Overview

Ketamine for OUD and Comorbid Depression (OUDCD)

Status:
Not yet recruiting
Trial end date:
2024-01-01
Target enrollment:
0
Participant gender:
All
Summary
Methadone is a first-line, evidence-based treatment for opioid use disorder (OUD). Unfortunately, retention and adherence in methadone treatment is a major challenge. OUD patients frequently present with co-morbid depression (OUDCD), a risk factor for poor OUD treatment outcomes, overdose, and suicide. The last two decades have seen an exciting and transformational development in the treatment of depression - ketamine. As a safe, rapid-acting anti-depressant deliverable within the context of methadone maintenance treatment, ketamine could feasibly change the landscape of treatment for OUD patients with comorbid depression. This proposal seeks to evaluate implementation outcomes (feasibility and patient acceptance) as well as preliminary efficacy of ketamine on methadone treatment outcomes for OUD patients (n=6) with comorbid depression and depressive symptoms presenting for methadone treatment.
Phase:
Phase 2
Accepts Healthy Volunteers?
Accepts Healthy Volunteers
Details
Lead Sponsor:
University of Maryland, Baltimore
Treatments:
Ketamine
Criteria
Inclusion Criteria

- From NHS prescreen (no contact, Study Day 0): Between the ages of 18 to 65 years old

- From NHS prescreen (no contact, Study Day 0): Daily use of illicit opioids

- From NHS prescreen (no contact, Study Day 0): Fulfillment of DSM-5/ICD-10 criteria for
moderate-to-severe opioid or heroin use disorder

- From NHS prescreen (no contact, Study Day 0): Acceptance into methadone maintenance
care for treatment of opioid or heroin use disorder

- From screening for study eligibility (Study Contact Day 1): A total of 10 or more
points on the PHQ-9

- From screening for study eligibility (Study Contact Day 1): A total of 3 points or
less on the PC-PTSD-5

- From screening for study eligibility (Study Contact Day 1): Have had no prior
sustained experience/dependence on ketamine (i.e., must answer "no" to all four
questions on the ketamine screen)

Exclusion Criteria

- From NHS prescreen (no contact, Study Day 0): Patients transferring from another
program of opioid agonist treatment

- From NHS prescreen (no contact, Study Day 0): Electrocardiogram (ECG) findings of
tachycardia, prior myocardial infarction, myocardial ischemia, or aberrant conduction

- From NHS prescreen (no contact, Study Day 0): Baseline urine drug test positive for
ketamine, benzodiazepine, psychostimulants (cocaine, amphetamine, methamphetamine, or
methylene-dioxymethamphetamine [MDMA]), phencyclidine (PCP), methadone, or
buprenorphine

- From NHS prescreen (no contact, Study Day 0): Self-report of recent prescribed or
illicit benzodiazepine use ("Xannies", or "bars")

- From NHS prescreen (no contact, Study Day 0): Urine screen positive for pregnancy

- From NHS prescreen (no contact, Study Day 0): Stage 2 hypertension, defined by a
systolic blood pressure (SBP) > 140 mmHg or a diastolic blood pressure (DBP) > 90 mmHg

- From NHS prescreen (no contact, Study Day 0): Clinically significant abnormal
laboratory values, physical exam findings or self-reported medical conditions for
which a transient increase in blood pressure could be significantly detrimental (e.g.,
cardiovascular disease), as determined by the evaluating intake physician

- From NHS prescreen (no contact, Study Day 0): Any clinically significant abnormal
findings from intake health and physical examination

- From NHS prescreen (no contact, Study Day 0): Any indication of serious mental illness
or psychiatric disorder from the attending's evaluation notes

- From Liver Function Screen (Study Contact Day 2): Baseline alkaline phosphatase > 2.5
times the upper limit of normal

- From Liver Function Screen (Study Contact Day 2): Baseline aspartate aminotransferase
> 3 times the upper limit of normal

- From Psychiatric Evaluation (Study Contact Day 2) Current or previous recreational use
of ketamine or PCP

- From Psychiatric Evaluation (Study Contact Day 2): Subjects who meet DSM-5 criteria
for current bipolar disorder

- From Psychiatric Evaluation (Study Contact Day 2): Past or current presence of
psychotic symptoms, or diagnosis of a lifetime psychotic disorder including
schizophrenia or schizoaffective disorder

- Subjects who meet DSM-5 criteria for current or history of psychotic spectrum
disorders