to investigate the safety and efficacy of applying low-intensity focused ultrasound targeting the nucleus accumbens in individuals with opioid or amphetamine use disorders. The main questions it aims to answer is: \- Low-intensity focused ultrasound targeting the nucleus accumbens demonstrates sufficient safety and predictable therapeutic efficacy in individuals with opioid or amphetamine use disorders. Participants will: * Received Low-intensity focused ultrasound neuromodulation once * Visit the clinic for checkups and asessment at 1 week, 1 month, 3 months, 6 months, 9 months, 1 year, 1.5 years, and 2 years after received Low-intensity focused ultrasound neuromodulation.
Interventions
transcranially deliver focal energy into the accumbens nucleus in the brain
DEVICEfalse stimulus
false stimulus
Sponsors
National Taiwan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
20 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Meets the DSM-5 criteria for opioid use disorder or amphetamine use disorder, with a severity level of severe, and does not currently meet the criteria for in sustained remission; * Within 7 days prior to the screening assessment, the participant must have been receiving a stable dose of medication treatment, such as methadone, buprenorphine/naloxone, or naltrexone; * Within 7 days prior to the screening assessment, the participant must have abstained from illicit substances and alcohol, and must have a negative urine drug test; * The bilateral nucleus accumbens must be clearly identifiable on magnetic resonance imaging (MRI), such that they are sufficient for treatment targeting and for indirect measurement from other anatomical structures; * The participant must be able to communicate effectively and express their feelings and experiences during the study procedures; * The participant must be willing to comply with the study requirements, including adherence to prescribed medications and cooperation with study visits and assessments. (The participant must have the capacity to make independent medical decisions, as determined by the clinical team.)
Exclusion criteria
* Presence of neurological disorders or major psychiatric disorders, such as acute-phase schizophrenia spectrum disorder, acute-phase bipolar disorder, acute-phase major depressive disorder, severe cognitive impairment, or recent suicidal ideation or plan; * Antisocial personality disorder; * Occurrence of major physical health problems within 6 months prior to the trial, including: Cardiovascular or hemodynamic abnormalities, such as heart failure, arrhythmia, tachycardia or bradycardia (\>100 bpm or \<60 bpm), abnormal systolic blood pressure (\>180 mmHg or \<90 mmHg), or abnormal diastolic blood pressure (\>180 mmHg); Platelet or coagulation abnormalities (INR \> 1.5) or current use of medications that may cause anticoagulation, such as warfarin or Avastin; Renal dysfunction (eGFR \< 30 mL/min/1.73 m²) or ongoing hemodialysis; Severe infection; Immunocompromised status; History of intracranial hemorrhage, intracranial aneurysm, cerebrovascular events within the past 6 months, or brain tumor; Neurological diseases, such as stroke, epilepsy, Parkinson's disease, dementia, or related disorders; Any other physical illness that, based on clinical evaluation, may pose a significant risk to physical function or life during treatment. * Participants who, upon evaluation, are deemed unsuitable for MR-guided focused ultrasound treatment, including those with a low skull density ratio (\<0.4), intracranial implants, or energy-absorbing structures or sensitive tissues along the ultrasound beam path that cannot be avoided (such as prior ventriculoperitoneal shunt sites, surgical metal clips, significant calcifications, extensive scarring, or any rigid implants). During the pre-treatment evaluation, a head CT scan will be performed to determine whether the skull density ratio is suitable for focused ultrasound treatment. Based on prior theoretical evidence, an excessively low skull density ratio may reduce the efficiency of MR-guided focused ultrasound and increase the risk of adverse effects, and therefore such participants are considered unsuitable for focused ultrasound treatment. * Structural abnormality of either side of the nucleus accumbens; * Contraindications to MRI, such as claustrophobia, allergy to MRI contrast agents, or the presence of metallic implants incompatible with MRI; * Contraindications to PET imaging, such as allergy to radiopharmaceutical contrast agents; * Inability to comply with trial-related instructions, lack of legal/behavioral capacity, or lack of motivation to receive treatment; * Pregnancy or breastfeeding; * Scalp atrophy or poor wound healing of the scalp; * Any other condition that, in the physician's judgment, makes the participant unsuitable for enrollment in the clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Substance craving intensity | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using visual analogue scale (VAS) to measure craving intensity, higher score shows greater craving for substance |
| Urinalysis | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year after treatment | Whether urine screening tests are positive for opioids and amphetamines. The intervention will be considered effective if the positivity rate decreases by 50% one month after the intervention compared with the time of intervention. |
| Severity of Dependence | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Severity of Dependence Scale (SDS) to measure craving intensity, higher score shows greater severity of Dependence |
| Stimulant Relapse Risk | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Stimulant Relapse Risk Scale (SRRS) to measure craving intensity, higher score shows higher stimulant relapse risk |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mental health state | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Patient Health Questionnaire (PHQ-9) to measure participants' mental health state, greater scores of these scales shows worse mental health state. |
| Executive function assessment | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Behavior Rating Inventory of Executive Function (BRIEF) to assess how well executive function of participants is. |
| Neuropsychological function assessment | Before intervention, three months, six months, a year, two year after treatment | Using Cambridge Gambling Task (CGT) to assess Neuropsychological function since the intervention is to nucleus accumbens and could potentially affect Neuropsychological function. |
| functional Magnetic Resonance Imaging | Before intervention, 24hours, a month, three months after treatment | Because the nucleus accumbens, the intervention target, may be involved in craving, functional magnetic resonance imaging (fMRI) will be used to assess changes in brain activation during the craving task before and after treatment. |
| Positron Emission Tomography | Before intervention, a month after treatment | Because neuromodulation may affect metabolic activity in the nucleus accumbens, positron emission tomography (PET) will be used to measure cerebral metabolism and compare changes before and after the intervention. |
| Anxiety state | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Hamilton Anxiety Rating Scale (HAM-A), and Generalized Anxiety Disorder questionnaire(GAD-7) to measure participants' anxiety state, greater scores of these scales shows worse anxiety state. |
| Depression state | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Hamilton Depression Rating Scale (HAM-D), to measure participants' mental health state, greater scores of these scales shows worse depression state. |
| Attendtion state | Before intervention, one week, a month, three months, six months, nine months, a year, one and half year and two years after treatment | Using Adult ADHD Self-Report Scale (ASRS) to assess how well attention state of participants is. |
| Working memory capacity | Before intervention, three months, six months, a year, two year after treatment | Using N-back test to assess working memory capacity since the intervention is to nucleus accumbens and could potentially affect Neuropsychological function. |
Countries
Taiwan
Contacts
CONTACTChien Yi-Ling
Outcome results
None listed