Tobacco withdrawal among opioid-dependent smokers.

Abstract

Prevalence of cigarette smoking among opioid-dependent individuals is 6-fold that of the general U.S. adult population and their quit rates are notoriously poor. One possible reason for the modest cessation outcomes in opioid-dependent smokers may be that they experience more severe tobacco withdrawal upon quitting. In this secondary analysis, we evaluated tobacco withdrawal in opioid-dependent (OD) smokers versus smokers without co-occurring substance use disorders (SUDs). Participants were 47 methadone- or buprenorphine-maintained smokers and 25 non-SUD smokers who completed 1 of several 2-week studies involving daily visits for biochemical monitoring, delivery of financial incentives contingent on smoking abstinence, and assessment of withdrawal via the Minnesota Nicotine Withdrawal Scale (MNWS). Prior to quitting smoking, OD smokers presented with higher baseline withdrawal scores than non-SUD smokers (1.7 ± 0.2 vs. 0.7 ± 0.2, respectively; [1, 63] = 7.31, p< .001). Withdrawal scores in both groups decreased over the subsequent 2-week period with no group differences, (1, 910) = 0.50, p = .48. A similar pattern was observed on craving (i.e., Desire to Smoke item of MNWS), although the trajectory of decrease over time on this item was also moderated by gender. Overall, there was no difference in withdrawal during biochemically verified smoking abstinence between OD and non-SUD smokers, suggesting that elevated withdrawal severity following quitting may not be a major factor contributing to the poor cessation outcomes consistently observed among OD smokers. Further scientific efforts are needed to improve our understanding of the high smoking rates and modest cessation outcomes in this challenging population. (PsycINFO Database Record

Investigating tobacco withdrawal in response to reduced nicotine cigarettes among smokers with opioid use disorder and other vulnerabilities.

“…These results are consistent with our recent study examining tobacco withdrawal severity in a different sample of OM versus non-SUD smokers in which no differences in withdrawal or craving severity were observed between groups across a 2-week period of biochemically verified smoking abstinence (Streck, Heil, Higgins, Bunn, & Sigmon, 2018). Whereas Streck et al (2018) examined individuals who quit smoking their usual brand cigarettes for a 2-week study period, the current study further extends that work by including an evaluation of the effects of multiple cigarettes varying in nicotine content using rigorous double-blind conditions. The finding that OM smokers did not experience greater tobacco withdrawal or craving relative to other smokers selected from vulnerable populations without OUD (smokers with affective disorders or socioeconomic disadvantage) are promising, though additional research is needed to thoroughly understand the effects of this proposed policy in OM smokers.…”

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

“…One possibility is that OD smokers may experience more severe withdrawal upon discontinuing smoking, which could undermine quit attempts. Recent data from our group, however, have suggested remarkably similar withdrawal severity between OD and non-OD smokers during abstinence (Streck et al, 2018). Another potential factor is that OD smokers may present with a greater severity of nicotine dependence (ND) more generally, and elevated baseline severity of ND is associated with lower rates of smoking cessation over time (Breslau and Johnson, 2000).…”

Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers

“…While both epidemics present unique challenges to public health, tobacco control efforts may be overshadowed by steadily declining smoking rates among the general population [ 3 , 4 ]. Despite this decline, smoking continues to disproportionately affect marginalized subpopulations, especially those with substance use disorders [ 5 ]. In particular, individuals with opioid use disorders (OUDs) have disproportionately higher smoking rates compared to the general population; data suggest the prevalence of smoking among this demographic is nearly 6-fold that of the general U.S. adult population (~84–94% vs. 14%, respectively) [ 5 , 6 ].…”

“…Despite this decline, smoking continues to disproportionately affect marginalized subpopulations, especially those with substance use disorders [ 5 ]. In particular, individuals with opioid use disorders (OUDs) have disproportionately higher smoking rates compared to the general population; data suggest the prevalence of smoking among this demographic is nearly 6-fold that of the general U.S. adult population (~84–94% vs. 14%, respectively) [ 5 , 6 ]. This disparity among individuals with OUDs compounds the burden of smoking-related morbidity and mortality and increases risks for opioid relapse and poorer quality of life [ 7 , 8 ].…”