Achieving smoking cessation milestones in opioid treatment patients: a randomized 2 x 2 factorial trial of directly observed and long-term varenicline

在阿片类药物治疗患者中实现戒烟里程碑：直接观察和长期伐尼克兰的随机 2 x 2 析因试验

• 批准号: 10063497
• 负责人: Shadi Nahvi
• 金额: $ 66.74万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10063497
• 关键词: Abstinence; Achievement; Address; Adherence; Behavioral; Biological Factors; Chronic; Clinical; Clinical Trials; Communities; Data; Directly Observed Therapy; Disease; Double-Blind Method; Enrollment; Evidence based intervention; Funding; HIV/TB; Health; Health Care Costs; Hour; Individual; Intervention; Methadone; Modeling; Motivation; National Institute of Drug Abuse; Nature; Opioid; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Pharmacogenetics; Pharmacotherapy; Placebos; Prevalence; Process; Psychological Factors; Psychosocial Factor; Randomized; Randomized Controlled Trials; Relapse; Research; Self Administration; Smoker; Smoking; Smoking Cessation Intervention; Substance Use Disorder; Testing; Therapeutic Intervention; Time; Tobacco; Tobacco use; Withholding Treatment; active method; addiction; adherence rate; base; cigarette smoke; comorbidity; double-blind placebo controlled trial; efficacy testing; evidence base; improved; innovation; intervention effect; medication compliance; methadone patient; model design; nicotine replacement; novel; novel strategies; opioid treatment program; opioid use disorder; pilot trial; prevent; psychologic; recruit; skills; smoking cessation; social; social factors; standard care; success; theories; tobacco abstinence; tobacco smokers; treatment effect; varenicline

ABSTRACT Tobacco use and tobacco-related disease are highly prevalent among persons with opioid use disorders (OUD). Unfortunately, traditional evidence-based smoking cessation interventions have yielded low rates of tobacco abstinence in this group. The majority of trials evaluating smoking cessation treatment interventions among persons with OUD have relied on short-term interventions that do not account for the unique challenges faced by these smokers, specifically, establishing initial abstinence, adhering to evidence-based cessation treatments, and maintaining abstinence once active treatments cease. Long-term smoking cessation medication treatment approaches have shown promise in promoting cessation and decreasing relapse among individuals without OUD, however the applicability of extended medication approaches to smokers with OUD may be limited by poor adherence to smoking cessation medications. Though adherence to cessation medication is strongly associated with cessation success, adherence is especially challenging for persons with OUD. Opioid treatment program-based directly observed therapy (DOT) interventions improve clinical outcomes in HIV and TB, and our pilot data suggest that DOT varenicline is associated with increased smoking cessation medication adherence and may increase smoking cessation rates. We therefore propose a 2 x 2 factorial, randomized, double-blind, placebo-controlled trial to efficiently test two interventions: directly observed medication therapy, and long-term therapy with varenicline. Our analytic strategy will evaluate the milestones in smoking cessation—achieving initial abstinence, preventing lapse and preventing relapse-- necessary for long-term cessation, and evaluate theoretically-guided psychological and social factors and pharmacogenetic factors that influence these cessation processes. We will recruit 450 smokers with OUD from community-based, outpatient opioid treatment programs and test the following specific aims: (1) to test the efficacy of directly observed varenicline therapy compared to self-administered varenicline therapy on smoking cessation milestones, (2) to test the efficacy of long-term varenicline compared to short-term varenicline on smoking cessation milestones, and (3) to understand the mechanism of smoking cessation by examining the impact of theory-guided psychological and social factors and of pharmacogenetic factors on cessation milestones. This proposal is innovative, and addresses the challenges of both promoting and maintaining tobacco abstinence among smokers with OUD.

摘要