Early Quit Days Among Methadone-Maintained Smokers in a Smoking Cessation Trial

Dios, Marcel A. de; Anderson, Bradley J.; Caviness, Celeste M.; Stein, Michael D.

doi:10.1093/ntr/ntu099

Cited by 16 publications

(4 citation statements)

References 42 publications

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“…This may reflect inaccurate self-report of cigarettes smoked per day, or, alternately, proximity of cigarette smoking prior to research assessments. The limited tobacco abstinence we observed is consistent with data showing low rates of early tobacco cessation among smokers with substance use disorders (de Dios et al 2014; Nahvi et al 2014), and may be partially attributable to the short varenicline treatment course. Further, these tobacco abstinence rates are consistent with the modest cessation observed among smokers with opioid and other substance use disorders treated with varenicline (Nahvi et al 2014; Rohsenow et al 2017; Stein et al 2013).…”

Section: Discussionsupporting

confidence: 90%

Feasibility and Preliminary Effectiveness of Varenicline for Treating Co-Occurring Cannabis and Tobacco Use

Adams

Arnsten

Ning

et al. 2017

Journal of Psychoactive Drugs

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Few studies have evaluated treatment for co-occurring cannabis and tobacco use. The objective of this pilot study was to evaluate the feasibility and preliminary effectiveness of varenicline for co-occurring cannabis and tobacco use. Participants who reported cannabis use on ≥5 days per week were recruited from an urban, outpatient opioid treatment program (OTP). Participants were randomized to either four weeks of standard OTP clinical care (SCC; medication-assisted treatment for opioid use disorder and individual behavioral counseling), followed by four weeks of SCC plus varenicline (SCC+VT), or to four weeks of SCC+VT followed by four weeks of SCC. All participants contributed feasibility and outcome data during both study phases. Of 193 persons screened, seven were enrolled. Retention at eight weeks was 100%. No adverse effects prompted varenicline discontinuation. Participants reported lower cannabis craving during the SCC+VT phase compared to baseline, and lower frequencies and quantities of cannabis use compared to both baseline and the SCC alone phase. In the SCC+VT phase, participants also reported fewer cigarettes per day. Among persons with co-occurring cannabis and tobacco use, varenicline is well-tolerated and may reduce cannabis craving, cannabis use, and tobacco use.

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Section: Discussionsupporting

confidence: 90%

Feasibility and Preliminary Effectiveness of Varenicline for Treating Co-Occurring Cannabis and Tobacco Use

Adams

Arnsten

Ning

et al. 2017

Journal of Psychoactive Drugs

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“…Prior studies in the general smoker population, 30,31 as well as among opioid-dependent smokers, 16,[32][33][34] have shown that adherence to smoking cessation pharmacotherapies is highly correlated with abstinence. However, opioid-maintained patients have notoriously poor rates of adherence to non-opioid medications, 35,36 including smoking cessation medications.…”

Section: Support Medication Adherencementioning

confidence: 99%

Are Pharmacotherapies Ineffective in Opioid-Dependent Smokers? Reflections on the Scientific Literature and Future Directions: Table 1.

Miller

Sigmon

2015

NICTOB

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While rates of smoking in the general population have decreased in recent years, dramatic disparities remain among disadvantaged subgroups of smokers, particularly those with concurrent substance abuse. Prevalence rates of smoking among opioid-dependent patients, for example, are fourfold those of the general population. While pharmacotherapies are recommended as a first-line treatment for nicotine dependence, the few studies that have investigated their effectiveness in this population have shown dramatically poorer outcomes compared to the general population. Indeed, these findings have led some researchers to suggest that pharmacotherapies may simply be ineffective in opioid-maintained smokers. In this commentary, we briefly summarize the extant literature on pharmacotherapies in opioid-maintained smokers and contribute new data investigating the contribution of bupropion on smoking outcomes in 81 methadone- and buprenorphine-maintained participants from two randomized trials of financial incentives for smoking cessation. We also discuss several important parameters (ie, timing of the quit attempt, medication adherence, nicotine withdrawal) that may be leveraged to strengthen smoking pharmacotherapy outcomes in opioid-dependent patients. Taken together, an improved understanding of these issues will aid efforts to reduce tobacco-related health disparities in this group of challenging smokers.

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“…Adherence to NRT, bupropion or varenicline is associated with improvement in smoking cessation outcomes [16][17][18][23][24][25][26][27][28][29][30][31][32][33], with a dose-dependent relationship between adherence and abstinence [19,25,32]. In large smoking cessation trials among smokers with OUD, adherence to cessation medications was associated with improved cessation outcomes [16,17,21,23,34]; in one trial there was a sevenfold odds of abstinence on days on which participants used (versus did not use) NRT [16]. These results highlight the critical importance of addressing adherence to achieve tobacco abstinence among smokers with OUD.…”

Section: Introductionmentioning

confidence: 99%

Effect of varenicline directly observed therapy versus varenicline self‐administered therapy on varenicline adherence and smoking cessation in methadone‐maintained smokers: a randomized controlled trial

et al. 2020

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Background and Aims Level of adherence to tobacco cessation medication regimens is believed to be causally related to medication effectiveness. This study aimed to evaluate the efficacy of varenicline directly observed therapy (DOT) on varenicline adherence and smoking cessation rates among smokers with opioid use disorder (OUD) receiving methadone treatment. Design Multicenter, parallel‐group two‐arm randomized controlled trial. Setting Urban opioid treatment program (OTP) in the Bronx, New York, USA. Participants Daily smokers of ≥ 5 cigarettes/day, interested in quitting (ladder of change score 6–8), in methadone treatment for ≥ 3 months, attending OTP ≥ 3 days/week. Participants’ mean age was 49 years, 56% were male, 44% Latino, 30% Black, and they smoked a median of 10 cigarettes/day. Interventions Individual, block, random assignment to 12 weeks of varenicline, either directly observed with methadone (DOT, n = 50) or via unsupervised self‐administered treatment (SAT, n = 50). Measurements The primary outcome was adherence measured by pill count. The secondary outcome was 7‐day point prevalence tobacco abstinence verified by expired carbon monoxide (CO) < 8 parts per million. Findings Retention at 24 weeks was 92%. Mean adherence was 78.5% [95% confidence interval (CI) = 71.8–85.2%] in the DOT group versus 61.8% in the SAT group (95% CI = 55.0–68.6%); differences were driven by DOT effects in the first 6 weeks. CO‐verified abstinence did not differ between groups during the intervention (P = 0.26), but was higher in the DOT than the SAT group at intervention end (DOT = 18% versus SAT = 10%, difference = 8%, 95% CI = –13, 28); this difference was not significant (P = 0.39) and was not sustained at 24‐week follow‐up. Conclusions Among daily smokers attending opioid treatment programs, opioid treatment program‐based varenicline directly observed therapy was associated with early increases in varenicline adherence compared with self‐administered treatment, but findings were inconclusive as to whether directly observed therapy was associated with a difference in tobacco abstinence.

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Early Quit Days Among Methadone-Maintained Smokers in a Smoking Cessation Trial

Cited by 16 publications

References 42 publications

Feasibility and Preliminary Effectiveness of Varenicline for Treating Co-Occurring Cannabis and Tobacco Use

Feasibility and Preliminary Effectiveness of Varenicline for Treating Co-Occurring Cannabis and Tobacco Use

Are Pharmacotherapies Ineffective in Opioid-Dependent Smokers? Reflections on the Scientific Literature and Future Directions: Table 1.

Effect of varenicline directly observed therapy versus varenicline self‐administered therapy on varenicline adherence and smoking cessation in methadone‐maintained smokers: a randomized controlled trial

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