## Protocol Section
### Identification Module
**NCT ID:** NCT06430580

**Acronym:** COBRAS

**Brief Title:** Cannabinoids and Biological Reactivity to Stress

**Official Title:** Cannabinoids and Biological Reactivity to Stress

#### Organization Study ID Info
**ID:** 20241368
#### Organization
**Class:** OTHER
**Full Name:** Auburn University
#### Secondary ID Infos
**ID:** R21DA058780-01A1
**Link:** https://reporter.nih.gov/quickSearch/R21DA058780-01A1
**Type:** NIH
### Status Module
#### Completion Date
**Date:** 2026-03-15

**Type:** ESTIMATED

#### Expanded Access Info
#### Last Update Post Date
**Date:** 2024-05-28

**Type:** ACTUAL

**Last Update Submit Date:** 2024-05-21

**Overall Status:** NOT_YET_RECRUITING

#### Primary Completion Date
**Date:** 2026-03-15

**Type:** ESTIMATED

#### Start Date
**Date:** 2024-08-15

**Type:** ESTIMATED

**Status Verified Date:** 2024-05

#### Study First Post Date
**Date:** 2024-05-28
**Type:** ACTUAL
**Study First Submit Date:** 2024-05-13
**Study First Submit QC Date:** 2024-05-21
### Sponsor Collaborators Module

#### Collaborators

**Class:** OTHER

**Name:** Wayne State University

**Class:** NIH

**Name:** National Institute on Drug Abuse (NIDA)

#### Lead Sponsor

**Class:** OTHER

**Name:** Auburn University

#### Responsible Party

**Investigator Affiliation:** Auburn University

**Investigator Full Name:** Richard Macatee

**Investigator Title:** Assistant Professor

**Type:** PRINCIPAL_INVESTIGATOR

### Oversight Module

**Is FDA Regulated Device:** False

**Is FDA Regulated Drug:** True

**Oversight Has DMC:** False

### Description Module

**Brief Summary:** The goal of this study is to test the impact of two drugs that produce temporary stress-like symptoms, both in isolation and together, on cannabis use motivation in individuals with Cannabis Use Disorder. The main questions it will answer are:

1. How do different forms of stress affect cannabis use motivation?
2. How do different forms of stress affect the body's natural cannabinoids?

Researchers will compare a placebo to both drugs in isolation, as well as together, across four separate lab visits.

Participants will:

1) Complete a clinical screening interview (by phone or in-person) and visit the lab for a medical screening, and if eligible:

a) Visit the lab four times where they will: i). Take one of four drug combinations ii). Complete an interview, questionnaires, and computerized tasks iii). Have their brain activity recorded with an EEG cap iv). Provide three blood samples

**Detailed Description:** The prevalence of daily cannabis use and cannabis use disorder (CUD) has increased in the United States over the past two decades. Unfortunately, psychosocial treatments produce minimal long-term abstinence rates and no FDA-approved medications for CUD exist. Thus, identifying novel CUD treatment targets is an increasingly urgent public health need.

Stress-elicited cannabis use motivation has been implicated in worse CUD outcomes, but a mechanistic understanding of how acute stress increases cannabis use motivation in CUD is limited. Prior work has demonstrated that acute psychosocial stress enhancement of subsequent cannabis cue incentive salience, as indexed by the late positive potential (neural measure of approach-motivated attention recorded using electroencephalography \[EEG\]), was associated with worse CUD severity and intervention response, independent of subjective craving. Moreover, hypothalamic pituitary adrenal \[HPA\]-axis, rather than noradrenergic or subjective reactivity to the psychosocial stressor was associated with subsequent potentiation of the cannabis cue-elicited late positive potential. These studies suggest that non-genomic, rapid glucocorticoid effects may be a contributing mechanism in stress amplification of neural drug-cue reactivity, but their correlational designs preclude causal inference. Further, psychosocial stressors are unable to isolate HPA-axis vs. noradrenergic components of stress reactivity.

To isolate HPA-axis activation and test causality, pharmacological manipulations, common in animal models but rare in human studies, will be used to produce separate and co-operative glucocorticoid (20mg hydrocortisone) and noradrenergic (54mg yohimbine) activation. The investigators will employ a 2x2 randomized, placebo-controlled double-blind crossover design in 36 participants with severe CUD. The primary aim is to test the causal potentiating effect of glucocorticoids on drug-cue reactivity and drug use motivation, and further determine if the effect depends on co-occurring noradrenergic stimulation. Preclinical work indicates that glucocorticoids can potentiate reward motivation via mobilization of endocannabinoid activity (primary target of cannabis). Thus, as an exploratory aim, the investigators will obtain plasma samples to test the impact of pharmacological stress on circulating endocannabinoids (2-AG, AEA) and their mediating role in glucocorticoid potentiation of drug-cue reactivity and drug use motivation. This project represents a highly novel integration of a rigorous pharmacological challenge design with biological markers of drug-cue incentive salience and endocannabinoid system activity. If hypotheses are confirmed, one causal mechanism through which stress increases neural cannabis cue reactivity will be known, which has immediate implications for testing experimental therapeutics. The long-term goal is to understand how a stress-related mechanism predictive of worse CUD phenotype is generated and can be blocked in CUD. Development of this model will provide a valid, efficient and (relative to other neuroimaging methods) low-cost approach to screen candidate medications and optimize psychosocial drug cue exposure therapies.

### Conditions Module

**Conditions:**

- Cannabis Use Disorder

### Design Module

#### Design Info

**Allocation:** RANDOMIZED

**Intervention Model:** CROSSOVER

**Intervention Model Description:** 2x2 randomized double-blind within-subject crossover

##### Masking Info

**Masking:** TRIPLE

**Masking Description:** Double-blind

**Who Masked:**

- PARTICIPANT

- INVESTIGATOR

- OUTCOMES_ASSESSOR

**Primary Purpose:** BASIC_SCIENCE

#### Enrollment Info

**Count:** 36

**Type:** ESTIMATED

**Phases:**

- EARLY_PHASE1

**Study Type:** INTERVENTIONAL

### Arms Interventions Module

#### Arm Group 1

**Description:** 20mg hydrocortisone, single oral dose 54mg yohimbine hcl, single oral dose

**Intervention Names:**

- Drug: Hydrocortisone Oral

- Drug: Yohimbine Hydrochloride

**Label:** 20mg hydrocortisone + 54mg yohimbine hcl

**Type:** EXPERIMENTAL

#### Arm Group 2

**Description:** 20mg hydrocortisone, single oral dose 54mg cornstarch placebo, single oral dose

**Intervention Names:**

- Drug: Hydrocortisone Oral

- Drug: Cornstarch Placebo 54mg

**Label:** 20mg hydrocortisone + 54mg placebo

**Type:** EXPERIMENTAL

#### Arm Group 3

**Description:** 20mg cornstarch placebo, single oral dose 54mg yohimbine hcl, single oral dose

**Intervention Names:**

- Drug: Yohimbine Hydrochloride

- Drug: Cornstarch Placebo 20mg

**Label:** 20mg placebo + 54mg yohimbine hcl

**Type:** ACTIVE_COMPARATOR

#### Arm Group 4

**Description:** 20mg cornstarch placebo, single oral dose 54mg cornstarch placebo, single oral dose

**Intervention Names:**

- Drug: Cornstarch Placebo 20mg

- Drug: Cornstarch Placebo 54mg

**Label:** 20mg placebo + 54mg placebo

**Type:** PLACEBO_COMPARATOR

### Interventions

#### Intervention 1

**Arm Group Labels:**

- 20mg hydrocortisone + 54mg placebo

- 20mg hydrocortisone + 54mg yohimbine hcl

**Description:** 20mg hydrocortisone, single oral dose

**Name:** Hydrocortisone Oral

**Type:** DRUG

#### Intervention 2

**Arm Group Labels:**

- 20mg hydrocortisone + 54mg yohimbine hcl

- 20mg placebo + 54mg yohimbine hcl

**Description:** 54mg yohimbine hcl, single oral dose

**Name:** Yohimbine Hydrochloride

**Type:** DRUG

#### Intervention 3

**Arm Group Labels:**

- 20mg placebo + 54mg placebo

- 20mg placebo + 54mg yohimbine hcl

**Description:** 20mg cornstarch placebo, single oral dose

**Name:** Cornstarch Placebo 20mg

**Type:** DRUG

#### Intervention 4

**Arm Group Labels:**

- 20mg hydrocortisone + 54mg placebo

- 20mg placebo + 54mg placebo

**Description:** 54mg cornstarch placebo, single oral dose

**Name:** Cornstarch Placebo 54mg

**Type:** DRUG

### Outcomes Module

#### Primary Outcomes

**Description:** Change in electroencephalography-recorded (EEG) late positive potential amplitude to cannabis cue images after hydrocortisone (with or without yohimbine) compared to placebo+placebo and yohimbine+placebo conditions (higher amplitudes indicate worse outcome)

**Measure:** Amplitude of neurophysiological response to cannabis cues (μV)

**Time Frame:** Late positive potential amplitude outcome is assessed at each of the four lab visits, which take place over the study period (10-22 days)

**Description:** Marijuana purchase task-derived Intensity after hydrocortisone administration (with or without yohimbine) compared to placebo+placebo and yohimbine+placebo (increased Intensity indicates worse outcome)

**Measure:** Amplitude of Demand Intensity for Cannabis (# of hits at $0)

**Time Frame:** Intensity is assessed at each of the four lab visits, which take place over the study period (10-22 days)

**Description:** Marijuana purchase task-derived OMax after hydrocortisone administration (with or without yohimbine) compared to placebo+placebo and yohimbine+placebo (increased OMax indicates worse outcome)

**Measure:** Peak Total Monetary Expenditure for Cannabis (total amount of money spent on hits)

**Time Frame:** OMax is assessed at each of the four lab visits, which take place over the study period (10-22 days)

**Description:** Marijuana purchase task-derived Breakpoint after hydrocortisone administration (with or without yohimbine) compared to placebo+placebo and yohimbine+placebo (increased Breakpoint indicates worse outcome)

**Measure:** Breakpoint of Monetary Expenditure for Cannabis (price at which no hits are purchased)

**Time Frame:** Breakpoint is assessed at each of the four lab visits, which take place over the study period (10-22 days)

**Description:** Marijuana purchase task-derived Elasticity after hydrocortisone administration (with or without yohimbine) compared to placebo+placebo and yohimbine+placebo (decreased Elasticity indicates worse outcome)

**Measure:** Sensitivity of Cannabis Hit Purchasing Behavior to Price Increases

**Time Frame:** Elasticity is assessed at each of the four lab visits, which take place over the study period (10-22 days)

**Description:** Change in cannabis image selections on the Implicit Image Choice Task (computerized behavioral task; range 0-30; higher scores indicate worse outcome) after hydrocortisone administration (with and without yohimbine) compared to placebo+placebo and yohimbine+placebo

**Measure:** Frequency of implicit cannabis image choice

**Time Frame:** Implicit choice task # of cannabis image selections outcome is assessed at each of the four lab visits, which take place over the study period (10-22 days)

**Description:** Change in cannabis image selections on the Explicit Image Choice Task (computerized behavioral task; range 0-30; higher scores indicate worse outcome) after hydrocortisone administration (with and without yohimbine) compared to placebo+placebo and yohimbine+placebo

**Measure:** Frequency of explicit cannabis image choice

**Time Frame:** Explicit choice task # of cannabis image selections outcome is assessed at each of the four lab visits, which take place over the study period (10-22 days)

### Eligibility Module

**Eligibility Criteria:** Inclusion Criteria:

* Meets criteria for current, severe Cannabis Use Disorder (CUD) as assessed by the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) during the screening interview.
* Reports engagement in daily cannabis use.
* Provide a urine sample positive for THC.
* Must be adequately informed of the nature and risks of the study and given written informed consent prior to screening.
* Able to read and write in English.

Exclusion Criteria:

* Has a history of serious psychiatric problems (i.e., psychosis, Bipolar Disorder I), as assessed by the SCID-V-RV.
* Reports current active suicidal ideation.
* Meets DSM-5 criteria for any other current substance use disorder (other than CUD or Tobacco Use Disorder)
* Has a positive result urine drug screen for all other drugs aside from THC (i.e., amphetamine, methamphetamine, benzodiazepine, cocaine, MDMA, morphine, oxycodone, methadone, buprenorphine) at screening or at any lab visit.
* Has structural brain abnormalities (e.g., neoplasms), stroke, seizures, infectious disease, a history of other neurological diseases, or a history of head trauma resulting in unconsciousness.
* Has a history of cardiovascular disease, myocardial infarction, chest pain, or palpitations on exertion or drug use, edema, hypertension, resting heart rate \<50 BPM or \>90 BPM. Cardiovascular diseases include:

  . a. Benign prostatic hyperplasia (BPH) b. Post-myocardial infarction
* Demonstrates systolic BP outside of acceptable range (80-160mmHG), or diastolic BP outside of acceptable range (50-90 mmHG)
* Has a history of obstructive pulmonary disease, cor pulmonale, dyspnea, orthopnea, tachypnea (\>24 breaths per minute), or asthma.
* Currently taking any daily psychotropic medication
* Currently taking any of the following medications:

  1. Angiotensin-Converting Enzyme (ACE) inhibitors including Lisinopril, Enalapril, Benazepril, and Bamipril
  2. Angiotensin II Receptor Blockers (ARB) including Losartan, Valsartan, and Olmesartan
  3. Thiazide Diuretics including Hydrochlorothiazide (HCTZ), Chlorthalidone
  4. Calcium Channel Blockers including Amlodipine, Diltiazem, and Verapamil
  5. Beta-blockers including Carvedilol, Metoprolol, Atenolol, Propranolol
  6. Anti-Arrythmic Medication including Disopyramide, Flecainide, and Mexiletine
  7. Edema (Diuretics)
  8. Thiazide Diuretics (as above)
  9. Loop Diuretics including Furosemide and Torsemide
  10. Potassium Sparing Diuretics: Spironolactone and Eplerenone
  11. Anti-Platelet Medications such as Clopidogrel, Prasugrel, and Ticagrelor
* Reproductively capable candidates who are pregnant (based on urine test at screening or at any lab visit) or are heterosexually active and not using medically approved birth control measures (oral contraceptives, IUD, condom, sterilization).
* Self-reports currently seeking or engaging in CUD treatment or any other alcohol or drug treatment.
* Self-reports intent to imminently quit cannabis use.
* Has a Blood-Injection-Injury Phobia, as determined by scores greater than 15 on the Injection and Blood Draw subscale of the Medical Fear Survey

**Maximum Age:** 50 Years

**Minimum Age:** 18 Years

**Sex:** ALL

**Standard Ages:**

- ADULT

### Contacts Locations Module

#### Central Contacts

**Contact 1:**

**Email:** brains@auburn.edu

**Name:** Julia Gorday, MS

**Phone:** (334)-844-6642

**Role:** CONTACT

#### Overall Officials

**Official 1:**

**Affiliation:** Auburn University

**Name:** Richard J Macatee, PhD

**Role:** PRINCIPAL_INVESTIGATOR

## Derived Section

### Condition Browse Module - Browse Branches

- Abbrev: BC25

- Name: Substance Related Disorders

- Abbrev: BXM

- Name: Behaviors and Mental Disorders

- Abbrev: All

- Name: All Conditions

### Condition Browse Module - Browse Leaves

- ID: M5449

- Name: Marijuana Abuse

- Relevance: LOW

- As Found: Unknown

### Intervention Browse Module - Ancestors

- ID: D000000893

- Term: Anti-Inflammatory Agents

- ID: D000009184

- Term: Mydriatics

- ID: D000001337

- Term: Autonomic Agents

- ID: D000018373

- Term: Peripheral Nervous System Agents

- ID: D000045505

- Term: Physiological Effects of Drugs

- ID: D000058669

- Term: Adrenergic alpha-2 Receptor Antagonists

- ID: D000000317

- Term: Adrenergic alpha-Antagonists

- ID: D000018674

- Term: Adrenergic Antagonists

- ID: D000018663

- Term: Adrenergic Agents

- ID: D000018377

- Term: Neurotransmitter Agents

- ID: D000045504

- Term: Molecular Mechanisms of Pharmacological Action

- ID: D000064804

- Term: Urological Agents

### Intervention Browse Module - Browse Branches

- Abbrev: Infl

- Name: Anti-Inflammatory Agents

- Abbrev: All

- Name: All Drugs and Chemicals

- Abbrev: Urol

- Name: Urological Agents

- Abbrev: HB

- Name: Herbal and Botanical

### Intervention Browse Module - Browse Leaves

- ID: M9912

- Name: Hydrocortisone

- Relevance: HIGH

- As Found: Group A

- ID: M155245

- Name: Hydrocortisone 17-butyrate 21-propionate

- Relevance: LOW

- As Found: Unknown

- ID: M228609

- Name: Hydrocortisone acetate

- Relevance: LOW

- As Found: Unknown

- ID: M263259

- Name: Hydrocortisone hemisuccinate

- Relevance: LOW

- As Found: Unknown

- ID: M17752

- Name: Yohimbine

- Relevance: HIGH

- As Found: Blood pressure measured

- ID: M4217

- Name: Anti-Inflammatory Agents

- Relevance: LOW

- As Found: Unknown

- ID: M12139

- Name: Mydriatics

- Relevance: LOW

- As Found: Unknown

- ID: M20746

- Name: Adrenergic Agents

- Relevance: LOW

- As Found: Unknown

- ID: M29195

- Name: Adrenergic alpha-2 Receptor Antagonists

- Relevance: LOW

- As Found: Unknown

- ID: M3669

- Name: Adrenergic alpha-Antagonists

- Relevance: LOW

- As Found: Unknown

- ID: M20755

- Name: Adrenergic Antagonists

- Relevance: LOW

- As Found: Unknown

- ID: M20504

- Name: Neurotransmitter Agents

- Relevance: LOW

- As Found: Unknown

- ID: T332

- Name: Yohimbe

- Relevance: HIGH

- As Found: Blood pressure measured

### Intervention Browse Module - Meshes

- ID: D000006854

- Term: Hydrocortisone

- ID: D000015016

- Term: Yohimbine

### Misc Info Module

- Version Holder: 2024-05-31
