Smoking During Medically Managed Opioid Withdrawal is Associated with Increased Craving for Opioids and Nicotine
Over 80% of people with opioid addiction smoke tobacco. Smoking rates remain high among people who undergo medically managed withdrawal (detoxification). It is not known if smoking cessation during opioid detoxification treatment impacts craving, withdrawal symptoms, or subsequent substance use. Very low doses of naltrexone (0.125 mg–0.25 mg) given concurrently to patients receiving methadone for detoxification has been associated with reduced opioid withdrawal and craving. Using data from a randomized clinical trial of very low-dose naltrexone administered during detoxification, researchers conducted an observational study of craving, opioid treatment completion, and substance use in the next week among 174 subjects categorized as in-treatment smokers, non-smokers, and smokers not allowed to smoke. Smoking cessation counseling and pharmacotherapy were not offered as part of treatment.
- In-treatment smokers had more severe opioid craving scores—but not more severe opioid withdrawal scores—than non-smokers and smokers not allowed to smoke.
- In-treatment smokers had higher cigarette craving scores than smokers who were not allowed to smoke.
- In-treatment smokers were less likely to complete detoxification treatment (59% versus 79%) and smoked more cigarettes in the week after treatment (20 versus 13 per day) than smokers not allowed to smoke. No differences were found in use of opioids, alcohol, cocaine, or cannabis.
- Among the in-treatment smokers, those treated with very low-dose naltrexone had lower opioid withdrawal and craving scores than those receiving placebo.