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Trial registered on ANZCTR
Registration number
ACTRN12608000024347
Ethics application status
Approved
Date submitted
27/02/2007
Date registered
17/01/2008
Date last updated
17/01/2008
Type of registration
Retrospectively registered
Titles & IDs
Public title
The acceptability, safety and tolerability of combined methadone-naloxone in methadone maintained individuals aged between 18 - 65
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Scientific title
To investigate the pharmacokinetics and pharmacodynamics of orally administered methadone-naloxone in a 50:1 ratio in partcipants who are opioid dependant and methadone maintained individuals aged between 18- 65
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Participants are opiod dependant and methadone maintained individuals aged between 18-65
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Condition category
Condition code
Mental Health
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Addiction
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
A cross over design is used for the trial, therefore both the subjects and controls will recieve 14 days of their usual daily oral methadone dose, and 14 days of the daily oral study medication: Methadone-Naloxone in a ratio of 50:1 (0.1mg/ml). Participants will be randomly allocated to either recieve 14 days of their usual methadone dose first or the study medication; methadone-naloxone first.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
Methadone
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Control group
Active
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Outcomes
Primary outcome [1]
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The primary outcome measure is severity of opioid withdrawal symptoms.
Measured: Subjective opioid withdrawal scale (SOWS)
Measure: Objective opioid withdrawal scale (OOWS)
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Assessment method [1]
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Timepoint [1]
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Research assessments will occur on day 0 and 2, and then twice weekly for the duration of the study prior to medication administration
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Secondary outcome [1]
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Craving
measured: by mean difference in visual analogue scale scores
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Assessment method [1]
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Timepoint [1]
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Twice weekly for the duration of the study prior to medication administration
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Secondary outcome [2]
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Mood
Measured: by mean difference in Profile Of Mood States (POMS) score
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Assessment method [2]
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Timepoint [2]
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Day 0, 13, 27
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Secondary outcome [3]
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Opioid Use:
Measured: by mean difference in days of self reported opioid use
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Assessment method [3]
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Timepoint [3]
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Research assessments will occur on day 0 and 2, and then twice weekly for the duration of the study
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Secondary outcome [4]
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Intoxication
Measured: by mean difference in Morphine-Benzedrine Group Scale (MBG)
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Assessment method [4]
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Timepoint [4]
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Research assessments will occur on day 0 and 2, and then twice weekly for the duration of the study
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Secondary outcome [5]
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Absorption
Measured: by mean difference in peak and trough ng/ml of racemic methadone
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Assessment method [5]
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Timepoint [5]
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Research assessments will occur on day 0 and 2, and then twice weekly for the duration of the study
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Secondary outcome [6]
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Sleep quality
Measured: by mean difference in Pittsburgh Sleep Quality Index score
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Assessment method [6]
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Timepoint [6]
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0, 13, 27
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Secondary outcome [7]
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Constipation
Measured: by mean difference in number of bowel movements
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Assessment method [7]
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Timepoint [7]
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Research assessments will occur on day 0 and 2, and then twice weekly for the duration of the study
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Eligibility
Key inclusion criteria
• Opioid dependent clients;
• In treatment for greater than 2months
• Stabilised on current dose for greater than 4 weeks
• Willing to remain on current dose for duration of the trial
• Venous access
• Able to provide voluntary informed consent
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
• Considered unwilling, unable or unlikely to comply with the study protocol
• Lactating and pregnant women
• Active psychotic illness
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
centralised by fax
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation. The sequence will be generated by drawing slips of paper from an envelope
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
The subjects, researcher, therapist and data analyst are blind in the study.
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Phase
Phase 2 / Phase 3
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Type of endpoint/s
Pharmacokinetics / pharmacodynamics
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/02/2007
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
10
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment postcode(s) [1]
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2010
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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Biomed Pty Ltd
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Address [1]
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Auckland
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Country [1]
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New Zealand
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Primary sponsor type
Hospital
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Name
Langton Centre
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Address
Surry Hills
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Nil
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Address [1]
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Country [1]
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Secondary sponsor category [2]
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None
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Name [2]
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Address [2]
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Country [2]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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The Langton Centre
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Ethics committee address [1]
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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28/06/2006
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Ethics approval number [1]
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05/270
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Summary
Brief summary
The acceptability, safety and tolerability of combined methadone-naloxone: Is oral methadone-naloxone indistinguishable from mono-methadone? Does injection of methadone-naloxone precipitate withdrawal? Robert Graham, Suzanne Rizzo, Kristy Korompay, James Bell Introduction: Daily methadone and buprenorphine dosing is associated with high costs and rigidity. Maintenance models that predominantly employ dispensed medication (i.e. unsupervised dosing) may be more cost effective and preferable to clients and health departments. However, takeaway doses are often used in unintended ways including being injected by the client or other persons. The addition of naloxone to methadone has the potential to discourage the diversion of takeaway doses. Aims: To ascertain the safety and tolerability of oral methadone-naloxone in a 50:1 ratio by investigating aspects of its pharmacokinetic and pharmacodynamic properties, and in a second study, to investigate the effectiveness of the combination in precipitating withdrawal when administered intramuscularly. Methods: A randomised phase II study, double-blind, crossover design was used for the oral study. 10 subjects attending methadone clinics who were on a stable dose of least 20mg methadone volunteered and were given either methadone-naloxone or methadone alone for 14 days and then switched to the alternative for a total of 28 day study period. The second study was a Phase II, single group before-after design. Five of the subjects from the first study were administered IM saline solution followed by IM 10mg methadone/0.2mg naloxone prior to their scheduled methadone dose and were observed for 60 minutes. In the absence of objective signs of withdrawal at 30 minutes, participants were administered an additional 20mg methadone/0.4mg naloxone intramuscularly and observed for a further 60 minutes. Findings: Oral methadone naloxone in a 50:1 ratio appeared to be well tolerated. The same preparation reliably precipitated opioid withdrawal upon injection among methadone maintained individuals.
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Trial website
N/A
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Trial related presentations / publications
Australasian Professional Society for Alcohol and Drugs (APSAD) Conference, November 2007 Auckland New Zealand
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Anni Ryan
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Address
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The Langton Centre
591 South Dowling St
Surry Hill 2010
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Country
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Australia
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Phone
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9332 8777
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Anni Ryan
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Address
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The Langton Centre
591 South Dowling St
Surry Hill 2010
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Country
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Australia
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Phone
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9332 8777
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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