Cannabidiol for Reducing Cigarette Use
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. |
ClinicalTrials.gov Identifier: NCT06218056 |
Recruitment Status :
Not yet recruiting
First Posted : January 23, 2024
Last Update Posted : May 8, 2024
|
Tracking Information | |||||||||
---|---|---|---|---|---|---|---|---|---|
First Submitted Date ICMJE | December 27, 2023 | ||||||||
First Posted Date ICMJE | January 23, 2024 | ||||||||
Last Update Posted Date | May 8, 2024 | ||||||||
Estimated Study Start Date ICMJE | July 15, 2024 | ||||||||
Estimated Primary Completion Date | December 31, 2026 (Final data collection date for primary outcome measure) | ||||||||
Current Primary Outcome Measures ICMJE |
|
||||||||
Original Primary Outcome Measures ICMJE | Same as current | ||||||||
Change History | |||||||||
Current Secondary Outcome Measures ICMJE |
|
||||||||
Original Secondary Outcome Measures ICMJE | Same as current | ||||||||
Current Other Pre-specified Outcome Measures |
|
||||||||
Original Other Pre-specified Outcome Measures | Same as current | ||||||||
Descriptive Information | |||||||||
Brief Title ICMJE | Cannabidiol for Reducing Cigarette Use | ||||||||
Official Title ICMJE | Evaluating the Efficacy of Cannabidiol for Reducing Cigarette Use | ||||||||
Brief Summary | The goal of this research is to evaluate the efficacy of cannabidiol (CBD) in reducing cigarette smoking. Although there are safe and effective treatments for smoking cessation, not everyone who attempts smoking cessation is successful, even with these treatments. Relapse rates are high, leaving a need for new approaches. Despite justification to evaluate CBD for this indication, human research on the topic is scant. Larger, more extended studies are warranted and essential. We will recruit participants from CRI-Help, Inc., a substance abuse treatment program in North Hollywood, where residents who indicate the desire to stop smoking are prohibited from using other cannabis products which would affect recruitment. The aims of this study are:
Participants who meet eligibility criteria will take part in a 56-day treatment phase during which they receive the study medication under supervision (CBD or placebo twice daily) and complete questionnaires on side effects, withdrawal, craving and mood symptoms. Blood, breath, and urine tests will also be performed throughout the study. Participants who complete the treatment will also be assessed at 1-month and 3-month follow up visits. |
||||||||
Detailed Description | This will be a randomized, double-blind, placebo-controlled, comparison study of Nantheia ATL5 (CBD) vs. placebo in participants who have Tobacco Use Disorder and indicate desire for smoking cessation. We will instruct participants and provide support for them using messages from the National Cancer Institute's (NCI) Smokefree.gov website. Smokefree.gov offers free text messaging programs that give encouragement, advice, and tips for becoming smoke-free and being healthier. The NCI website also helps people who smoke create a personalized quit plan that makes it easier to stay on track, get through hard times, and quit for good. Creating this plan will be part of baseline procedures. Recruitment and intervention will take place at CRI-Help, Inc., a community-based, private non-profit behavioral healthcare organization located in Southern California with several agency sites, including the one in north Hollywood, where this protocol will be conducted. CRI-Help's treatment team is composed of licensed and certified treatment professionals, including doctors, nurses, psychologists, therapists, and certified drug counselors. Additionally, CRI-Help is licensed and certified by the State of California, and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). Clients take part in individual and group counseling, integrated health and counseling, and vocational assistance. Additional services include recreational and fitness activities, family education, neurofeedback, trauma groups, grief counseling, treatment for co-occurring mental health conditions, and daily 12-Step meetings. The rehabilitation treatment programs are designed to integrate 12-Step philosophy into daily life. We will enroll up to 120 participants who have Tobacco Use Disorder, express a desire for smoking cessation, and are in residential treatment for substance use disorders. A staff member of Cri-Help, Inc. will identify participants who meet the general recruitment criteria for the study, and will provide them with a flyer describing the study and inviting them to contact University of California Los Angeles (UCLA) staff at Cri-Help if they are interested in participating. Interested potential participants will meet with research staff for a description of the study in a private room, where informed consent will be taken remotely by Dr. Larissa Mooney. Participants will then complete questionnaires and will travel to UCLA for medical evaluation (blood and urine tests, ECG, history and physical) at the Clinical and Translational Research Center (CTRC). Dr. Mooney/CTRC Nurse Practitioners will review lab results (and History & Physical report) and will advise Dr. London (Principal Investigator) on medical aspects in determining eligibility. TREATMENT PHASE The treatment phase of the study will be performed in two cohorts of participants. The first cohort (60 participants) will receive CBD at a dose of 400 mg/day or matching placebo (n = 30/group). If efficacy in reducing smoking is indicated at 400 mg/day (group difference in change in cigarette use, either statistically significant at p < 0.05 or a trend at p < or = 0.1), the second cohort (60 participants) will be tested in a replication--400 mg/day vs. placebo (n = 30/group). However, if there is no indication of efficacy at 400 mg/day, the second cohort will be tested in a trial of 800 mg/day CBD vs. placebo. Note: Blood will be drawn for clinical lab tests to determine safety of participation (25 ml each time), and also for assay of CBD, anandamide, 2 arachidonoylglycerol (2-AG) and cotinine (2 ml each time). Blood will be drawn on 6 days: at screening (Days -7 to 0: 25 ml for screening), at baseline (Day 0: 2 ml for assay of cotinine and cannabinoids), and during the intervention (Days 7, 14, 28, and 56: 27 ml each time for safety labs as well as cotinine + cannabinoids). The total volume of blood taken will be up to (135 ml over the course of the entire study). RANDOMIZATION TO TREATMENT We will randomize by sex and age (18-30, 31 years or older) to ensure equal representation across the groups. We will use an intention-to-treat analysis, including data from all participants who are randomized. SAFETY ASSESSMENTS AND MONITORING The following tests and procedures will be performed for safety monitoring throughout the study:
DOSING AND TESTING SCHEDULE The investigational product will be Nantheia-ATL5, which is CBD, extracted from hemp, at a 10% strength (softgel capsules with 100 mg/ml of CBD per capsule) or matching placebo. The formulation to be used in for this trial contains CBD and the following excipients:
ATL5 Softgel Capsules will be manufactured by Baxco Pharmaceutical Inc., (California, USA) under current good manufacturing practice (cGMP) conditions. They will be administered orally as indicated below. DOSAGE AND DURATION OF TREATMENT The planned study will evaluate Nantheia ATL5 (400 and 800 mg per day; 200 mg and 400 mg twice a day (BID), respectively). The treatment period with CBD or placebo will be 56 days. Participants will be in the study for up to 24 weeks (8 weeks intervention + 4-week and 12-week follow-up) 16 weeks. DOSE JUSTIFICATION CBD will be tested at 400 and 800 mg daily. These doses were selected on the basis of safety data from human studies. In a previous clinical trial, doses of CBD as high as 50 mg/kg (i.e., 350 mg for a 70-kg participant) were well tolerated. Doses between 300 and 1500 mg have been used in humans without toxicity or serious adverse events. Forty-two subjects received 200 mg of CBD four times daily (total 800 mg per day) for 2 to 4 weeks to treat schizophrenia without notable side effects. Additionally, a review of 132 reports, which included animal and human studies, concluded that CBD was well-tolerated in humans, at doses of up to 1500 mg/day for 4 weeks to treat schizophrenia without notable side effects; and a review of 132 reports, including animal and human studies, concluded that CBD was well-tolerated in humans, at doses of up to 1500 mg/day. MEASURES COLLECTED: Following screening, a baseline assessment will include sampling blood for assay of cotinine as an indication of heaviness of smoking, and self-reports of smoking-related behaviors on the following smoking-related questionnaires:
These symptoms are scored on an ordinal scale [0 (not present) to 3 (severe)].
Participants will self-report cigarette use and adverse events at each visit using structured questionnaires. On Days 7, 14, 28 and 56, we will take vital signs, and draw blood for clinical laboratory tests (to assure safety) and to assay cotinine as an index of heaviness of smoking and for assay of cannabinoids (CBD, anandamide, 2-AG); participants will complete the Anti-depressant Side Effect Checklist (ASEC), FTND, MNWS, GAD-7, PHQ-9. At 1- and 3-month follow up, we will take the same self-report and behavioral measures, and vital signs (no blood assays). ADHERENCE TO MEDICATION Participants will report to the nursing station in the morning and evening according to the CRI-Help medication schedule. They will receive the investigational product (CBD or placebo) and will take it under the direct observation of a Residential Technician (Registered Alcohol and Drug Technician, RADT, certified by the California Consortium of Addiction Programs and Professionals). Any unused or missed medication will be collected weekly and will be returned to the manufacturer. PARTICIPANT RETENTION The index of retention will be number of days a participant remains in the study. ASSAYS OF CBD, ANANDAMIDE, 2-AG AND COTININE We will use liquid chromatography/mass spectrometry-multiple reaction monitoring (LC/MS-MRM) assays that we have developed for these compounds in plasma. Internal standards are added after sample extracts are processed and injected onto a multi-mode column with reversed phase, cation and anion exchange capabilities. After equilibration and elution, column effluents are passed through an electrospray ion source attached to a triple quadrupole mass spectrometer, and nuclear magnetic resonance (NMR) signals are recorded. Peak areas, measured with manufacturer-supplied software, are checked and adjusted if needed. Each compound is quantified by interpolation from response curves from data obtained using internal standards and increasing concentrations of unlabeled authentic analytes. |
||||||||
Study Type ICMJE | Interventional | ||||||||
Study Phase ICMJE | Phase 2 | ||||||||
Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
||||||||
Condition ICMJE |
|
||||||||
Intervention ICMJE |
|
||||||||
Study Arms ICMJE |
|
||||||||
Publications * | Not Provided | ||||||||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
|||||||||
Recruitment Information | |||||||||
Recruitment Status ICMJE | Not yet recruiting | ||||||||
Estimated Enrollment ICMJE |
120 | ||||||||
Original Estimated Enrollment ICMJE | Same as current | ||||||||
Estimated Study Completion Date ICMJE | December 31, 2026 | ||||||||
Estimated Primary Completion Date | December 31, 2026 (Final data collection date for primary outcome measure) | ||||||||
Eligibility Criteria ICMJE | Inclusion Criteria: We will study equal numbers of males and females, 18 - 65 years of age, who smoke cigarettes and are in residential treatment for substance use disorders. Recruitment will be from participants at Cri-Help Treatment Center in North Hollywood, CA. Participants will not be recruited from the general population for this study because common use of cannabis in the greater Los Angeles area would confound measurements of CBD, interfering with evaluation of the association of plasma level from treatment with efficacy. This problem is avoided in studying participants who are receiving treatment at a facility where cannabis use is not allowed. We will include all racial and ethnic groups. Based on the population of the surrounding communities in the Los Angeles region, we anticipate a racial and ethnic makeup of approximately 26% White, 9% Black/African American, 49% Hispanic/Latino, 14% Asian American, and 2% multi-racial/unknown. These percentages align with our recent studies. Smoking cigarettes and at least moderate nicotine dependence, as indicated by a score of at least 4 on the Fagerström Test for Nicotine Dependence (Heatherton et al., 1991) are inclusion criteria. Although vaping is popular and a high proportion of participants who vape also report cigarette smoking (58%) (Smith et al., 2022), we will exclude participants who vape nicotine. Vaping is not allowed at Cri-Help, Inc. - Exclusion Criteria:
|
||||||||
Sex/Gender ICMJE |
|
||||||||
Ages ICMJE | 18 Years to 65 Years (Adult, Older Adult) | ||||||||
Accepts Healthy Volunteers ICMJE | No | ||||||||
Contacts ICMJE |
|
||||||||
Listed Location Countries ICMJE | United States | ||||||||
Removed Location Countries | |||||||||
Administrative Information | |||||||||
NCT Number ICMJE | NCT06218056 | ||||||||
Other Study ID Numbers ICMJE | 23-001793 | ||||||||
Has Data Monitoring Committee | Yes | ||||||||
U.S. FDA-regulated Product |
|
||||||||
IPD Sharing Statement ICMJE |
|
||||||||
Current Responsible Party | Edythe London, University of California, Los Angeles | ||||||||
Original Responsible Party | Same as current | ||||||||
Current Study Sponsor ICMJE | University of California, Los Angeles | ||||||||
Original Study Sponsor ICMJE | Same as current | ||||||||
Collaborators ICMJE | Not Provided | ||||||||
Investigators ICMJE |
|
||||||||
PRS Account | University of California, Los Angeles | ||||||||
Verification Date | May 2024 | ||||||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |