Integrated Nicotine Replacement and Behavioral Support to Reduce Smoking in Opioid Agonist Therapy

IF 22.5 1区医学 Q1 PSYCHIATRY

JAMA Psychiatry Pub Date : 2025-02-12 DOI:10.1001/jamapsychiatry.2024.4801

Karl Trygve Druckrey-Fiskaaen, Tesfaye Madebo, Jan Tore Daltveit, Jørn Henrik Vold, Einar Furulund, Fatemeh Chalabianloo, Torgeir Gilje Lid, Lars Thore Fadnes

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Abstract

ImportanceApproximately 85% of individuals receiving opioid agonist therapy for opioid dependence smoke tobacco. Despite the significant health risks associated with smoking-related diseases, there has been limited evaluation of smoking interventions tailored to this population.ObjectiveTo determine the effectiveness of an intervention combining nicotine replacement with brief behavioral support in reducing cigarette use.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted from April 2022 to October 2023 in 7 specialized opioid agonist therapy clinics in Bergen and Stavanger, Norway. The analyst was blinded to patient groupings. Assessors (study nurses) were not fully blinded to participant allocation. Individuals diagnosed with opioid dependency receiving opioid agonist therapy at participating clinics and smoking at least 1 cigarette per day were eligible for participation. Data analysis was performed from December 2023 through October 2024.InterventionIn addition to standard opioid agonist therapy, participants in the intervention group received a 16-week integrated treatment combining nicotine replacement with brief behavioral support. Participants in the control group received only standard opioid agonist therapy.Main Outcomes and MeasuresThe primary outcome was at least a 50% reduction in the number of cigarettes smoked, self-reported as cigarette use in the past 7 days at week 16. The analysis followed intention-to-treat principles. Cigarette use was self-reported as per the timeline-follow-back method.ResultsAmong the 259 participants (mean [SD] age, 48.5 [10.4] years; 80 [30.9%] female), 135 were allocated to the intervention group and 124 to the control group. The odds ratio of at least halving the number of cigarettes smoked was 2.07 (95% CI, 1.14-3.75) in the intervention group compared with the control group.Conclusions and RelevanceProviding integrated nicotine replacement and behavioral support at opioid agonist treatment clinics effectively helped opioid-dependent participants reduce the number of cigarettes smoked.Trial RegistrationClinicalTrials.gov Identifier: NCT05290025

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综合尼古丁替代和行为支持减少阿片类激动剂治疗中的吸烟

约85%接受阿片类药物激动剂治疗的阿片类药物依赖者吸烟。尽管与吸烟有关的疾病存在重大的健康风险，但针对这一人群的吸烟干预措施的评估有限。目的探讨尼古丁替代与短暂行为支持相结合的干预措施对减少吸烟的效果。设计、环境和参与者这项多中心随机临床试验于2022年4月至2023年10月在挪威卑尔根和斯塔万格的7个专门的阿片类药物激动剂治疗诊所进行。分析师对患者分组一无所知。评估员（研究护士）对参与者分配没有完全盲法。被诊断为阿片类药物依赖的个体在参与的诊所接受阿片类药物激动剂治疗，每天至少吸烟1支，符合参与条件。数据分析时间为2023年12月至2024年10月。干预：除了标准的阿片类激动剂治疗外，干预组的参与者还接受了为期16周的综合治疗，包括尼古丁替代和短暂的行为支持。对照组的参与者只接受标准的阿片受体激动剂治疗。主要结局和措施主要结局是吸烟数量至少减少50%，在第16周的过去7天内自我报告吸烟情况。分析遵循意向治疗原则。吸烟情况是根据时间轴追踪法自我报告的。结果259名参与者(平均[SD]年龄48.5[10.4]岁；女性80例（30.9%），干预组135例，对照组124例。与对照组相比，干预组吸烟数量至少减半的优势比为2.07 （95% CI, 1.14-3.75）。结论及相关性在阿片类激动剂治疗诊所提供综合尼古丁替代和行为支持，有效帮助阿片类依赖参与者减少吸烟数量。临床试验注册号：NCT05290025

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来源期刊

JAMA Psychiatry PSYCHIATRY-

CiteScore

30.60

自引率

1.90%

发文量

233

期刊介绍： JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.