Smoking continues to be a major health concern among individuals undergoing opioid therapy. Research shows that approximately 85% of those receiving opioid agonist therapy (OAT) for opioid use disorder are smokers, putting them at a significantly higher risk of smoking-related illnesses. These risks include chronic obstructive pulmonary disease (COPD), cancer, and cardiovascular disease, compounding already existing health vulnerabilities. Smoking cessation in opioid therapy is therefore a vital step towards improving health outcomes for this population.

This article explores the impact of nicotine dependence within OAT, challenges faced in quitting smoking, and the importance of targeted interventions to support a tobacco-free lifestyle.

Why Smoking Rates Are High Among Opioid-Dependent Individuals

People undergoing opioid therapy face unique challenges when it comes to quitting smoking. For many, nicotine alleviates some withdrawal symptoms and enhances the short-term effects of opioids. However, this creates a double dependency, making it more difficult to quit either substance.

Social dynamics also contribute significantly. Smoking is often normalised in environments where opioid therapy is administered, and peer influences can reinforce these habits. Furthermore, individuals receiving OAT may already suffer from serious mental health issues such as depression or anxiety, which are known to complicate smoking cessation efforts.

It’s clear that quitting smoking during opioid treatment requires specialised support, distinct from general smoking cessation strategies.

Limited Progress with Traditional Smoking Cessation Treatments

Traditional methods for quitting smoking have shown only modest success in this population. According to a study on smoking cessation among people with opioid use disorders, “Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with opioid use disorder. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared to standard treatment regimens.” (Source)

These findings highlight the need for approaches tailored specifically to individuals undergoing OAT. While nicotine replacement therapy (NRT) and behavioural counselling can be beneficial, their effectiveness remains limited due to the high dependency levels and unique physiological and psychological factors at play.

Integrated Approaches for Quitting Smoking During Opioid Treatment

Despite the challenges, there are promising avenues for improving smoking cessation during opioid treatment. Combining behavioural counselling with pharmacological aids like NRT has shown some progress. However, as noted in a related study, “Pharmacotherapies, such as nicotine replacement or varenicline, have modest effect rates for smoking cessation among methadone-maintained and other patients with opioid use disorder.” (Source)

This underscores the potential of integrating smoking cessation services directly into opioid therapy programmes. Strategies may include providing patients with free or subsidised access to NRT, regular counselling sessions during medical appointments, and additional long-term support to prevent relapses.

Why Smoking Cessation in Opioid Therapy Should Be Prioritised

Quitting smoking during opioid treatment has profound health benefits. Even a partial reduction in cigarette consumption can significantly lower the risks of developing serious illnesses. For those receiving OAT, addressing tobacco dependency alongside opioid recovery aligns with broader health improvement goals and ensures a comprehensive approach to treatment.

Achieving long-term smoking cessation may require multiple attempts, but persistence pays off. Healthcare providers play a critical role in encouraging patients, offering resources, and fostering an environment where smoking reduction and eventual cessation are achievable.

Source: Jama Network