Abstract
Background and Objectives
Rates of tobacco use disorder (TUD) are high among individuals with opioid use disorder (OUD), who consistently show lower response rates to evidence-based treatment approaches for TUD relative to the general population. This systematic review aims to provide a comprehensive and updated examination of the current evidence regarding TUD treatments for individuals with OUD. We first summarize potential mechanisms driving TUD and treatment nonresponse among those with OUD, given the likely roles of overlapping reward and withdrawal processes in co-occurrence and treatment challenges. We then provide an updated review of the relevant literature on treating TUD among those with OUD.
Methods
Our review identified a total of 25 studies, with 9 examining pharmacological treatments, 5 examining behavioral treatments, and 11 examining a combination treatment approach.
Results
Consistent with previous research, pharmacological treatments were generally ineffective for smoking cessation among those with OUD. No studies reported continuous abstinence at 6 months post-quit date. Contingency management interventions showed some promise but smoking largely resumed after incentives were removed.
Discussion and Conclusions
Overall, findings demonstrate limited progress in identifying durable, effective smoking cessation interventions for individuals with OUD.
Scientific Significance
Traditional cessation treatment approaches fail to address smoking in individuals with OUD. Novel pharmacological and behavioral strategies that can be implemented into existing medications for OUD clinical care are necessary.