Methamphetamine use disorder (MUD) is a significant public health concern with burden to individuals, families and health systems estimated to cost over $5 billion annually in Australia. In 2016/17 there were 49,670 Australian treatment episodes for MUD, the first step of which typically involves inpatient withdrawal. Currently there are no approved medications to help manage methamphetamine withdrawal and consequently many people drop out of treatment prematurely, leaving them vulnerable to relapse. Oxytocin is a candidate medication that has the potential to increase treatment retention, reduce withdrawal syndrome severity, increase post-withdrawal treatment engagement and reduce relapse rates. The aim of this pilot study is to investigate whether intranasal oxytocin can improve withdrawal treatment outcomes in adult women with MUD. The study will examine the feasibility of intranasal oxytocin as a treatment for methamphetamine withdrawal in women. This will be explored by assessing length of stay in residential withdrawal, withdrawal symptom severity, post-discharge treatment engagement and relapse rates in a group of women who are prescribed intranasal oxytocin during their medically supervised methamphetamine withdrawal at a residential detoxification program. The safety of intranasal oxytocin will also be assessed. A secondary objective of the study is to conduct an exploratory analysis regarding participants' capacity to interact effectively with others, as well as changes in social networks and/or engagement with therapeutic services. There is an observational sub-study affiliated with this main pilot study that is optional for individuals recruited to the main pilot trial to additionally participate in. This sub-study aims to investigate how sleep quality and patterns change before, during, and after detoxification from methamphetamine in women. MUD and sleep disturbances have a complex bidirectional relationship. The use of methamphetamine is known to disrupt sleep quality and the circadian rhythm, although withdrawal from methamphetamine also induces significant sleep-wake cycle changes. There is evidence that methamphetamine disrupts functions regulated by the circadian rhythm. Furthermore, disruptions in circadian rhythms, including mutations in key genes, increases the propensity for addiction. Evaluation of how chronic methamphetamine use may disrupt rhythmicity, and vice versa, may provide invaluable information with regard to potential treatment options of methamphetamine use disorder. There has been little focus, so far, on the therapeutic potential of circadian rhythm modifiers as treatment options in the addiction space, as sleep disturbances have often been merely viewed as a consequence of substance use. Specific to the sub-study, participants will be asked to wear an actigraphy watch. The actigraphy watch device will be worn for at least 7 days prior to, 7 days during, and 7 days post methamphetamine detoxification. This is the only difference between the sub-study and the main pilot study; there are no other additional requirements or assessments involved in the actigraphy sub-study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Intranasal oxytocin, administered dose 24 international units (IU) twice daily, delivered over 7 days of a residential inpatient withdrawal admission.
Turning Point
Richmond, Victoria, Australia
Feasibility assessment
Feasibility assessment, as measured by the proportion of screen failures compared to those who received the study drug.
Time frame: Screening to Admission Day 1
Length of stay in the inpatient withdrawal unit
Medical chart review to determine number of days stayed in the inpatient withdrawal unit.
Time frame: Admission Day 1 to Admission Day 7
Methamphetamine withdrawal symptom severity
Individual average score across the participants' length of stay in the inpatient withdrawal unit on the Amphetamine Withdrawal Questionnaire (scores on this measure range from 0 to 40 with higher score indicating greater severity).
Time frame: Admission Day 1 to Admission Day 7
Methamphetamine craving
Individual average score across the participants' length of stay in the inpatient withdrawal unit on the Visual Analogue Scale for Craving (scores on this measure range from 0 to 100, with higher scores indicating greater craving).
Time frame: Admission Day 1 to Admission Day 7
Sleep dysfunction
Individual average score across the participants' length of stay in the inpatient withdrawal unit on the Insomnia Severity Index (scores on this measure range from 0 to 28, with higher scores indicating greater sleep dysfunction).
Time frame: Admission Day 1 to Admission Day 7
Mood disturbance
Individual average score across the participants' length of stay in the inpatient withdrawal unit on the Abbreviated Profile of Mood States - Revised Version (total mood disturbance scores on this measure range from 0 to 116, with higher scores indicating greater disturbance)
Time frame: Admission Day 1 to Admission Day 7
Methamphetamine relapse
Relapse is defined as a yes/no result for any methamphetamine use in the month following discharge from the withdrawal unit, as assessed using the Timeline Follow Back measure.
Time frame: 1-month post-discharge
Treatment engagement
Yes/No attendance at any form of treatment to assess treatment engagement at 1-month post-discharge.
Time frame: 1-month post-discharge
Therapeutic alliance
Working Alliance Inventory-Short Form Revised will be used to assess therapeutic alliance with nominated primary provider (scores on this measure range from 12 to 60, with higher scores indicating better therapeutic alliance).
Time frame: 1-month post-discharge
Incidence of adverse events
Number and categorisation of reported adverse events.
Time frame: Day 1 of admission to 1-month post-discharge
Perceived burden of intranasal oxytocin
Individual average score across the participants' length of stay in the inpatient withdrawal unit on the Visual Analogue Scale for Medication Utilisation Burden (scores on this measure range from 0 to 100, with higher scores indicating greater perceived burden).
Time frame: Admission Day 1 to Admission Day 7
Perceived satisfaction with intranasal oxytocin
Satisfaction with medication based on results from the Treatment Satisfaction Questionnaire (scores on this measure range from 0 to 100, with higher scores indicating greater satisfaction).
Time frame: Admission Day 3 and 7
Severity of Clinical Condition
Change in clinician-rated assessment of the participant's condition using the Clinical Global Impression - Severity Scale (scores on this measure range from 1 to 7, with higher scores indicating poorer condition).
Time frame: Baseline to 1-month post-discharge
Improvement of Clinical Condition
Clinician-rated assessment of the participant's overall clinical condition, substance use, and related problems compared to a baseline assessment, using the Clinical Global Impression - Improvement Scale (scores on this measure range from 5 to 35, with higher scores indicating a worsening of condition in comparison to baseline).
Time frame: 1-month post-discharge
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