Medications Development for the Treatment of Cannabis Related Disorders

Stress (emotional, physical, social) facilitates drug seeking behavior through the activation of the HPA axis, autonomic nervous system, and brain DA systems. Furthermore, alterations within several neuropeptide systems (CRF, Substance P, and others) also contribute to the role of stress in addiction. Central to this project is that anxiety and stress responses are modulated by substance P and its preferred target, the NK1 receptor. Therefore the aim of this pilot clinical trial is to determine the safety and efficacy of aprepitant (a neurokinin 1 (NK1) receptor antagonist). We hypothesize that the NK1 receptor antagonist, aprepitant, will be safe, tolerable and efficacious at reducing the withdrawal symptoms, cue craving, and reinforcement value for both cannabis and tobacco resulting from the cessation of either or both drugs. We will assess this hypothesis in the context of a carefully controlled human laboratory study in which subjects (N=72) will be randomized in a 3 x 2 factorial design to one of 3 behavioral conditions; a) withdrawn from both substances, b) withdrawn from tobacco only, or c) withdrawn from cannabis only, and to receive one of 2 medication dose conditions: placebo or aprepitant (160 mg/day). Medication will be administered for 5 days, followed by a cue challenge, choice procedure, and then a consequence (i.e., oral cannabis or a cigarette or money) also on day 5.

Inclusion criteria

• Must meet DSM-IV/ICD-10 criteria for cannabis abuse or dependence
• Must be non-treatment seeking individuals
• Participant does not meet DSM-IV criteria for any current (i.e., criteria met at any point in the past 30 days) dependence on a substance other than alcohol, nicotine, caffeine, or marijuana or physiological dependence on alcohol requiring medical detoxification.
• No subjects who have trouble reading the English language or visual or hearing problems that may interfere with the collection of data
• Not currently taking other medications (with the exception of oral contraceptives) that would preclude safe participation in this study
• Must test negative for pregnancy prior to inclusion
• females using birth control pills must agree to use a condom during intercourse for 1 month after participation in study because the study medication will decrease the effectiveness of the birth control pill rendering it ineffective
• Should be in general good health
• No evidence of recent use of other illicit drugs on a urine toxicity screen prior to admission

Exclusion criteria

• Major current (within last 90 days) Axis I psychopathology (e.g., major depressive disorder, bipolar disorder, schizophrenia)
• Presence of significant medical illness (e.g., diabetes, cardiovascular disease, hypertension, cancer, epilepsy, kidney disease)
• Current, repeated illicit drug use (other than marijuana)
• Subject is breastfeeding or pregnant
• Concurrent therapy with drugs known to inhibit CYP3A4 activity
• Request for drug treatment
• Current parole or probation
• Recent history of significant violent or suicide behavior
• Allergic to sesame oil