Dronabinol for Pain Management in Opioid Users

(THC Trial)

Overseen By Joao P. De Aquino, M.D.

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: Yale University

Must be taking: Methadone, Buprenorphine

Must not be taking: Cannabis, Opioids

Disqualifiers: Psychotic disorders, Neurological illness, others

Compensation: Varies

Number of Visits: 5

Duration: 3 sessions, each separated by at least 72 hours

36 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not require you to stop taking your current medications, but you must be on a stable dose of any psychoactive drugs that affect pain threshold or tolerance. If possible, take your morning dose after the study visit.

What data supports the effectiveness of the drug dronabinol for pain management in opioid users?

Research shows that dronabinol, a synthetic form of THC, can help reduce pain intensity and increase satisfaction in patients using opioids for chronic pain. In a study, patients who took dronabinol reported less pain and more satisfaction compared to those who took a placebo, indicating its potential as an effective add-on treatment for pain management. ^{1 2 3 4 5}

Is dronabinol safe for use in humans?

Dronabinol is generally considered safe for use in humans, with common side effects including dry mouth, dizziness, and headache, which are usually mild to moderate and temporary. Long-term use has shown a decrease in adverse reactions, and there is no significant evidence of drug abuse or dependency. ^{4 6 7 8 9}

How does the drug dronabinol differ from other pain management options for opioid users?

Dronabinol is unique because it is a synthetic form of THC (tetrahydrocannabinol), the active ingredient in cannabis, and is used as an add-on treatment to enhance pain relief in patients already taking opioids. Unlike traditional pain medications, dronabinol works by interacting with the body's cannabinoid receptors, potentially offering additional pain relief and increased patient satisfaction without the serious side effects often associated with opioids. ^{1 4 10 11 12}

What is the purpose of this trial?

Twenty male and female (ages 18-70) participants with OUD currently receiving methadone or buprenorphine will be enrolled. Prior to their daily methadone or buprenorphine dose and thus at trough plasma levels of opioid, participants will receive dronabinol (2.5 mg, 5mg) or placebo. Subsequently, all participants will undergo laboratory testing of opioid-related outcomes. Pain sensitivity will be measured using a technique called the (QST) quantitative sensory testing, which involves the administering heat or cold stimulation. A Short-Form McGill Pain Questionnaire (SF-MPQ) and a pain Visual Analog Scale (VAS). Attentional bias will be measured using a visual probe task. Negative affect will be measured using the Positive and Negative Affect Schedule (PANAS). Cognitive performance will be measured by a comprehensive cognitive battery. The order of study medication administration will be counterbalanced order to minimize carryover effects. On the initial screening day and at the end of medication treatment, blood will be drawn to determine serum cytokine levels. One week after the last study medication dose, a follow-up session will be conducted during which participants will undergo urine toxicology testing and a safety evaluation before final discharge from the study.

Research Team

Joao P. De Aquino, M.D.

Principal Investigator

VA healthcare System West Haven CT

Eligibility Criteria

This trial is for men and women aged 18-70 with opioid use disorder (OUD) who are on stable methadone or buprenorphine treatment. Participants must not be pregnant, should use birth control, have recent cannabis exposure without a cannabis use disorder, and no major medical issues or other substance use disorders.

Inclusion Criteria

Cannabis use, with recent cannabis exposure confirmed by urine toxicology

I am currently receiving methadone or buprenorphine for opioid use disorder.

I can understand and sign the consent form in English.

Exclusion Criteria

My doctor says I'm taking medication that could affect how I feel pain.

Liver function tests (ALT or AST) greater than 3x normal

Serious medical or neurological illness or treatment for a medical disorder that could interfere with study participation as determined by principal investigator

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 day

1 visit (in-person)

Treatment

Participants receive dronabinol (2.5 mg, 5 mg) or placebo prior to their daily methadone or buprenorphine dose, followed by laboratory testing of opioid-related outcomes.

3 sessions, each separated by at least 72 hours

3 visits (in-person)

Follow-up

Participants undergo urine toxicology testing and a safety evaluation one week after the last study medication dose.

1 week

1 visit (in-person)

Treatment Details

Interventions

• Dronabinol
• Placebo

Trial Overview The study tests the effects of Dronabinol versus placebo in patients maintained on opioids. It involves taking the study medication before their regular dose of methadone or buprenorphine and then undergoing pain sensitivity tests, attentional bias tasks, mood assessments, cognitive performance evaluations, and blood tests to measure cytokines.

Participant Groups

Group I: Dronabinol 5mg Active Control 1 Intervention

Dronabinol 5mg

Group II: Dronabinol 2.5mg Active Control 1 Intervention

Dronabinol 2.5mg

Group III: Placebo Placebo Group 1 Intervention

Placebo

Who Is Running the Clinical Trial?

Yale University

Lead Sponsor

Trials

1,963

Recruited

3,046,000+

US Department of Veterans Affairs

Collaborator

Trials

881

Recruited

502,000+

Findings from Research

In a study of 674 patients with severe neuropathic pain, the oromucosal spray nabiximols (NBX) showed a 55.4% improvement in pain relief compared to a 40.5% improvement with oral dronabinol (DRO), indicating that NBX is more effective for this condition.

NBX also had a better safety profile, with significantly lower rates of treatment-related adverse events (21.1% for NBX vs. 35% for DRO) and fewer discontinuations due to side effects (5.9% for NBX vs. 14.8% for DRO), highlighting its tolerability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of the Effectiveness and Tolerability of Nabiximols (THC:CBD) Oromucosal Spray versus Oral Dronabinol (THC) as Add-on Treatment for Severe Neuropathic Pain in Real-World Clinical Practice: Retrospective Analysis of the German Pain e-Registry. Ueberall, MA., Essner, U., Vila Silván, C., et al.[2022]

In a study of 1,145 patients with refractory chronic pain, adding Δ9-tetrahydrocannabinol (dronabinol) to their treatment significantly reduced average pain intensity from 46.3 to 26.8 mm on a visual analog scale over 12 weeks.

Dronabinol was well tolerated, with 46.8% of patients reporting mild drug-related adverse events, and many patients were able to reduce or stop other pain medications during the treatment period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness and Tolerability of Dronabinol Use in Patients with Chronic Pain: A Retrospective Analysis of 12-Week Open-Label Real-World Data Provided by the German Pain e-Registry. Ueberall, MA., Horlemann, J., Schuermann, N., et al.[2022]

In a 12-week trial involving 156 cannabis-dependent adults, dronabinol (a synthetic form of THC) did not significantly increase the rate of abstinence compared to placebo, with both groups showing similar reductions in marijuana use.

However, dronabinol improved treatment retention (77% vs. 61% for placebo) and resulted in fewer withdrawal symptoms, suggesting it may be a well-tolerated option for supporting individuals in cannabis dependence treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. Levin, FR., Mariani, JJ., Brooks, DJ., et al.[2022]

In a study involving 30 patients on opioids for chronic pain, dronabinol (synthetic THC) was found to significantly reduce pain intensity and increase treatment satisfaction compared to a placebo, indicating its potential as an effective adjuvant treatment.

The extended Phase II trial showed that titrated doses of dronabinol provided significant pain relief and reduced pain bothersomeness, although side effects were dose-related, suggesting careful monitoring is needed when using this medication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. Narang, S., Gibson, D., Wasan, AD., et al.[2013]

In a Phase II study with 29 healthy adults, the combination of hydromorphone and a low dose of dronabinol (2.5 mg) modestly improved pain relief, while higher doses of dronabinol (5 mg and 10 mg) increased the risk of abuse and adverse effects.

The study found that the effects of the drug combinations varied based on individual opioid sensitivity, suggesting that some people may respond differently to these treatments, which highlights the need for further research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Within-subject, double-blinded, randomized, and placebo-controlled evaluation of the combined effects of the cannabinoid dronabinol and the opioid hydromorphone in a human laboratory pain model. Dunn, KE., Bergeria, CL., Huhn, AS., et al.[2023]

In a clinical trial involving 240 multiple sclerosis patients over 16 weeks, dronabinol reduced neuropathic pain intensity by 1.92 points, similar to the 1.81 points reduction seen with placebo, indicating no significant difference in pain relief between the two treatments.

Dronabinol was found to be a safe long-term treatment option, with a higher rate of adverse reactions compared to placebo (50% vs. 25.9%), but these reactions decreased to 26% during extended use, and there were no significant signs of drug abuse or dependency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients. Schimrigk, S., Marziniak, M., Neubauer, C., et al.[2018]

Nabilone (Cesamet) has not been approved by the FDA for marketing, contrary to previous claims, while dronabinol (Marinol) is the synthetic cannabinoid that has received FDA approval.

Corrections were made regarding the authors' affiliation and inaccuracies in references from the original article, ensuring the integrity of the published information.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erratum. [2010]

In a study of 2,112 adult patients with chronic pain, 92.5% reported improvement in their primary symptoms after using cannabis-based oral formulations, indicating high efficacy as an adjuvant treatment.

The majority of patients experienced minimal side effects, with 71.7% reporting none, and the most common mild side effects, such as somnolence and dizziness, tended to decrease over time, suggesting that these formulations are safe for chronic pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in Colombia. Moreno-Sanz, G., Madiedo, A., Hernandez, P., et al.[2022]

In a meta-analysis of 16 trials, nabilone was associated with significantly higher rates of drowsiness, dizziness, and dry mouth compared to placebo, indicating a notable risk of these side effects.

Dronabinol also showed increased occurrences of dry mouth, dizziness, and headache compared to placebo, but the overall severity of adverse events was generally mild-to-moderate, suggesting that the benefits may outweigh the risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Safety of Dronabinol and Nabilone: A Systematic Review and Meta-Analysis of Clinical Trials. Bajtel, Á., Kiss, T., Tóth, B., et al.[2022]

In a study involving 24 multiple sclerosis (MS) patients, dronabinol (delta-9-tetrahydrocannabinol) significantly reduced spontaneous pain intensity compared to a placebo, indicating its potential analgesic effect.

Although the reduction in pain was modest, the findings suggest that dronabinol could be a valuable option for managing central pain in MS patients, a condition that is often challenging to treat.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Effect of the synthetic cannabinoid dronabinol on central pain in patients with multiple sclerosis--secondary publication]. Svendsen, KB., Jensen, TS., Bach, FW.[2013]

A systematic review of 18 randomized controlled trials found that cannabinoids, including smoked cannabis and extracts, significantly relieve chronic non-cancer pain, particularly in conditions like neuropathic pain, fibromyalgia, and rheumatoid arthritis.

Cannabinoids were generally safe, with no serious adverse effects reported, and most side effects were mild to moderate, indicating they could be a viable option for patients seeking pain relief.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Lynch, ME., Campbell, F.[2022]

In a study of 19 patients with refractory neuropathic pain, 75% of those who continued dronabinol treatment for over 3 months reported an improvement in their health, suggesting its potential efficacy as a pain management option.

However, 74% of patients experienced at least one adverse event, with six needing to discontinue treatment, highlighting the importance of careful monitoring and evaluation of the drug's safety and benefit-risk balance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Use of dronabinol in the treatment of resistant neuropathic pain: Feedback from patients followed in a multidisciplinary pain center]. Richet, E., Ferret, L., Gaboriau, L., et al.[2023]

References

1. New Zealand pubmed.ncbi.nlm.nih.gov

Comparison of the Effectiveness and Tolerability of Nabiximols (THC:CBD) Oromucosal Spray versus Oral Dronabinol (THC) as Add-on Treatment for Severe Neuropathic Pain in Real-World Clinical Practice: Retrospective Analysis of the German Pain e-Registry. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Effectiveness and Tolerability of Dronabinol Use in Patients with Chronic Pain: A Retrospective Analysis of 12-Week Open-Label Real-World Data Provided by the German Pain e-Registry. [2022]

3. Ireland pubmed.ncbi.nlm.nih.gov

Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. [2013]

5. England pubmed.ncbi.nlm.nih.gov

Within-subject, double-blinded, randomized, and placebo-controlled evaluation of the combined effects of the cannabinoid dronabinol and the opioid hydromorphone in a human laboratory pain model. [2023]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Erratum. [2010]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Sex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in Colombia. [2022]

9. Switzerland pubmed.ncbi.nlm.nih.gov

The Safety of Dronabinol and Nabilone: A Systematic Review and Meta-Analysis of Clinical Trials. [2022]

10. Denmark pubmed.ncbi.nlm.nih.gov

[Effect of the synthetic cannabinoid dronabinol on central pain in patients with multiple sclerosis--secondary publication]. [2013]

11. England pubmed.ncbi.nlm.nih.gov

Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. [2022]

12. France pubmed.ncbi.nlm.nih.gov

[Use of dronabinol in the treatment of resistant neuropathic pain: Feedback from patients followed in a multidisciplinary pain center]. [2023]