Academic journal article Journal of Drug Issues

Effects of Smoking Cessation on Illicit Drug Use among Opioid Maintenance Patients: A Pilot Study

Academic journal article Journal of Drug Issues

Effects of Smoking Cessation on Illicit Drug Use among Opioid Maintenance Patients: A Pilot Study

Article excerpt

Opioid treatment program patients and staff often have concerns that smoking cessation may jeopardize abstinence from illicit drug use. In this study, we evaluated whether smoking abstinence produced with a two-week contingency-management (CM) intervention was associated with relapse to illicit drug use among patients enrolled in opioid maintenance. Opioid-maintenance patients who were stable in treatment and abstinent from illicit drugs were enrolled in a 14-day smoking-cessation study. Participants were dichotomized into Abstainers (> 90% smoking-negative samples, n=12) and Smokers (< 10% smoking-negative samples, n=16). Illicit drug assays included opioids, oxycodone, propoxyphene, cannabis, amphetamines, cocaine, and benzodiazepines. There were no differences between the Abstainers and Smokers, with 99% and 96% of samples testing negative for all illicit drugs in each group, respectively. Data from this study provide no evidence that smoking cessation among stable opioid-maintained patients undermines drug abstinence and lend support for programs that encourage smoking cessation during drug abuse treatment.

INTRODUCTION

Methadone maintenance (MM) represents one of the most widely used and effective treatments for opioid dependence, with over 200,000 patients in the United States receiving this opioid agonist medication in a clinic-based setting annually (Drug Abuse and Alcohol Treatment Information System [DASIS], 2006). A second opioid-agonist medication, buprenorphine, was more recently approved for the treatment of opioid dependence in 2002. Available from trained physicians in an office-based setting, buprenorphine also has been demonstrated effective in treating opioid dependence (see Johnson, Strain, & Amass, 2003 for a comprehensive review). While both forms of agonist treatment have been proven to reduce illicit opioid use and maintain patients in treatment, rates of cigarette smoking remain substantially higher among opioid-maintained individuals than in the general population. For example, compared to 25% in the general U.S. adult population (Center for Disease Control [CDC], 2005; Substance Abuse and Mental Health Services Administration [SAMHSA], 2007), prevalence of current smoking among MM patients is 84 - 94% (Clemmey, Brooner, Chutuape, Kidorf, & Stitzer, 1997; Nahvi, Richter, Li, Modali, & Arnsten, 2006; Richter, Gibson, Ahulwalia, & Schmelzte, 2001). While specific data is not yet available on the prevalence of smoking among buprenorphine-maintained patients, it is reasonable to assume a similar prevalence among these patients as well (e.g., Mello, Lukas, & Mendelson, 1985).

As is the case in the general population, smoking in opioid-treatment patients is associated with increased morbidity and mortality (Engstrom, Adamsson, Alleback, & Rydberg, 1 99 1 ; Hser, McCarthy, & Anglin, 1 994). The ten-year mortality rate of opioid-dependent smokers is estimated to be four-fold greater than that of opioiddependent nonsmokers (Hser et al., 1994), and individuals who abuse alcohol and other drugs are more likely to die of tobacco-related disorders than problems related to their drug use (Hurt et al., 1 996). An effective smoking cessation intervention among patients enrolled in opioid treatment could significantly reduce the economic and health-related costs associated with their smoking. Methadone and buprenorphine programs may offer an excellent setting for implementing smoking-cessation interventions as many patients achieve prolonged periods of abstinence from illicit drug use and remain engaged in treatment for extended periods of time. This set of conditions could support the frequent and, if necessary, prolonged clinical contact to help facilitate success with smoking cessation. Opioid maintenance programs adhere to a uniform set of state and federal regulations (Federal Register 42 CFR , 2001), which could greatly facilitate the dissemination of an effective smokingcessation intervention in this population across the country. …

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