While rates of smoking in the general population have decreased in recent years, dramatic disparities remain among disadvantaged subgroups of smokers, particularly those with concurrent
substance abuse. Prevalence rates of smoking among
opioid-dependent patients, for example, are fourfold those of the general population. While
pharmacotherapies are recommended as a first-line treatment for
nicotine dependence, the few studies that have investigated their effectiveness in this population have shown dramatically poorer outcomes compared to the general population. Indeed, these findings have led some researchers to suggest that
pharmacotherapies may simply be ineffective in
opioid-maintained smokers. In this commentary, we briefly summarize the extant literature on
pharmacotherapies in
opioid-maintained smokers and contribute new data investigating the contribution of
bupropion on smoking outcomes in 81
methadone- and
buprenorphine-maintained participants from two randomized trials of financial incentives for smoking cessation. We also discuss several important parameters (ie, timing of the quit attempt, medication adherence,
nicotine withdrawal) that may be leveraged to strengthen smoking
pharmacotherapy outcomes in
opioid-dependent patients. Taken together, an improved understanding of these issues will aid efforts to reduce tobacco-related health disparities in this group of challenging smokers.