Preliminary Study of Buprenorphine and Bupropion for Opioid‐Dependent Smokers

Abstract

In this double-blind, placebo-controlled trial, bupropion (BUPRO, 300 mg/day) was compared to placebo (PBO) for concurrent treatment of opioid and tobacco addiction in 40 opioid-dependent smokers stabilized on buprenorphine (BUPRE, 24 mg/day). Participants received contingent, monetary reinforcement for abstinence from smoking, illicit opioids, and cocaine. Significant differences in treatment retention were observed (BUPRE+BUPRO, 58%; BUPRE+PBO, 90%). BUPRO treatment was not more effective than placebo for abstinence from tobacco, opioids, or cocaine in BUPRE stabilized patients. These preliminary findings do not support the efficacy of BUPRO, in combination with BUPRE, for concurrent treatment of opioid and tobacco addiction.Keywords opioid dependence; smoking cessation; bupropion; buprenorphine Despite declining rates of smoking in the general population, rates of cigarette smoking continue to be elevated among those dependent on opioids, with estimates ranging from 71% to 98%. 1, 2 Converging lines of evidence support the complex interaction between nicotine and the endogenous opioid system 3 , with opioids increasing cigarette smoking 4-8 and nicotine and tobacco increasing opioid use 9 , and levels of the endogenous opioid, β-endorphin. 10-13 Given the synergistic relationship between nicotine and opioids, the disproportionate rate of smoking in opioid users is not surprising.Only recently have researchers begun to evaluate smoking cessation treatments for opioiddependent individuals. 8, 14-17 Interventions have involved behavioral treatments (e.g., supportive counseling, motivational interviewing, and contingency management [CM]) or behavioral treatment in conjunction with pharmacotherapy (i.e., nicotine patch, nicotine gum, or bupropion [BUPRO]). In general, these trials have shown modest or null findings in terms of cessation rates in this challenging population of smokers.No placebo controlled trials of smoking cessation pharmacotherapies have been conducted in opioid dependent patients, although behavioral interventions have been compared to each other. 14, 16 Further, all smoking cessation trials in opioid dependent smokers have involved

Methadone-Nicotine Interactions in Methadone Maintenance Treatment Patients

“…13,22,52Y55 Results have shown negative results or modest success in smoking cessation rates. Recently, Mooney et al 52 noted that there continues to be a deficiency of evidenced-based smoking cessation treatment options in opioid-dependent individuals.…”

Use of Smoking Cessation Methods Among Patients Receiving Office-based Buprenorphine Maintenance Treatment

“…Tobacco cessation treatments have modest efficacy among patients in MMT (Miller and Sigmon, 2015), but only one trial has tested their effects among patients in buprenorphine treatment (Mooney et al, 2008). Though some studies have described tobacco use characteristics among BMT patients (Chisolm et al, 2013; Pajusco et al, 2012), none to date have described smoking cessation treatment experience in this group.…”

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

“…In studies of MMT smokers, poor medication adherence has been identified as a significant barrier to successfully quitting Mooney et al, 2008;Richter et al, 2001;Stein et al, 2006Stein et al, , 2007.…”

“…Yet, all of the smoking cessation pharmacotherapies that have been tested in opioiddependent persons have far lower quit rates (Mooney et al, 2008;Okoli et al, 2010;Reid et al, 2008;Shoptaw et al, 2002;Stein et al, 2006) than those reported in trials of nondrug users (Hurt et al, 1994;Mooney et al, 2008;Okoli et al, 2010;Reid et al, 2008;Shoptaw et al, 2002;Stead et al, 2008;Stein et al, 2006). Over the last two decades, there have been four fully powered randomized clinical trials (RCTs) involving smoking cessation interventions specifically with MMT smokers (Haug, Advance Access publication June 20, 2014 nicotine & tobacco research, volume 16, number 11 (november 2014) 1463-1469 early quit days among methadone-maintained smokers Svikis, & Diclemente, 2004;Shoptaw et al, 2002;Stein et al, 2006Stein et al, , 2013Story & Stark, 1991).…”