Effect of Opioid Infusion Rate on Abuse Liability Potential of Intravenous Hydromorphone for Cancer Pain

Last updated: April 3, 2025
Sponsor: M.D. Anderson Cancer Center
Overall Status: Active - Not Recruiting

Phase

4

Condition

Neoplasms

Chronic Pain

Acute Pain

Treatment

Placebo Administration

Hydromorphone

Questionnaire Administration

Clinical Study ID

NCT04296305
2019-0678
2019-0678
NCI-2020-00732
  • Ages > 18
  • All Genders

Study Summary

In cancer inpatient settings, intravenous (IV) opioids are frequently administered in a bolus fashion in order to obtain immediate pain relief. However, data on the abuse liability (AL) potential of IV opioids in cancer patients is limited. No study has investigated the effect of different IV infusion rates on AL potential in patients receiving parenteral opioids for pain control. This phase IV trial will determine the AL potential of a slow IV hydromorphone (SH) bolus administration compared with a fast IV hydromorphone (FH) bolus administration among inpatients with cancer pain. It will also determine the analgesic efficacy and adverse effect profiles of SH versus FH bolus infusions, and explore the relationship between pharmacogenetics and pharmacokinetic (PK) and pharmacodynamic (PD) effects of hydromorphone. This study will eventually help develop evidence-based guidelines regarding the best style of IV opioid administration which will achieve the most optimal pain control while avoiding the undesirable complication of nonmedical opioid use

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Hospitalized patients with diagnosis of cancer

  • History of moderate to severe cancer related pain, defined as Numerical Rating Scale (NRS) pain score >= 4/10

  • Receiving no or only on as needed doses of opioids

  • Normal cognitive status, defined as a normal state of arousal and an absence ofobvious clinical findings of confusion, memory deficits or concentration deficits ora Memorial Delirium Assessment Scale (MDAS) score of < 13

  • Ability to read and communicate in the English language

  • Written informed consent from patient

Exclusion

Exclusion Criteria:

  • Contraindications to opioids, or history of opioid allergy

  • Inability to secure IV access

  • Known history or evidence of nonmedical opioid use (e.g. abuse, misuse, addiction)

  • Oxygen saturations < 92% or respiratory rate < 12 breaths/minute on initialassessment

  • Resting heart rate > 120 on initial assessment

  • Systolic blood pressure > 180 < 90 mmHg or diastolic pressure > 100 < 60 mmHg oninitial assessment

  • Patients receiving scheduled chronic opioid therapy (defined as the treatment ofpain with opioids for >= 7 days)

  • Moderate to severe renal insufficiency (defined as glomerular filtration rate [GFR] < 60 ml/min/1.73 m^2)

  • Hepatic insufficiency (defined as alanine aminotransferase [ALT] or aspartateaminotransferase [AST] > 3 times the highest normal value, or total bilirubin > 1.5times the highest normal value)

Study Design

Total Participants: 84
Treatment Group(s): 3
Primary Treatment: Placebo Administration
Phase: 4
Study Start date:
September 10, 2020
Estimated Completion Date:
December 31, 2025

Study Description

PRIMARY OBJECTIVE:

I. To compare the abuse liability potential of slow intravenous (IV) hydromorphone bolus infusion rate with fast IV hydromorphone bolus infusion rate among inpatients with breakthrough cancer pain (from the "DRUG LIKING" scale of the Drug Effects Questionnaire [DEQ] questionnaire).

SECONDARY OBJECTIVES:

I. To compare the abuse liability potentials of slow IV hydromorphone bolus with fast IV hydromorphone bolus among inpatients with breakthrough cancer pain (from the other scales of the DEQ questionnaire).

II. To compare the analgesic efficacy of slow IV hydromorphone bolus with fast IV hydromorphone bolus among inpatients with breakthrough cancer pain.

III. To compare the adverse effects of slow IV hydromorphone bolus with fast IV hydromorphone bolus among inpatients with breakthrough cancer pain.

IV. To explore the abuse liability potential of slow IV hydromorphone bolus with fast IV hydromorphone bolus among the sub group of patients who achieved successful analgesia, defined as at least a two point or 30% reduction in pain intensity score on a 0-10 scale.

V. To obtain exploratory data regarding the relationship between pharmacogenetics and pharmacokinetic (PK) and pharmacodynamic (PD) effects of hydromorphone.

OUTLINE: Patients are randomized to 1 of 2 groups.

GROUP A:

TREATMENT PHASE I: Patients concurrently receive IV hydromorphone over 2 minutes and IV placebo over 15 minutes.

TREATMENT PHASE II: Patients are then crossed over to concurrently receive IV hydromorphone over 15 minutes and IV placebo over 2 minutes.

GROUP B:

TREATMENT PHASE I: Patients concurrently receive IV hydromorphone over 15 minutes and IV placebo over 2 minutes.

TREATMENT PHASE II: Patients are then crossed over to concurrently receive IV hydromorphone over 2 minutes and IV placebo over 15 minutes.

Connect with a study center

  • M D Anderson Cancer Center

    Houston, Texas 77030
    United States

    Site Not Available

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