Suvorexant for Opioid/Stimulant Co-use

This between-subjects, double-blinded, randomized controlled pilot study will recruit patients who are receiving methadone or buprenorphine treatment for OUD and are using cocaine. Participants will be randomly assigned to receive up to 30-days of Suvorexant (SUVO) or placebo. They will visit the clinic regularly to provide urine drug screens and complete questionnaires and will wear a device that can measure their sleep parameters. We expect that relative to persons who receive placebo, individuals who receive SUVO will 1) be less likely to screen positive for cocaine and/or opioids on urine drug screens, 2) will report lower drug craving, 3) will have longer total sleep time, 4) will report fewer insomnia symptoms, and 5) will report overall lower stress than persons who receive placebo. We also expect that patients will not have side effects from SUVO. These preliminary data will inform whether this FDA-approved medication may help patients stop co-using opioids and stimulants, which can be scaled up to reduce public health consequences related to co-use.

Inclusion criteria

• Ages 18-65,
• Meet criteria for stimulant use disorder, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
• Currently receiving methadone or buprenorphine treatment for OUD and considered to be stable on current dose for at least 30 days
• Willingness to engage with study protocol
• Use of birth control (as appropriate)

Exclusion criteria

• Psychiatric or medical conditions that are judged by the investigators to interfere with participation or that are contraindicated for use with SUVO
• Pregnant or breastfeeding
• Current use of benzodiazepines, tranquilizers, or other schedule IV sleep medications
• Moderate or severe substance use disorder other than opioid or stimulant use disorder
• SUVO consumption in the last 30 days
• Use of medications that are contraindicated with the study
• Past 30-day suicidal behavior
• Use of continuous positive airway pressure (CPAP) device for sleep apnea