Journal of substance abuse treatment | 2021
Reductions in tobacco use in naltrexone, relative to buprenorphine-maintained individuals with opioid use disorder: Secondary analysis from the National Drug Abuse Treatment Clinical Trials Network.
Abstract
BACKGROUND\nSmoking prevalence in individuals with opioid use disorder (OUD) is over 80%. Research suggests that opioid use significantly increases smoking, which could account for the strikingly low smoking-cessation rates observed in both methadone- and buprenorphine-maintained patients, even with the use of first-line smoking-cessation interventions. If opioids present a barrier to smoking-cessation, then better smoking outcomes should be observed in OUD patients treated with extended-release naltrexone (XR-NTX, an opioid antagonist) compared to those receiving buprenorphine (BUP-NX, a partial opioid agonist).\n\n\nMETHODS\nThe current study is a secondary analysis of a 24-week, multi-site, open-label, randomized clinical trial conducted within the National Drug Abuse Treatment Clinical Trials Network comparing the effectiveness of XR-NTX vs. BUP-NX for adults with OUD. Longitudinal mixed effects models were used to determine if there was a significant reduction in cigarette use among daily smokers successfully inducted to treatment (n\xa0=\xa0373) and a subset of those who completed treatment (n\xa0=\xa0169).\n\n\nRESULTS\nAmong daily smokers inducted onto OUD medication, those in the XR-NTX group smoked fewer cigarettes per day (M\xa0=\xa011.36, SE\xa0=\xa00.62) relative to smokers in the BUP-NX group (M\xa0=\xa013.33, SE\xa0=\xa00.58) across all study visits, (b (SE)\xa0=\xa0-1.97 (0.55), p\xa0<\xa0.01). Results were similar for the treatment completers.\n\n\nCONCLUSIONS\nOUD patients treated with XR-NTX reduced cigarette use more than those treated with BUP-NX, suggesting that XR-NTX in combination with other smoking cessation interventions might be a better choice for OUD smokers interested in reducing their tobacco use.