Spontaneous reductions in smoking during double-blind buprenorphine detoxification.
OBJECTIVE
Evidence suggests a positive association between administration of psychoactive drugs and rates of cigarette smoking. Prevalence of smoking among opioid-dependent individuals, for example, is four times greater than the general population. We recently completed a randomized double-blind trial evaluating outpatient buprenorphine taper for prescription opioid (PO) abusers, which provided a unique opportunity to examine naturalistic changes in smoking among participants who detoxified without resumption of illicit opioid use.


METHODS
Participants received no smoking-cessation services and were not encouraged to alter their smoking in any way. A subset of 10 opioid-dependent smokers, who were randomized to receive the same 4-week buprenorphine taper and successfully completed detoxification, were included in the present study. They provided staff-observed urine specimens thrice-weekly throughout the 12-week trial. Specimens were analyzed on-site via enzyme-multiplied immunoassay for urinary cotinine, a metabolite of nicotine that provides a sensitive biochemical measure of smoking status.


RESULTS
Mean cotinine levels were significantly different across study phases, with significantly lower cotinine levels during taper (1317.5 ng/ml) and post-taper (1015.8 ng/ml) vs. intake (1648.5 ng/ml) phases (p''s<.05). Overall, mean cotinine levels decreased by 38% between intake and end-of-study, reflecting a reduction of approximately eight cigarettes per day.


CONCLUSIONS
These data provide additional evidence that opioids influence smoking and extend prior findings to include primary PO abusers, rigorous double-blind opioid dosing conditions and urinary cotinine. These results also suggest that, while likely insufficient for complete cessation, patients who successfully taper from opioids may also experience concurrent reductions in smoking and thus may be ideal candidates for smoking cessation services.
University of Vermont, Vermont Center on Behavior and Health, United States; University of Vermont, Department of Psychology, United States. Electronic address: mollie.patrick@uvm.edu.
Mollie E
ME
Patrick
Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
Kelly E
KE
Dunn
University of Vermont, Department of Biostatistics, United States.
Gary J
GJ
Badger
University of Vermont, Vermont Center on Behavior and Health, United States; University of Vermont, Department of Psychology, United States; University of Vermont, Department of Psychiatry, United States.
Sarah H
SH
Heil
University of Vermont, Vermont Center on Behavior and Health, United States; University of Vermont, Department of Psychology, United States; University of Vermont, Department of Psychiatry, United States.
Stephen T
ST
Higgins
University of Vermont, Vermont Center on Behavior and Health, United States; University of Vermont, Department of Psychology, United States; University of Vermont, Department of Psychiatry, United States.
Stacey C
SC
Sigmon
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003367:Cotinine / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000652:urine; D016896:Treatment Outcome; D055815:Young Adult
D009292:Narcotic Antagonists; D002047:Buprenorphine; D003367:Cotinine
Buprenorphine; Cigarettes; Detoxification; Opioid; Smoking