Managing tobacco smoking leads to reductions in opioid use, study shows

Jan 25 2018

In a six-month study recently concluded, a research unit affiliated with two hospital institutions and a university in Ottawa found that a reduction in the number of cigarettes smoked daily also reduced a smoker's dependence on opioids.

The study, "Management and Point-of-Care for Tobacco Dependence (PROMPT): a feasibility mixed methods Community Based Participatory Action Research project in Ottawa, Canada," was published in the latest issue of BMJ Open. This latest research by The Bridge Engagement Centre (The Bridge), affiliated with The Ottawa Hospital, Ottawa Hospital Research Institute and the University of Ottawa, followed a previous study at The Bridge of 856 participants drawn primarily from the homeless community.

When that study revealed that 96 per cent of the participants smoked, compared to just 9 percent of the Ottawa population, The Bridge undertook the second study to determine if it could reduce the prevalence of addiction among the homeless.

"The majority of the homeless are at high risk," said Smita Pakhale, MD, FRCPC, MSc, Clinician-Scientist Lead at The Bridge, and a member of the American Thoracic Society's Tobacco Action Committee. "If they have housing, they fear losing it; 79 percent have no ready access to food; mental health issues, caused by stress and/or generational problems, are up to eight times more prevalent among the homeless than in the general population. They cope with these problems by turning to caffeine, alcohol and cigarettes, which are readily available."

The second study, The Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence (PROMPT), followed 80 of Ottawa's most vulnerable residents for 6 months while providing peer support, regular counselling with a mental health nurse, free Nicotine Replacement Therapy (nicotine patch, gum, inhaler), and peer-led life-skills workshops.

The content of the study and its administration was a joint effort by The Bridge and the participants who were trained in the ethics of recruitment and management. This joint action, Dr. Pakhale said, placed participants in the driver's seat which built their confidence and helped them to focus on a productive future.

PROMPT's findings included a reduction in the participants' daily cigarette use from an average of 20 a day at the start of the study to the average of nine a day at the study's end. There was also an 18.8 percent reduction in the use of opioids such as heroine, fentanyl and Oxycontin.

More than a third of PROMPT participants reported an overall improvement in quality of life, including returning to work, greater community engagement and community support, accessing drug treatment programs and school enrolment.

The Bridge research team will expand the scale of the PROMPT project in an upcoming e-cigarette project funded by the Canadian Institute of Health Research.

"The PROMPT project demonstrates that a community-based tobacco dependence program can foster positive life changes," said Dr. Pakhale. "Moreover, PROMPT's patient engagement and tobacco management model, a whole-person strategy, can be used to deal with the growing opioid crisis in North America."