Investigating tobacco withdrawal in response to reduced nicotine cigarettes among smokers with opioid use disorder and other vulnerabilities

Abstract

Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

FIGURE 1.

Minnesota Tobacco Withdrawal Scale (MTWS) Total (upper panel) and Desire to Smoke (lower panel) mean scores at the baseline usual brand cigarette session across time in opioid-maintained (solid lines) smokers vs. smokers without other substance use disorders (dashed lines). Error bars represent standard error of the mean. The pre-smoking baseline timepoint represents conditions of acute abstinence prior to smoking the usual brand cigarette and +15, +30, +45, +60 min represent assessment timepoints after smoking the usual brand cigarette.

FIGURE 2.

Minnesota Tobacco Withdrawal Scale (MTWS) Total (upper panels) and Desire to Smoke (lower panels) mean scores across the research cigarette doses and across time in opioid-maintained (left panels) smokers vs. smokers without other substance use disorders (right panels). Error bars represent standard error of the mean. The pre-smoking baseline timepoint represents conditions of acute abstinence prior to smoking the research cigarettes and +15, +30, +45, +60 min represent assessment timepoints after smoking each research cigarette.