Opioid antagonists for smoking cessation

Abstract

BackgroundThe reinforcing properties of nicotine may be mediated through release of various neurotransmitters both centrally and systemically. People who smoke report positive effects such as pleasure, arousal, and relaxation as well as relief of negative affect, tension, and anxiety. Opioid (narcotic) antagonists are of particular interest to investigators as potential agents to attenuate the rewarding effects of cigarette smoking. ObjectivesTo evaluate the efficacy of opioid antagonists in promoting long-term smoking cessation. The drugs include naloxone and the longeracting opioid antagonist naltrexone. Search methodsWe searched the Cochrane Tobacco Addiction Group Specialised Register for trials of naloxone, naltrexone and other opioid antagonists and conducted an additional search of MEDLINE using 'Narcotic antagonists' and smoking terms in April 2013. We also contacted investigators, when possible, for information on unpublished studies. Selection criteriaWe considered randomised controlled trials comparing opioid antagonists to placebo or an alternative therapeutic control for smoking cessation. We included in the meta-analysis only those trials which reported data on abstinence for a minimum of six months. We also reviewed, for descriptive purposes, results from short-term laboratory-based studies of opioid antagonists designed to evaluate psychobiological mediating variables associated with nicotine dependence. Data collection and analysisWe extracted data in duplicate on the study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. Abstinence at end of treatment was a secondary outcome. We extracted cotinine-or carbon monoxide-verified abstinence where available. Where appropriate, we performed meta-analysis, pooling risk ratios using a Mantel-Haenszel fixed-effect model.

New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

“…The promotion of opioid antagonists naltrexone, naloxone and buprenorphine was based on the idea that the reinforcing properties of nicotine may be mediated by the release of neurotransmitters which impact on the endogenous opiate system [311]. Naloxone is routinely administered to reverse the effects of narcotic overdose and naltrexone to blunt certain effects of narcotics, while buprenorphine reduces withdrawal symptoms following opioid discontinuation.…”

“…Research to date suggests that opioid antagonists do not promote smoking cessation, while results are mixed for effects on withdrawal symptoms, the hedonic effects of smoking, and cigarette consumption [311]. However, generally positive effects on post-cessation weight gain have been reported [313].…”

A review of interventions for smoking cessation

“…Clear evidence is available that naltrexone is not useful in aiding smokers to quit smoking, nor does it add any benefit to the effects of NRT if combined in treatment (21).…”

Other Pharmacological and Developing Treatments in Smoking Cessation/Nicotine Vaccines

“…Nikotin bağımlılığını da tedavi edebileceği düşünülerek yapılan çalışmalarda sigara bırakmada kullanılabileceğine dair yeterli kanıt elde edilememiştir (4,13) . Naloksan ve buprenorphine ile yapılan çalışmalarda da yeterli kanıt bulunamamış olup şu anda sigara bırakma tedavisinde kullanımları öne-rilmemektedir (13) .…”