Smoking Status and Opioid-related Problems and Concerns Among Men and Women on Chronic Opioid Therapy

Abstract

Objectives Smokers on chronic opioid therapy for non-cancer pain use prescription opioids at higher dosages and are at increased risk for opioid misuse and dependence relative to non-smokers. The current study aims to assess whether smoking is associated with problems and concerns with chronic opioid therapy from the perspective of the patient. Methods In a large sample (N = 972) of adult patients prescribed opioids for chronic noncancer pain, we examined sex-specific associations between smoking status and patient perceptions of problems and concerns with chronic opioid therapy using regression analyses, adjusting for covariates. Results The sample self-identified as 27% current smokers, 44% former smokers, and 29% never smokers. Current smoking (vs. never smoking) was associated with increased odds of an opioid use disorder among males and females, and higher daily opioid dose among males only. Current and former smokers reported significantly fewer problems with opioids relative to never smokers, and this was driven primarily by lower endorsement of problems that are affected by the stimulant properties of nicotine (e.g., difficulties thinking clearly, felt less alert or sleepy). Discussion This study contributes to an understanding of perceived problems and concerns with chronic opioid therapy among current, former, and never smokers with chronic noncancer pain. Results suggest that current and former smokers may be a difficult population to target to decrease chronic opioid therapy, given that they perceive fewer problems with prescription opioid use, despite higher odds of having an opioid use disorder (males and females) and greater opioid doses (males only).

Chronic opioids in gastroparesis: Relationship with gastrointestinal symptoms, healthcare utilization and employment

“…Our finding that GpCO are more likely to be unemployed and work less is consistent with the multi-national questionnaire based study showing that the chronic use of opiates negatively influences the quality of life[ 41 ]. We found a higher prevalence of current smoking in GpCO, and a study by Young-Wolff et al[ 42 ] suggested a higher likelihood of opioid use disorder in current smokers vs non-smokers.…”

The Cholinergic System as a Treatment Target for Opioid Use Disorder

“…On the other hand, chronic nicotine exposure attenuated the analgesic effects of opioids, suggesting a cross-tolerance between opioids and nicotine. In humans, opioids and nicotine products (e.g., tobacco cigarettes) are commonly abused together and smoking status is an important predictor for using higher doses of prescription opioids and misuse of prescription opioids [127, 128]. Together, these studies suggest that ACh and opioids may play an important role in modulating the pharmacological effects of each other as well as impact ongoing use and addiction to opioids and nicotine.…”

Preliminary study of the impact of elevated circulating plasma levels of catecholamines on opioid requirements for acute surgical pain

“…However, in Cryar's study, the MMEs, ranged between 250 to 5,540mgs compared to zero to 3,600mgs in the control group (23). In addition, other reports investigating the correlation between smoking and analgesic use during the first 12 hour postoperative period suggested that females, who underwent pelvic surgery and reported smoking, consumed ~20% more opioid drugs for controlling postoperative pain (13mg/12h versus 10.5mg/12h reported by controls) (24). In contrast, our findings suggest that there is not a statistical difference in total MMEs administered during the first 24 hour postoperative period between those with elevated circulating levels of catecholamines with no psychosocial issues, compared to controls with psychosocial issues, including; depression and history of nicotine and alcohol use.…”