Pregabalin Plus Lofexidine for the Outpatient Treatment of Opioid Withdrawal

Inclusion Criteria

• Male and/or female subjects ≥ 18 years of age
• Meet DSM-5 criteria for an Opioid Use Disorder with physiologic features. Have met 2 or more of the 11 criteria for an OUD including tolerance and withdrawal within the last 12 months
• Interested in opioid antagonist treatment
• Used opioids in 20 or more of the last 30 days
• A stable address in the local area; not planning to move in the next 60 days.
• Have documents for ID check
• Absence of medical or psychiatric conditions that are likely to interfere with study participation
• Has 12 lead ECG demonstrating a QTc ≤450 msec and a QRS ≤120 msec. Site PI has final determination for study inclusion if readings exceed these limits. The PENN cardiologists and medical monitor are available for consultation when needed
• Negative pregnancy test and using adequate contraception if of childbearing potential.

Exclusion Criteria

• Current psychotic disorder (bipolar I, schizophrenia, major depression that is not in remission
• Alcohol, benzodiazepine, or other sedative use disorder with physiological features that require medication for detoxification
• Allergy or other serious adverse event due to treatment with pregabalin, XR-NTX, or lofexidine
• Pending incarceration or plans to leave the immediate area in the next 30 days
• Homicidal or otherwise behaviorally disturbed requiring immediate attention
• High risk for suicide as determined by answering 'yes' to questions 4 and/or 5 on C-SSRS
• Blood pressure \<90 mm Hg (systolic) or \<60 mm Hg (diastolic). If value out of normal range, the investigator and study Clinician will decide subject inclusion/exclusion on case-by-case basis
• Heart rate and/or pulse\<50 bpm at screening-sitting
• An Estimated Glomerular Filtration Rate eGFR\<70 mL/min/1.73m2
• A History of, or current Seizure disorder (excluding childhood febrile seizures)
• Inability to read and/or understand English. For example, unable to understand the informed consent as demonstrated by failing to answer 9/10 questions correctly on the quiz
• 12. Pregnant or breastfeeding
• 13. Currently taking sympathomimetic drugs, or a thiazolidinedione antidiabetic
• ALT and/or AST >4X upper limit of normal
• A Child-Pugh score >7
• Currently receiving opioids for pain management
• In a treatment study where medication was administered in the last 30 days
• Currently using medications that are known to be strong or moderate inhibitors of CYP2D6 such as fluoxetine, paroxetine, mirabegron, bupropion, quinidine, terbinafine, cimetidine, cinacalcet, duloxetine, or fluvoxamine
• In a methadone maintenance or buprenorphine treatment program within the last 30 days