Associations between opioid and nicotine dependence in nationally representative samples of United States adult daily smokers

Parker, Maria A.; Streck, Joanna M.; Sigmon, Stacey C.

doi:10.1016/j.drugalcdep.2018.01.024

Cited by 48 publications

(20 citation statements)

References 23 publications

(24 reference statements)

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“…The prevalence and persistence of cigarette smoking in individuals with OUD far exceed that of the general U.S. adult population 18 and the severity of nicotine dependence is significantly greater than that among smokers without OUD. 19 As reviewed above, a more rapid nicotine metabolism, reflected by a higher NMR, is associated with a lower likelihood of smoking cessation. Thus, in addition to the increase in NMR associated with pregnancy, chronic opioid exposure also appears to increase NMR, and thus likely increases nicotine metabolism.…”

Section: Discussionmentioning

confidence: 98%

Pregnant Smokers Receiving Opioid Agonist Therapy Have an Elevated Nicotine Metabolite Ratio: A Replication Study

Kranzler

Washio

Zindel

et al. 2020

Nicotine &Amp; Tobacco Research

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Introduction Pregnant women exposed chronically to opioids smoked more cigarettes per day (CPD) and had a higher nicotine metabolite ratio (NMR), 3-hydroxycotinine/cotinine, a biomarker of nicotine metabolism and clearance, than those not receiving opioids. We examined CPD and NMR in a group of pregnant smokers, a quarter of whom were receiving opioid agonist therapy (OAT). Aims and Methods Pregnant smokers recruited to participate in a placebo-controlled trial of bupropion for smoking cessation provided a blood sample for measurement of NMR. Results Half (52.4%) of the 124 women with NMR data were African American. OAT-treated women (n = 34, 27.4%; 27 receiving methadone and 7 buprenorphine) were more likely to be white (79% vs. 30%, p < .001) and to have a lower mean PHQ-9 total score (2.91 [SD = 2.83] vs. 4.83 [SD = 3.82], p = .007). OAT-treated women reported smoking more CPD (9.50 [SD = 5.26] vs. 7.20 [SD = 3.65], p = .005) and had higher NMR (0.78 [SD = 0.36] vs. 0.56 [SD = 0.25], p = .001) than the non-OAT-treated group. In a linear regression analysis adjusting for race, depression severity, and CPD, NMR was greater in the OAT group (p = .025), among whom the daily methadone-equivalent dosage correlated with NMR (Spearman’s ρ = 0.49, p = .003). Conclusions Consistent with the findings of Oncken et al. (2019), we found that OAT smokers smoked more and had higher NMR than non-OAT smokers. As higher NMR is associated with a reduced likelihood of smoking cessation, the effects on NMR of both pregnancy and OAT could contribute to a lower smoking cessation rate in pregnant smokers receiving chronic opioid therapy. Implications We replicated the finding that the NMR is significantly greater among pregnant smokers receiving OAT than those not receiving this treatment for opioid use disorder. Furthermore, we found that the dosage of the OAT was significantly associated with the NMR level. These findings may contribute to a poorer response to smoking cessation treatment in pregnant women treated with OAT, particularly those receiving high-dose therapy, and raise the question of whether novel approaches are needed to treat smoking in this subgroup of pregnant smokers.

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Section: Discussionmentioning

confidence: 98%

Pregnant Smokers Receiving Opioid Agonist Therapy Have an Elevated Nicotine Metabolite Ratio: A Replication Study

Kranzler

Washio

Zindel

et al. 2020

Nicotine &Amp; Tobacco Research

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“…Previous research has only focused on samples from the general population or specialty treatment settings, which also showed elevated prevalence of tobacco use among persons with opioid misuse or OUD. For instance, data derived from the NSDUH from 2006–2014 showed that approximately 80% of adults who were opioid dependent smokers met criteria for nicotine dependence (Parker et al, 2018). Among addiction treatment samples, the prevalence of smoking ranged from 73.5% to 94.0% among patients who were treated primarily for opioid misuse (Guydish et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Research has shown that the mortality rate of persons with OUD who smoke is four times greater than those with OUD who do not smoke (Hser et al, 1994; Hurt et al, 1996). Moreover, it has been reported that cigarette smokers with opioid dependence had greater rates of and more severe nicotine dependence than smokers without opioid dependence (Parker et al, 2018). Although most patients with OUD reported a desire to quit cigarette smoking (Hall et al, 2018; Nahvi et al, 2006), smoking cessation interventions generally considered effective among other populations (e.g., nicotine replacement therapy, varenicline, and bupropion) have limited effectiveness among OUD-smokers (Miller and Sigmon, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…This over-representation may be due to consequential medical problems and other negative sequelae of substance use for which primary care treatment is sought (Cherpitel and Ye, 2008). Indeed, research suggests there may be medical issues that underlie the presence of tobacco and opioid misuse for which treatment in primary care is received including chronic pain, hepatitis C, HIV, depression, or other psychiatric disorders (LaRowe et al, 2018; Parker et al, 2018; Sehgal et al, 2012; Zale et al, 2015). Furthermore, routine screening for tobacco use should be standard practice in many primary care settings based on recommendations from the U.S. Preventative Services Taskforce (Siu,2015).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco

John

Zhu

Mannelli

et al. 2019

Drug and Alcohol Dependence

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Background: Current data suggest that opioid misuse or opioid use disorder (OUD) may be over represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity in opioid misuse among primary care patients who use tobacco may have implications for improved primary care-based screening, prevention, and intervention approaches. Methods: Data were derived from a sample of 2,000 adult (aged ≥18) primary care patients across 5 distinct clinics. Among past-year tobacco users (n=882), we assessed the prevalence of opioid misuse and OUD by sociodemographic characteristics and past-year polysubstance use. Latent class analysis (LCA) was used to identify heterogeneous subgroups of tobacco users according to past-year polysubstance use patterns. Multinomial logistic regression was used to examine variables associated with LCA-defined class membership. Results: Past-year tobacco use was reported by >84% of participants who reported past-year opioid misuse or OUD. Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14.0% and 9.5%, respectively. The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed. Three LCA-defined classes among tobacco users were identified including a tobacco-minimal drug use group (78.0%), a tobacco-cannabis use group (10.1%), and a tobacco-opioid/polydrug use group (11.9%). Class membership differed by sociodemographic characteristics. Conclusions: Results from this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users.

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“…145,146 In addition, opioid-dependent smokers present with more severe nicotine dependence, respond poorly to smoking cessation medications, and may have a higher risk of relapse compared to non-opioid dependent smokers. [147][148][149][150] The relationship between nicotine and the opioidergic system is similarly substantial in preclinical studies, which is important given the roles of both systems in reward processing. Early adolescent nicotine exposure in mice enhances subsequent morphine reward.…”

Section: Nicotine Interacts With the Opioidergic Systemmentioning

confidence: 99%

Nicotine Gateway Effects on Adolescent Substance Use

Ren

Lotfipour

2019

WestJEM

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Given the rise in teenage use of electronic nicotine delivery systems ("vaping") in congruence with the increasing numbers of drug-related emergencies, it is critical to expand the knowledge of the physical and behavioral risks associated with developmental nicotine exposure. A further understanding of the molecular and neurochemical underpinnings of nicotine's gateway effects allows emergency clinicians to advise patients and families and adjust treatment accordingly, which may minimize the use of tobacco, nicotine, and future substances. Currently, the growing use of tobacco products and electronic cigarettes among teenagers represents a major public health concern. Adolescent exposure to tobacco or nicotine can lead to subsequent abuse of nicotine and other substances, which is known as the gateway hypothesis. Adolescence is a developmentally sensitive time period when risktaking behaviors, such as sensation seeking and drug experimentation, often begin. These hallmark behaviors of adolescence are largely due to maturational changes in the brain. The developing brain is particularly vulnerable to the harmful effects of drugs of abuse, including tobacco and nicotine products, which activate nicotinic acetylcholine receptors (nAChRs). Disruption of nAChR development with early nicotine use may influence the function and pharmacology of the receptor subunits and alter the release of reward-related neurotransmitters, including acetylcholine, dopamine, GABA, serotonin, and glutamate. In this review, we emphasize that the effects of nicotine are highly dependent on timing of exposure, with a dynamic interaction of nAChRs with dopaminergic, endocannabinoid, and opioidergic systems to enhance general drug reward and reinforcement. We analyzed available literature regarding adolescent substance use and nicotine's impact on the developing brain and behavior using the electronic databases of PubMed and Google Scholar for articles published in English between January 1968 and November 2018. We present a large collection of clinical and preclinical evidence that adolescent nicotine exposure influences long-term molecular, biochemical, and functional changes in the brain that encourage subsequent drug abuse. [West J Emerg Med. 2019;20(5)696-709.] examined in a recent study (2015), which reported that 38.8 percent of adolescents initiate nicotine before alcohol and/ or marijuana, while 21.3 percent use alcohol prior to nicotine and/or marijuana, and 8.6 percent use marijuana before nicotine and/or alcohol. 23 Although previous reports highlight that the rates of cigarette smoking are decreasing in the United States (U.S.), from 20.9 percent in 2005 to 15.5 percent in 2016, current trends in teen use of electronic nicotine delivery systems (e.g., e-cigarettes, vaporizers, hookah pens) are rapidly increasing. 24-26 In particular, the rate of current e-cigarette use in high school students jumped from 1.5 percent in 2011

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Associations between opioid and nicotine dependence in nationally representative samples of United States adult daily smokers

Cited by 48 publications

References 23 publications

Pregnant Smokers Receiving Opioid Agonist Therapy Have an Elevated Nicotine Metabolite Ratio: A Replication Study

Pregnant Smokers Receiving Opioid Agonist Therapy Have an Elevated Nicotine Metabolite Ratio: A Replication Study

Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco

Nicotine Gateway Effects on Adolescent Substance Use

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