Smoking Cessation Challenges in Opioid Use Disorder: A Review
Publication Title: Addressing tobacco use in the context of opioid use disorder: A systematic review of smoking cessation interventions
Summary
- Question
- This systematic review aimed to assess the effectiveness of smoking cessation interventions specifically for individuals with opioid use disorder (OUD). The researchers examined pharmacological treatments, behavioral approaches, and combined interventions to determine their impact on reducing tobacco use disorder (TUD) in this population.
- Why it Matters
Tobacco use is disproportionately high among individuals with OUD, with up to 85% of those receiving medications for OUD (MOUD) smoking regularly. Smoking exacerbates health risks and is a major contributor to preventable diseases. Despite interest in quitting, traditional smoking cessation treatments are less effective for individuals with OUD compared to the general population. Addressing this issue is crucial for improving health outcomes in patients with OUD and for reducing the burden of tobacco-related illnesses.
- Methods
- The researchers conducted a systematic review of 25 clinical trials that included individuals with OUD. The studies examined three types of interventions: pharmacological treatments, such as nicotine replacement therapy (NRT), bupropion, and varenicline; behavioral therapies, such as contingency management (CM); and combined approaches integrating both pharmacological and behavioral methods. Participants were primarily individuals receiving MOUD, such as methadone or buprenorphine, and outcomes were assessed through measures like smoking abstinence and cigarette reduction.
- Key Findings
- Pharmacological treatments, including NRT and varenicline, showed limited effectiveness in achieving long-term smoking abstinence in individuals with OUD. Behavioral approaches, particularly CM, demonstrated some success in promoting initial abstinence, but these effects were often short-lived once incentives were removed. Combined interventions provided modest reductions in cigarette consumption but failed to achieve durable abstinence. No study reported continuous abstinence at six months post-treatment.
- Implications
- The findings highlight the need for novel and tailored approaches to smoking cessation for individuals with OUD. Traditional treatments are less effective due to unique biological and psychosocial factors in this population. Harm reduction strategies, such as reducing cigarette consumption or incorporating e-cigarettes, may offer more achievable goals. Additionally, integrating smoking cessation into MOUD clinical care could improve outcomes, though long-term strategies are needed to sustain progress beyond initial interventions.
- Next Steps
- Future research should focus on developing innovative treatments that address the specific needs of individuals with OUD, including maintenance-based strategies and harm reduction approaches. Exploring the potential of emerging therapies, such as e-cigarettes combined with behavioral interventions or novel pharmacological agents, may be beneficial. Additionally, expanding contingency management programs and leveraging digital tools to sustain long-term outcomes are promising areas for further investigation.
- Funding Information
- This research was supported by the U.S. Department of Veterans Affairs (award 1IK2CX002286). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs. Yale University also provided funding and support for this research.
Full Citation
Parida S, Ameral V, Wolkowicz N, Kelly M, Patterson J, Sofuoglu M, MacLean R. Addressing tobacco use in the context of opioid use disorder: A systematic review of smoking cessation interventions. American Journal On Addictions 2026 PMID: 41773712, DOI: 10.1111/ajad.70154.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.
Authors
Suprit Parida
First AuthorR. Ross MacLean, PhD
Last AuthorAssociate Professor of Psychiatry