Extended Tobacco Dependence Intervention in Buprenorphine Treatment

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Tobacco dependence is prevalent in patients with opioid abuse histories. Cigarette smoking rates in both intreatment and out-of-treatment samples generally range from 80 to 90%. There have been few attempts to treat opioid dependent smokers, and the extant attempts have met with limited success. The proposed study is an attempt to use an innovative motivational system, combined with extended behavioral and pharmacological treatment, to produce sustained abstinence in this population. The intervention is modeled on those used successfully in published and on-going work by our group with other complex smokers. The primary hypothesis is that the Innovative System (IS) will be more effective than the Standard Treatment Control (STC) at 12 and 18 months after entrance into the intervention. Hypotheses concerning individual differences in outcomes are also proposed, and these include both behavioral and pharmacogenetic variables. The data will also provide preliminary information about whether smoking cessation or cessation attempts are correlated with change in use of illicit drugs. Two-hundred buprenorphine treatment patients who smoke more than five cigarettes per day will be randomly assigned to either IS or to STC. Intent to quit smoking is not required as an inclusion criterion. In the STC, participants will receive a brochure on quitting, a list of local referrals, and an information sheet that tells them how to obtain cessation medication through the City of San Francisco public health care system. In the IS, participants will be counseled using a computerized counseling system at baseline and months 3, 6, and 12. The system is designed to increase motivation to quit smoking. At any time after entrance into the study up until month 12, if the participant requests smoking cessation treatment, treatment that uses both combined pharmacotherapy and behavioral counseling will be provided. Pharmacotherapy will consist of nicotine replacement treatment (NRT). If NRT fails to produce abstinence, varenicline will be provided. Treatment is available for six months after it is initiated. Assessment points are at baseline, and months 3, 6, 12, and 18. Seven-day point prevalence abstinence from cigarettes is the primary dependent variable. This study is significant in that it offers an innovative approach for a population with high smoking rates.