A randomized clinical trial found that nicotine replacement therapy combined with behavioral support significantly reduced cigarette consumption among patients receiving opioid agonist therapy.

According to their study published in JAMA Psychiatry, researchers conducted the multicenter trial from April 2022 to October 2023 across seven opioid agonist therapy (OAT) clinics in Norway. They enrolled 259 participants (mean age 48.5 years, 30.9% female) who smoked daily while on OAT. At baseline, participants reported smoking 11.7 cigarettes per day for a mean of 20.4 pack years. Most participants (52.9%) used buprenorphine as their OAT.

Participants were randomized into:

• Intervention group (n = 135): Received 16 weeks of free nicotine replacement therapy (NRT; patches, lozenges, or gum) plus behavioral support.
• Control group (n = 124): Continued standard OAT without additional cessation support.

At week 16, 29.6% (40/153) of participants in the intervention group reduced the number of cigarettes smoked in a day by half, comapred with 16.9% (21/124) of control participants (odds ratio [OR] = 2.07; 95% confidence interval [CI] = 1.14-3.75).

A per-protocol analysis for participants who attended at least 50% of sessions showed 45.1% of participants in the intervention group reduced smoking vs. 20.4% in the control group (OR = 3.21; 95% CI = 1.54-6.66). 

"The results support making smoking reduction interventions available as a standardized and integrated part of OAT, providing opioid-dependent persons with repeated opportunities to quit or reduce smoking," wrote Karl Trygve Druckrey-Fiskaaen, MD, lead author from the University of Bergen in Norway, along with colleagues.

The researchers continued, "system changes allowing for continued and free-of-charge smoking reduction and cessation treatment could have the potential to reduce smoking-related morbidity and mortality among patients receiving OAT."

Limitations included some potential biases. The study was not designed to adjust for several variables, and the inclusion of the tobacco fraction mixed with cannabis in the number of cigarettes recorded may have resulted in fewer participant reports of smoking cessation. However, the researchers noted, a strength of the study was its "trial design [that] included all eligible persons willing to participate regardless of motivation to change smoking habits."

No conflicts of interest were disclosed.