Galantamine and CBT4CBT Pilot to Prevent Relapse.

Early Phase 1

Completed

Interventions: Drug: MAT taper with galantamine
Drug: MAT taper with placebo

Brief Summary: The investigators are proposing a randomized pilot feasibility study to evaluate the effects of galantamine versus placebo on preventing relapse to opioid use following tapering from methadone or buprenorphine maintenance (Medication Assisted Treatment, or MAT) among adults with opioid use disorder, with additional behavioral therapy (web-based cognitive behavioral therapy) provided across all conditions to help individuals successfully transition from MAT to a drug-free state.

Detailed Description: This is a randomized pilot study to examine the potential use of galantamine as an adjunct to the standard buprenorphine or methadone taper in the context of behavioral support. Early abstinence from opioids is associated with high relapse rates and there is a great need to develop interventions that will prevent relapse to opioid use.

In this randomized pilot, 30 adults enrolled in the methadone or buprenorphine maintenance programs at the APT Foundation and who have sought a medically supervised, voluntary taper from these medications will be offered participation in a double-blind, placebo controlled, randomized trial of galantamine as an adjunct to standard tapering procedures at this clinic along with the combined approach utilizing concurrent behavior therapy. Primary outcomes will be: (1) successful completion of taper (achieving a methadone/buprenorphine dose of 0), (2) opioid withdrawal symptoms, and (3) opioid use, assessed by self-report and urine samples during and up to 3 months after the end of opioid taper. The investigators will also closely monitor patient comfort and safety (assessed by opioid withdrawal symptoms, adverse events, with measures of stress, sleep and pain) as well as cognitive function (assessed by the CANTAB).

Recruitment & Eligibility

Inclusion Criteria

Are male and females, between the ages of 18 and 65
Are enrolled in the APT methadone or buprenorphine program, have been stabilized for at least one year, and who voluntarily wish to taper off MAT.
For women of child-bearing age, have a negative serum pregnancy test at screening, agree to adequate contraception to prevent pregnancy, and agree to have monthly urine pregnancy tests at the clinic.
Are fluent in English and have a 6th grade or higher reading level.
Can commit to at least 12 weeks of treatment and are willing to be randomized to treatment

Exclusion Criteria

Are undergoing administrative (non-voluntary) tapering (e.g., example due to non-payment of program fees, program rule infractions).
Meet DSM-V psychiatric classifications for lifetime schizophrenia or bipolar disorder, or have a depressive or anxiety disorder with current use of a prescribed psychotropic medication that cannot be discontinued;
Current DSM-V diagnosis of drug or alcohol use disorder (other than opioids or tobacco);
Demonstrate significant medical conditions, including asthma or chronic obstructive lung disease, history or current gastrointestinal ulcer, hepatic or renal impairment and cardiac rhythm disturbances or any other medical conditions that the study physician deems contraindicated for galantamine treatment;
Use of other medications including a) drugs that slow heart rate (e.g., beta-blockers),which may increase the risk of bradycardia and AV block and b) NSAIDs; increased potential for developing ulcers/active or occult gastrointestinal bleeding;
Have a screening liver function test (AST or ALT) greater than 3 times normal;
Known allergy or adverse reaction to galantamine

Arm && Interventions

Group	Intervention	Description
MAT taper with galantamine	MAT taper with galantamine	Following initial MAT taper, participants will be given up to 16mg daily of galantamine for up to 10 weeks of the active study
MAT taper with placebo	MAT taper with placebo	Following initial MAT taper, participants will be given up to 16mg daily of placebo for up to 10 weeks of the active study

Primary Outcome Measures

Name	Time	Method
Change in Methadone/Buprenorphine Dose to 0 mg for Successful Completion of Taper	during 10 weeks of study and up to 3 months after the end of opioid taper	Number of participants who were able to taper to 0 mg from methadone or buprenorphine over 10 weeks of treatment. Data about current medication and dose in mg was collected at the start of treatment (week 1) was recorded on a weekly medical sheet. Data was then collected weekly from participant self-report and verified through the clinic database.

Secondary Outcome Measures

Name	Time	Method
Substance Use Calendar	during 10 weeks of study	number of days of opioid use, assessed by self-report
Clinical Opioid Withdrawal Scale (COWS)	Data at week 0 (baseline) and week 10 (post treatment)	opioid withdrawal score at week 0 (baseline) and at 10 weeks (post treatment). 11-item scale designed to be administered by a clinician. Rates common signs and symptoms of opiate withdrawal and can be monitored over time. The summed score for the complete scale can be used to help clinicians determine the stage or severity of opiate withdrawal and assess the level of physical dependence on opioids. Score of 5-12 = mild; 13-24=moderate; 25-36=moderately severe; more than 36=severe withdrawal (Scale of 0 to 40).