Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment
Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment
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DOI：
10.1093/ntr/ntt046
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发表时间：
2013-10-01
影响因子：
4.7
通讯作者：
Gorelick, David A.
中科院分区：
文献类型：
--
作者：
Mannelli, Paolo;Wu, Li-Tzy;Gorelick, David A.
导言：烟草使用与阿片类药物成瘾的相关性产生了对可用和更有效干预措施的需求。因此，更少探索尼古丁阿片类药物的临床相互作用的进一步分析是warranted.Methods：在一个双盲，随机极低剂量纳洛酮（VLNTX）住院戒毒试验评估措施阿片类药物戒断和烟草使用的OA参与者的事后分析。治疗中的吸烟者进行了比较，与非吸烟者，或吸烟者谁不允许smoke.Results：共141（81%）的174 OA参与者吸烟者，所有尼古丁依赖。住院患者吸烟是阿片类药物戒断不适的预测因子。与不允许吸烟的吸烟者（n = 45）或非吸烟者（n = 33）相比，治疗中吸烟者（n = 96）表现出更高的阿片类药物渴求（F = 3.7，p <0.001）和更低的脱毒完成率（chi（2）= 7.9，p <0.02）。治疗期间吸烟与脱毒期间更高的香烟渴望（F = 4.1，p <0.001）和随访时更高的吸烟数量（F = 3.6，p <0.02）相关。在治疗中吸烟者，VLNTX除了美沙酮锥度是有效的缓解阿片类药物戒断和渴望比其他治疗，而组合VLNTX可乐定与显着减少香烟的渴望和吸烟在detoxetiz.Conclusions：未能解决烟草使用可能会产生负面影响，管理阿片类药物停药。阿片类药物解毒可能为扩大戒烟治疗提供了一个机会窗口，从而改善了OA的结局。观察到的效果支持在有或无药物滥用的个体中进行的VLNTX-可乐定戒烟试验。
Introduction: The relevance of tobacco use in opioid addiction (OA) has generated a demand for available and more effective interventions. Thus, further analysis of less explored nicotine-opioid clinical interactions is warranted.Methods: A post-hoc analysis of OA participants in a double-blind, randomized very low dose naltrexone (VLNTX) inpatient detoxification trial evaluated measures of opioid withdrawal and tobacco use. Intreatment smokers were compared with nonsmokers, or smokers who were not allowed to smoke.Results: A total of 141 (81%) of 174 OA participants were smokers, all nicotine-dependent. Inpatient smoking was a predictor of opioid withdrawal discomfort. Intreatment smokers (n = 96) showed significantly higher opioid craving (F = 3.7, p < .001) and lower detoxification completion rate (chi(2) = 7.9, p < .02) compared with smokers who were not allowed to smoke (n = 45) or nonsmokers (n = 33). Smoking during treatment was associated with more elevated cigarette craving during detoxification (F = 4.1, p < .001) and a higher number of cigarettes smoked at follow-up (F = 3.6, p < .02). Among intreatment smokers, VLNTX addition to methadone taper was effective in easing opioid withdrawal and craving more than other treatments, whereas the combination VLNTX-clonidine was associated with significantly reduced cigarette craving and smoking during detoxification.Conclusions: Failure to address tobacco use may negatively affect pharmacologically managed opioid discontinuation. Opioid detoxification may offer a window of opportunity to expand smoking cessation treatment, hence improving OA outcomes. The observed effects support testing of VLNTX-clonidine in smoking cessation trials among individuals with or without substance abuse.