Medications For Tobacco Dependence Research Articles

Leveraging National Data and Regional Innovations to Right-Size Tobacco Treatment Policy for Behavioral Health in a Midwestern State.

People with mental health (MH) and substance use disorders (SUD) have high rates of tobacco use and tobacco-related mortality. They want to stop smoking and studies have shown they can quit, but few behavioral health facilities provide tobacco treatment. The purpose of this paper is to describe how a midwestern statewide behavioral health collaboration used regional data to pinpoint strengths and weaknesses in tobacco treatment trends, identified policies in neighboring states that were associated with high rates of tobacco treatment, and worked with state leaders to implement these policies to enhance treatment. We used publicly available data from 2 SAMHSA annual national surveys of MH/SUD facilities to describe tobacco treatment services and policies in behavioral health facilities in Kansas and 3 neighboring states (Missouri, Nebraska and Oklahoma). We interviewed neighboring state leaders to identify policies they had implemented to boost tobacco recovery services in behavioral health. We collaborated with our state behavioral health agency to encourage adoption of similar policies. Using 7 years of survey data (2014-2020), rates for screening, counseling, and medications for tobacco dependence were highest in Oklahoma and Missouri facilities. Oklahoma had the highest percentages of facilities reporting smoke-free campuses. In all states, rates of tobacco service provision and smoke-free campuses were lower among SUD facilities than in MH facilities. State leaders associated several policies with high performance, including (a) requiring programs contracting with the state to conduct screening, provide counseling, and adopt smoke-free campuses (Oklahoma and Missouri); (b) state-based collection of tobacco treatment service provision data (Oklahoma); (c) providing facilities with free NRT for clients (Oklahoma); (d) setting benchmarks for service provision (Oklahoma); (e) comprehensive Medicaid coverage of cessation medications (Missouri). Upon review of these findings, Kansas behavioral health officials adopted a 2-year process to implement similar policies and are integrating tobacco treatment requirements into the state Certified Community Behavioral Health Clinic program. Summarizing and sharing freely-available data across states laid the groundwork for cross-border networking and policy change. State and federal agencies should integrate these policies into contracts and block grants to reduce tobacco-related disparities among individuals with behavioral health conditions.

Cytisinicline for Smoking Cessation in Adult Smokers

Cytisinicline is a naturally derived, plant-based medication that has been developed as a treatment for smoking cessation and nicotine dependence. Based on a product available in Europe, over 4 million smokers in Central and Eastern Europe have used this medication and over 10,000 subjects have participated in clinical trials worldwide. Cytisinicline acts as a partial agonist and partial antagonist for the alpha-4 beta-2 nicotinic acetylcholine receptors in the brain, which are the same receptors that are activated by nicotine. Cytisinicline helps to reduce cravings, withdrawal symptoms and the reward and satisfaction associated with smoking by preventing nicotine from binding to these receptors and releasing dopamine. The On-going Research of Cytisinicline for Addiction-1 clinical trial has shown that participants receiving 3.0 mg cytisinicline three times daily had the highest biochemically verified point-prevalence abstinence rate (50%) compared with placebo (10%) at the end of treatment, with no significant safety concerns. These quit results were statistically significant (p<0.001). Cytisinicline demonstrates weak binding to the 5-hydroxytryptamine 3 receptor that causes nausea, consistent with few observed nausea events in participants receiving cytisinicline. No new medications for tobacco dependence have received United States Food and Drug Administration approval since 2006. Cytisinicline represents a promising treatment for those globally who continue to smoke tobacco.

Do adjunctive interventions to standard behavioral support increase adherence to medications for tobacco dependence?

Interventions to enhance medication adherence increase the proportion of patients compliant with medication (on average, 628 per 1000 people in the adjunctive intervention group vs 526 per 1000 people in the standard behavioral support group adhered based on RCTs including around 1600 people). A small improvement in rates of adherence was noted as measured by the amount of medication consumed (moderate‐certainty evidence). However, this did not seem to lead to higher rates of abstinence from tobacco (low‐certainty evidence). No adverse effects seem to be associated with the studied adjunctive interventions.

Do adjunctive interventions to standard behavioral support increase adherence to medications for tobacco dependence?

Do adjunctive interventions to standard behavioral support increase adherence to medications for tobacco dependence?

Interventions to increase adherence to medications for tobacco dependence.

Interventions to increase adherence to medications for tobacco dependence.

A meta-ethnography of adult smokers' exploring the meanings of tobacco dependency medications adherence behaviours during smoking cessation.

To synthesize the experiences and adherence of adult smokers' with tobacco dependence medications. Meta-ethnography. Seven bibliographic databases were systematically searched until April 2016. A standardized appraisal tool evaluated the quality of the selected studies. Seven studies met the eligibility criteria. Three major themes described the experiences and adherence of adult smokers' with tobacco dependence medications; the psychosocial context, predilection for willpower and "natural" methods and a tendency to resist medications. The findings of this meta-ethnography are important to future clinical practice guideline development so health professionals contribute effectively to further reduction in smoking prevalence. Further research is needed to understand resistance to tobacco dependence medications and to inform the design of person-tailored interventions to improve tobacco dependence medication adherence that can be incorporated into smoking cessation interventions. Smoking causes more death and disability in the world than any other avoidable factor. Research on smoker perspectives on tobacco dependence medications is sparse. Tobacco dependency is a unique treatment context with specific adherence issues. Smokers are active decision-makers regarding tobacco dependence medications. Inconsistent adherence to tobacco dependency medication regimens was apparent. Implications for health professionals, healthcare policy and clinical practice guidelines regard the structure of consultations with smoking patients. It is critical for all health professionals to assess the person seeking to stop smoking and foresee the possible causes of non-adherence behaviour. Addressing non-adherence will to lead to more effective health communications and positively contribute to quality of smoking cessation care.

Study of monotherapy versus combination therapy for tobacco dependence among heavily addicted smokers

ObjectivesCombination therapy for tobacco dependence is becoming a standard of care. We sought to compare benefits and adverse events for combination therapy versus monotherapy for smokers in The Smokers' Health Project. MethodsThis secondary data analysis was derived from adult smokers (n = 198) who initially smoked 15 or more cigarettes per day and participated in The Smokers' Health Project. Participants were grouped as taking 1 medication or 2 concurrent medications for tobacco dependence for 1 year over the 2-year study period. Adverse events were compared between medication groups using chi-square tests. Crude and adjusted odds ratios were calculated for cessation at 6, 12, 18, and 24 months using logistic regression. ResultsNo differences were seen in the proportion of incident adverse events between the monotherapy (28.3%) and combination therapy (32.3%) groups (P = 0.54). At 6 months, the odds of quitting were less in the combination therapy group relative to those taking monotherapy (adjusted odds ratio = 0.47 [95% CI 0.24–0.93]). At 12, 18, and 24 months, the odds of quitting did not differ between therapy groups (P = 0.07, 0.33, 0.55, respectively). ConclusionMonotherapy and combination therapy for smoking cessation are similarly effective up to 24 months, and they exhibit similar adverse event attributes.

Interventions to increase adherence to medications for tobacco dependence.

Interventions to increase adherence to medications for tobacco dependence.

Outcomes From a Patient-Centered Residential Treatment Plan for Tobacco Dependence

St. Helena Hospital launched the first US residential stop-smoking program, The St. Helena Center for a Smoke-Free Life, in 1969. This observational report describes the center's treatment outcome rate for using a patient-centered approach to the use of tobacco dependence medications and behavioral treatment for patients who participated in the program from January 1, 2005 through December 31, 2007. A total of 284 patients used long-acting (nicotine patch, bupropion, and varenicline) and/or short-acting medications (nicotine nasal spray, nicotine gum, nicotine lozenge, and nicotine oral inhaler) alone or in combination during treatment and after discharge. Seven patients chose to use no medications. Patients using nicotine patch received a mean ± SD dose of 33.3±15.7 mg of nicotine in 16 hours (range, 5-90 mg). The 12-month 7-day point prevalence smoking abstinence rate after participation in the intensive, 1-week, residential program was 57.0%. Recommendations are discussed for future research and for implementing aspects of the St. Helena program in other treatment settings.

Nicotine Enhances Alerting, but not Executive, Attention in Smokers and Nonsmokers

Difficulty concentrating is a symptom of nicotine withdrawal that can contribute to relapse in individuals trying to quit smoking. The purpose of this study was to determine the effects of nicotine on executive and alerting attention in smokers and nonsmokers. Thirty daily smokers who were not tobacco deprived and 30 nonsmokers participated in the study. Participants received a single dose of intranasal nicotine (0, 0.5, or 1.5 mg) at each of 3 experimental sessions on separate days. Participants completed subjective ratings and 3 attention tasks before and after nicotine administration. Nicotine had no effect on executive attention as assessed by a Rapid Serial Visual Presentation (RSVP) task or the Attention Network Test in smokers and nonsmokers. In contrast, nicotine enhanced alerting attention by decreasing errors on a Continuous Performance Test (CPT) in nonsmokers and improving the correct identification of target words on the RSVP task in smokers. Nonsmokers were more sensitive than smokers to the subjective, but not the cardiovascular, effects of nicotine. The acute administration of intranasal nicotine improved alerting attention in nonsmokers as measured by the CPT, and in smokers as measured by the RSVP. Understanding the elements of attention enhanced by nicotine might guide the development of novel medications for tobacco dependence.

Abstinence and psychological distress in co-morbid smokers using various pharmacotherapies

BackgroundExisting trials of varenicline have typically excluded smokers with concurrent medical and psychiatric illnesses and no data exist comparing effectiveness of varenicline with combination pharmacotherapy. This study evaluated abstinence and psychiatric outcomes of various tobacco dependence medications, including varenicline. MethodsRetrospective cohort of 723 smokers, most with significant medical and psychiatric comorbidity, was evaluated at the UMDNJ-Tobacco Dependence Clinic from 2006 to 2008. Demographics, measures of tobacco dependence and co-morbidities, and a validated instrument measuring psychological distress (Kessler-6) were obtained. Primary outcome was 7-day point abstinence at 6 months after target quit date. ResultsCessation medications used included combination pharmacotherapy (39%), single nicotine replacement therapy (NRT) or bupropion (29%), and varenicline (23%), with 9% using no medications. Overall, 23% of patients were abstinent at 6 months. In an adjusted regression model, smokers using varenicline or combination medications were more likely abstinent at 6 months than those using no medications (adjusted odds ratio=2.99; 95% confidence interval=1.20–7.47 and 2.80; 1.15–6.82, respectively), but not statistically higher than those using single medications (AOR=1.70). Age, gender, education, marital status, cigarettes per day, time to first cigarette, night smoking, and menthol smoking were not significantly related to abstinence. Varenicline or combination medications did not significantly increase serious psychological distress over the treatment period compared to other medication options. ConclusionsBoth varenicline and combination pharmacotherapy were effective and did not increase psychological distress for up to 6 months in smokers with co-morbidities treated at a specialty clinic.

The endocannabinoid system: a new molecular target for the treatment of tobacco addiction.

Tobacco addiction is one of the leading preventable causes of mortality in the world and nicotine appears to be the main critical psychoactive component in establishing and maintaining tobacco dependence. Several lines of evidence suggest that the rewarding effects of nicotine, which underlie its abuse potential, can be modulated by manipulating the endocannabinoid system. For example, pharmacological blockade or genetic deletion of cannabinoid CB(1) receptors reduces or eliminates many behavioral and neurochemical effects of nicotine that are related to its addictive potential. This review will focus on the recently published literature about the role of the endocannabinoid system in nicotine addiction and on the endocannabinoid system as a novel molecular target for the discovery of medications for tobacco dependence.

Pharmacotherapy and smoking cessation at a tobacco dependence clinic

Background. Tobacco dependence medications are effective, and combinations may offer advantages. This study evaluates abstinence rates among smokers treated in a tobacco specialist clinic with individual and/or group counseling plus combination pharmacotherapy. Methods. 790 smokers treated at the Tobacco Dependence Clinic in New Jersey from 2001–2003 and contacted 4 weeks after quit-date were studied. Patients received medications and behavioral interventions. Abstinence over the previous 7 days was evaluated at 4 weeks and 6 months. Patients lost to 6-month follow-up were considered still smoking. Results. Overall, 36% of patients were abstinent at 6 months (20% who used no medications, 37% using one medication, 37% using 2 medications, 42% using 3 medications, and 42% using 4+ medications) ( P = 0.017). 27% still used medications at 6 months, and had higher abstinence rates (65%) than those who stopped their medications (27%) ( P < 0.001). Number of medications predicted abstinence at 4 weeks [adjusted odds ratios = 2.30 (95% CI; 1.27–4.18) for 1 medication, 4.78 (2.72–8.40) for 2 medications, 5.83 (2.98–11.40) for 3 medications, and 11.80 (4.10–33.95) for 4+ medications]. Increasing age, increasing level of education, longer time after waking to first cigarette, more than 7 clinical contacts, and more medications used were related to higher abstinence at 6 months. Conclusions. Smokers attending a specialist tobacco dependence treatment clinic who used more medications and for longer duration had higher abstinence rates.