Reduced cigarette smoking during injectable extended-release naltrexone treatment for opioid use disorder

ABSTRACT

Background

The prevalence of tobacco cigarette smoking in the US has declined to approximately 15%, yet, it remains over 90% among individuals with opioid use disorder regardless of whether they are currently using opioids illicitly or as opioid substitution therapy. This disparity raises the question of whether opioids facilitate smoking among individuals with opioid use disorder and whether opioid antagonists may reduce it.

Objectives

Determine whether injectable extended-release naltrexone (XR-NTX) treatment of opioid use disorder patients is associated with a spontaneous smoking reduction. We hypothesized that treatment with XR-NTX for would lead to a reduction in smoking in tobacco cigarette smokers with opioid use disorder.

Methods

We analyzed data from 64 tobacco cigarette smokers (38% female) with opioid use disorder who were induced on XR-NTX for prevention of relapse to opioids. The number of cigarettes smoked per day and opioid-related craving and withdrawal were assessed at baseline and during treatment.

Results

Smoking was reduced from 14.4 ± 1.0 to 9.8 ± 1.0(p < 0.001) cigarettes per day after one month and 8.6 ± 1.1 cigarettes per day after two months of treatment. Daily cigarette consumption was positively correlated with the pre-treatment frequency of opioid use and opioid-related craving during the XR-NTX treatment.

Conclusions

XR-NTX treatment in smokers with opioid use disorder was associated with a 29% decline in daily cigarette consumption. Together with prior evidence of increased smoking during opioid agonist therapy, our finding suggests a pharmacodynamic interaction between nicotine and opioid systems that could influence treatment choices in this population. Our findings merit confirmation in a prospective controlled study. (NCT02324725 and NCT01587196)

KEYWORDS:

• Opioids
• nicotine
• smoking
• extended-release injectable naltrexone
• opioid antagonist
• comorbid
• opioid addiction

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Correction

Acknowledgements

The authors wish to thank James Padley, BA for his assistance with data organization.

Additional information

Funding

R01 DA036028, R00 HD084746, SAP 4100055577, RDA015746; Eunice Kennedy Shriver National Institute of Child Health and Human Development [HD084746]; National Institute on Drug Abuse [DA015746,DA036028]; Commonwealth of Pennsylvania [SAP#4100055577].