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Are Pharmacotherapies Ineffective in Opioid-Dependent Smokers? Reflections on the Scientific Literature and Future Directions.

Abstract
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.
AuthorsMollie E Miller, Stacey C Sigmon
JournalNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco (Nicotine Tob Res) Vol. 17 Issue 8 Pg. 955-9 (Aug 2015) ISSN: 1469-994X [Electronic] England
PMID26180219 (Publication Type: Journal Article, Review)
Copyright© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
Chemical References
  • Analgesics, Opioid
  • Bupropion
  • Methadone
Topics
  • Analgesics, Opioid (adverse effects)
  • Bupropion (therapeutic use)
  • Forecasting
  • Humans
  • Methadone (therapeutic use)
  • Opioid-Related Disorders (drug therapy, epidemiology)
  • Randomized Controlled Trials as Topic (methods)
  • Smoking (drug therapy, epidemiology)
  • Smoking Cessation (methods)
  • Substance Withdrawal Syndrome (drug therapy, epidemiology)
  • Treatment Outcome

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