Smoking and Opiate Withdrawal Symptoms: The Impact of Psychosocial Variables among Individuals Receiving Medication Assisted Treatment for Opioid Detox

Abstract

Individuals with opioid use disorder (OUD) endorse high rates of combustible smoking (Zale et al., 2015) which is associated with poorer outcomes (e.g., opioid craving and lower detoxification completion rates) among individuals receiving medication-assisted treatment (MAT; Mannelli, Wu, Peindl, & Gorelick, 2013) and lower smoking cessation rates in smoking cessation treatment (Okoli et al., 2010). The complex pharmacological relationship between opioids and nicotine may help explain these findings (Kohut, 2017), however little is known about psychosocial variables that influence MAT processes among combustible smokers with OUD. The present study sought to expand upon prior work (Mannelli et al., 2013) by examining the impact of psychological factors and smoking-related variables on opiate withdrawal symptoms among smokers with OUD receiving Suboxene at baseline at an inpatient substance use treatment facility. Current smokers with OUD (N = 59) completed a battery of psychological measures at baseline. The present study tested the influence of daily smoking rate, nicotine dependence, smoking urges, anxiety, and depression on opiate withdrawal symptoms. Findings revealed that smoking urges predicted severity of opiate withdrawal symptoms while controlling for daily smoking rate and nicotine dependence. However, when depression was added as a predictor, it explained variance severity of withdrawal symptoms while controlling for smoking-related variables and above and beyond anxiety. Results highlight the importance of considering psychological factors, specifically depression, that impact treatment processes among smokers with OUD to help inform the development of effective treatment interventions.