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Format:
Print
Author:
Patrick, Mollie E.
Dept./Program:
Psychology
Year:
2013
Degree:
MA
Abstract:
The prevalence of smoking among opioid-dependent individuals is 4-fold that of the general population and associated with significant morbidity and mortality. Our group has conducted a series of randomized trials demonstrating the efficacy of a behavioral treatment for smoking cessation among methadone- and buprenorphine-maintained patients. In those trials, participants earned financial incentives contingent upon biochemically-verified smoking abstinence. A first-line smoking pharmacotherapy, bupropion (Zyban®), was also made available to any participants who were interested and eligible. In the present study, we sought to evaluate whether bupropion contributed to outcomes beyond the effects of the established-efficacious behavioral intervention.
Data were combined from 81 participants in two trials who received the same 2-week intervention in which they could earn voucher-based incentives contingent on achieving initial smoking abstinence. Measures of smoking abstinence, treatment retention and nocotine withdrawal were compared for opioid-dependent smokers who received bupropion withdrawal were compared for opioid-dependent smokers who received bupropion (n = 32) vs. those who did not (n = 49). Overall, participants achieved high levels of smoking abstinence, with an average of 57.6% abstinent samples provided during the 2-week intervention and 44.4% of participants still abstinent at the end of the study. These outcomes compare favorably to prior efforts by others to promote smoking cessation among opioid-dependent patients.
We found no significant effect of bupropion on smoking outcomes or nicotine withdrawal (p's> .05). There was a trend toward better retention in Bupropion group, with 81% and 61% of Bupropion and No Bupropion participants retained at Study Day 14, respectively (p =.06). Taken together, our results suggest that bupropion did not enhance the outcomes of an already efficacious behavioral treatment for smoking, at least in this sample of stable opioid-maintained patients. These findings are consistent with prior studies which have generally shown no significant benefit of smoking-cessation pharmacotherapies in opioid-maintained smokers. They also highlight the importance of investigating the population-related differences that might influence the efficacy of smoking treatments, as well as the need to tailor established evidence-based treatments to the unique needs of special subgroups of smokers.