Treatment Of Nicotine Dependence Research Articles

Abuse liability of transdermal nicotine patch: a case of “nicotine buzz”

ABSTRACT Background Transdermal nicotine patches are widely used for the treatment of nicotine dependence. The abuse liability of nicotine replacement therapies is considered low because of an absence of peaks observed with smoking. While typically well-tolerated, higher doses of transdermal nicotine patches may pose risks of adverse effects, as illustrated by a case of a young adult experiencing euphoria with a 63 mg patch. Case report A 27-year-old male with a history of multiple substance use, including cannabis, alcohol, and tobacco, was abstinent from tobacco with the use of a 21 mg/day transdermal nicotine patch. He increased the dosage to 63 mg/day temporarily, experiencing heightened alertness and a cannabis-like “buzz” sensation. Subsequent education on appropriate patch use led to a reduction in dosage and the disappearance of the sensation. Conclusions While higher doses have been utilized to manage cravings, associated adverse effects and potential for abuse emphasize the need for careful monitoring and individualized dosing strategies. Healthcare professionals should educate patients on the appropriate use of transdermal nicotine patches to mitigate risks and maximize therapeutic benefits.

Nicotine Addiction, Alcohol Use Disorder and Bipolar Disorder

Bipolar affective disorder has a wide range of effects on human health and is extremely harmful, and the mortality rate of patients continues to grow. Meanwhile, most people, especially those with mental illness, tend to numb themselves by smoking and drinking. Unfortunately, tobacco and alcohol abuse are also extremely harmful to human health, moreover, the cost of living will be increased due to addiction of these things. At the same time, the unconscious mind after using alcohol and tobacco has also brought great uneasiness to society, thus leading to increased burden on individuals and society. This review discusses the genetics, comorbidity, and treatment of nicotine dependence, alcohol use disorder, and bipolar disorder, and finds that the severity of bipolar disorder patients is positively correlated with the severity of alcohol use disorder and nicotine dependence. Both patients with bipolar disorder and alcohol use disorder exhibit mutations in the BDNF gene, and an age peak in bipolar disorder coincides with a peak in nicotine dependence. In the end, it is believed that the interaction between comorbidities may become a breakthrough in the diagnosis or treatment of bipolar disorder in the future, and the easy-to-observe alcohol and nicotine intake can be used to assist in judging the current state of patients.

Changes in National Prescribing Trends of Pharmacotherapy to Treat Tobacco and Nicotine Dependence in Relationship to the COVID-19 Pandemic

Changes in National Prescribing Trends of Pharmacotherapy to Treat Tobacco and Nicotine Dependence in Relationship to the COVID-19 Pandemic

Association of nicotine dependence and gut microbiota: a bidirectional two-sample Mendelian randomization study.

Nicotine dependence is a key factor influencing the diversity of gut microbiota, and targeting gut microbiota may become a new approach for the prevention and treatment of nicotine dependence. However, the causal relationship between the two is still unclear. This study aims to investigate the causal relationship between nicotine dependence and gut microbiota. A two-sample bidirectional Mendelian randomization (MR) study was conducted using the largest existing gut microbiota and nicotine dependence genome-wide association studies (GWAS). Causal relationships between genetically predicted nicotine dependence and gut microbiota abundance were examined using inverse variance weighted, MR-Egger, weighted median, simple mode, weighted mode, and MR-PRESSO approaches. Cochrane's Q test, MR-Egger intercept test, and leave-one-out analysis were performed as sensitivity analyses to assess the robustness of the results. Multivariable Mendelian randomization analysis was also conducted to eliminate the interference of smoking-related phenotypes. Reverse Mendelian randomization analysis was then performed to determine the causal relationship between genetically predicted gut microbiota abundance and nicotine dependence. Genetically predicted nicotine dependence had a causal effect on Christensenellaceae (β: -0.52, 95% CI: -0.934-0.106, P = 0.014). The Eubacterium xylanophilum group (OR: 1.106, 95% CI: 1.004-1.218), Lachnoclostridium (OR: 1.118, 95% CI: 1.001-1.249) and Holdemania (OR: 1.08, 95% CI: 1.001-1.167) were risk factors for nicotine dependence. Peptostreptococcaceae (OR: 0.905, 95% CI: 0.837-0.977), Desulfovibrio (OR: 0.014, 95% CI: 0.819-0.977), Dorea (OR: 0.841, 95% CI. 0.731-0.968), Faecalibacterium (OR: 0.831, 95% CI: 0.735-0.939) and Sutterella (OR: 0.838, 95% CI: 0.739-0.951) were protective factor for nicotine dependence. The sensitivity analysis showed consistent results. The Mendelian randomization study confirmed the causal link between genetically predicted risk of nicotine dependence and genetically predicted abundance of gut microbiota. Gut microbiota may serve as a biomarker and offer insights for addressing nicotine dependence.

The Italian Clinical Practice Guideline for the treatment of tobacco and nicotine dependence

The Italian Clinical Practice Guideline for the treatment of tobacco and nicotine dependence

SIGHR: Side information guided high-dimensional regression.

In this work, we develop a novel Bayesian regression framework that can be used to complete variable selection in high dimensional settings. Unlike existing techniques, the proposed approach can leverage side information to inform about the sparsity structure of the regression coefficients. This is accomplished by replacing the usual inclusion probability in the spike and slab prior with a binary regression model which assimilates this extra source of information. To facilitate model fitting, a computationally efficient and easy to implement Markov chain Monte Carlo posterior sampling algorithm is developed via carefully chosen priors and data augmentation steps. The finite sample performance of our methodology is assessed through numerical simulations, and we further illustrate our approach by using it to identify genetic markers associated with the nicotine metabolite ratio; a key biological marker associated with nicotine dependence and smoking cessation treatment.

The Italian clinical practice guideline for the treatment of tobacco and nicotine dependence

The Italian clinical practice guideline for the treatment of tobacco and nicotine dependence

The tobacco epidemic – pharmacological interventions for smoking cessation

Introduction: One of the biggest public health threats in the world is tobacco epidemic. According to WHO in the world cigarette smoking is the most common form of tobacco use. In the 2018 report of the World Health Organization (WHO), smoking was recognized as one of the main risk factors responsible for premature mortality due to non-communicable diseases. According to the Global Burden of Disease, estimates smoking causes almost 8 million deaths in 2019 worldwide. In Poland about one-quarter of adults smoke cigarettes. As a result, scientists are constantly looking for medications that could help people quit smoking.
 The aim of the study: The aim of our study is to present medication which are used for treating nicotine dependence nowadays. Moreover, we give attention to social and economic consequences of tobacco use.
 Materials and methods: The literature available on PubMed and Google Scholar was reviewed using the words: “smoking”, “smoking cessation”, “nicotine”, “nicotine replacement therapy”.
 Description of the state of knowledge: Exposure to tobacco smoke is a dominant factor in the incidence of many cancers as well as cardiovascular and respiratory diseases. Therefore, improving smoking cessation interventions is critical to reducing tobacco use and helping to minimize the burden of cancer and other diseases for example chronic obstructive pulmonary disease.
 Conclusions: Smoking cessation has a positive effect on health. Nicotine replacement therapy, Bupropion, Varenicline and Cytisine are used to reduce nicotine withdrawal symptoms in regular smokers who abstain from smoking.

State of external respiratory function in chronic obstructive pulmonary disease associated with nicotine dependence

A study of 151 patients with chronic obstructive pulmonary disease was conducted in order to assess the formation and effectiveness of the treatment of nicotine dependence in smokers with COPD. Ipratropium bromide was proposed as a therapy. Nicorette was used as a nicotine replacement therapy. As a result of the study, the proposed algorithm for the combined treatment of nicotine addiction and COPD was adapted for use in the treatment of various degrees of nicotine dependence and COPD severity in smokers in an outpatient setting.

Cytisinicline for Smoking Cessation

Cytisinicline (cytisine) is a plant-based alkaloid that, like varenicline, binds selectively to α4β2 nicotinic acetylcholine receptors, which mediate nicotine dependence. Although not licensed in the US, cytisinicline is used in some European countries to aid smoking cessation, but its traditional dosing regimen and treatment duration may not be optimal. To evaluate the efficacy and tolerability of cytisinicline for smoking cessation when administered in a novel pharmacokinetically based dosing regimen for 6 or 12 weeks vs placebo. A 3-group, double-blind, placebo-controlled, randomized trial (ORCA-2) compared 2 durations of cytisinicline treatment (6 or 12 weeks) vs placebo, with follow-up to 24 weeks, among 810 adults who smoked cigarettes daily and wanted to quit. It was conducted at 17 US sites from October 2020 to December 2021. Participants were randomized (1:1:1) to cytisinicline, 3 mg, 3 times daily for 12 weeks (n = 270); cytisinicline, 3 mg, 3 times daily for 6 weeks then placebo 3 times daily for 6 weeks (n = 269); or placebo 3 times daily for 12 weeks (n = 271). All participants received behavioral support. Biochemically verified continuous smoking abstinence for the last 4 weeks of cytisinicline treatment vs placebo (primary) and from end of treatment to 24 weeks (secondary). Of 810 randomized participants (mean age, 52.5 years; 54.6% female; mean of 19.4 cigarettes smoked daily), 618 (76.3%) completed the trial. For the 6-week course of cytisinicline vs placebo, continuous abstinence rates were 25.3% vs 4.4% during weeks 3 to 6 (odds ratio [OR], 8.0 [95% CI, 3.9-16.3]; P < .001) and 8.9% vs 2.6% during weeks 3 to 24 (OR, 3.7 [95% CI, 1.5-10.2]; P = .002). For the 12-week course of cytisinicline vs placebo, continuous abstinence rates were 32.6% vs 7.0% for weeks 9 to 12 (OR, 6.3 [95% CI, 3.7-11.6]; P < .001) and 21.1% vs 4.8% during weeks 9 to 24 (OR, 5.3 [95% CI, 2.8-11.1]; P < .001). Nausea, abnormal dreams, and insomnia occurred in less than 10% of each group. Sixteen participants (2.9%) discontinued cytisinicline due to an adverse event. No drug-related serious adverse events occurred. Both 6- and 12-week cytisinicline schedules, with behavioral support, demonstrated smoking cessation efficacy and excellent tolerability, offering new nicotine dependence treatment options. ClinicalTrials.gov Identifier: NCT04576949.

Editorial - Advancing Biomarkers for Treatment of Smoking and Nicotine Dependence: An Overview

The special issue on Biomarkers of Nicotine and Tobacco Dependence reviews the science for precision treatment of nicotine dependence and future opportunities for research on biomarkers for inclusion in tobacco product cessation and switching clinical trials to advance translation. This overview summarizes the articles contributed to the special issue by leading researchers in field of addiction.

Associations between nicotine product use and craving among stable daily and non-daily users

Nicotine craving typically develops shortly after last use and is conceptualized as essential to the development, maintenance, and treatment of nicotine dependence. Previous research has primarily examined the relationship between craving and use among individuals trying to quit smoking, and less is known about this relationship among active users, particularly e-cigarette users. The current study evaluated the association between craving and use by assessing both constructs twice daily over 7 days in a sample of daily (n = 80) and non-daily (n = 34) users of combustible tobacco and e-cigarette products. We used negative binomial regression modeling to analyze the relationship between nicotine craving and use in two ways. First, we evaluated a lagged model in which craving at the time of assessment predicted use during the next time period. Next, we evaluated a model in which maximum craving since the last assessment predicted use during the same time period. Maximum craving was significantly and positively associated with nicotine product use (p <.05) while craving at the time of assessment was not. These associations did not differ depending on use frequency or on specific products used. Findings provide evidence that self-report ratings of craving are associated with greater nicotine and tobacco product use for both frequent and intermittent users. Furthermore, these results may be useful in developing or modifying interventions for a wide variety of nicotine users, including those who are not yet intending to make a change to their nicotine use.

Interdisciplinary Approach to Developing Nicotine Dependence Treatment Order Set: An Innovative Pilot Implementation

Tobacco use remains the leading cause of preventable diseases and mortality in the United States. State quitline is an evidence-based tobacco cessation intervention for people who smoke. However, patients’ referral to quitline has been low. To address this gap in practice, we collected stakeholder feedback and engaged in an interdisciplinary and collaborative effort to create a new nicotine dependence treatment referral system using our electronic health record-based order sets. The project was conducted in 3 phases: (1) development process, (2) dissemination and approval from practice leaders, and (3) dissemination to clinicians. With the stakeholder feedback, we updated the existing nicotine dependence order set (NDO) by including links to the state quitline and local community resources targeting the social determinants of health. We created a brief educational material on the new NDO for dissemination. We measured the intention to use, implementation outcomes, acceptance, appropriateness, and feasibility of the new NDO. In the prepresentation survey, although 81% of the participants from the leadership and 77% from the clinician groups reported using the order set in general, only 13% from the leadership and 10% from the clinician group used the existing NDO. In the postpresentation survey, nearly 100% of the leadership and clinician respondents intended to use the new NDO in their practices. Acceptance (leadership vs clinicians: 82% vs 100%), appropriateness (leadership vs clinicians: 82% vs 95%), and feasibility (leadership vs clinicians: 82% vs 100%) were high in the postpresentation survey. Despite the positive reception to the new NDO, future research is needed to test the adoption, sustainability, and effectiveness of the NDO in addressing smoking cessation outcomes.

A scoping review of smoking cessation pharmacogenetic studies to advance future research across racial, ethnic, and ancestral populations.

Abstinence rates among smokers attempting to quit remain low despite the wide availability and accessibility of pharmacological smoking cessation treatments. In addition, the prevalence of cessation attempts and abstinence differs by individual-level social factors such as race and ethnicity. Clinical treatment of nicotine dependence also continues to be challenged by individual-level variability in effectiveness to promote abstinence. The use of tailored smoking cessation strategies that incorporate information on individual-level social and genetic factors hold promise, although additional pharmacogenomic knowledge is still needed. In particular, genetic variants associated with pharmacological responses to smoking cessation treatment have generally been conducted in populations with participants that self-identify as White race or who are determined to be of European genetic ancestry. These results may not adequately capture the variability across all smokers as a result of understudied differences in allele frequencies across genetic ancestry populations. This suggests that much of the current pharmacogenetic study results for smoking cessation may not apply to all populations. Therefore, clinical application of pharmacogenetic results may exacerbate health inequities by racial and ethnic groups. This scoping review examines the extent to which racial, ethnic, and ancestral groups that experience differences in smoking rates and smoking cessation are represented in the existing body of published pharmacogenetic studies of smoking cessation. We will summarize results by race, ethnicity, and ancestry across pharmacological treatments and study designs. We will also explore current opportunities and challenges in conducting pharmacogenomic research on smoking cessation that encourages greater participant diversity, including practical barriers to clinical utilization of pharmacological smoking cessation treatment and clinical implementation of pharmacogenetic knowledge.

L-theanine attenuates nicotine reward and withdrawal signs in mice

BackgroundL-theanine, 2-amino-4-(ethylcarbamoyl) butyric acid, an amino acid detected in green tea leaves, is used as a dietary supplement to attenuate stress and enhance mood and cognition. Furthermore, L-theanine induces anxiolytic effects in humans. Recently, L-theanine was reported to reduce morphine physical dependence in primates, suggesting the potential usefulness of L-theanine for drug dependence intervention. ObjectiveThe aim of this study is to determine whether L-theanine attenuates nicotine-withdrawal (somatic and affective signs) and nicotine reward in mice. We also investigated the effects of L-theanine on nicotinic receptors binding and function. MethodsICR male mice rendered dependent to nicotine through implanted subcutaneous osmotic minipumps for 14 days undertook precipitated nicotine withdrawal by mecamylamine on day 15. Anxiety-like behaviors using LDB, somatic signs observation and hot plate latency were assessed consecutively after treatment with L-theanine. Furthermore, we examined the effect of L-theanine on acute nicotine responses and nicotine conditioned reward in mice and on expressed nicotinic receptors in oocytes. Key findingsL-theanine reduced in a dose-dependent manner anxiety-like behavior, hyperalgesia and somatic signs during nicotine withdrawal. Also, L-theanine decreased the nicotine CPP, but it did not affect the acute responses of nicotine. Finally, L-theanine did not alter the binding or the function of expressed α4β2 and α7 nAChRs. ConclusionOur results support the potential of L-theanine as a promising candidate for treating nicotine dependence.

The Role of Emotion Differentiation in the Association Between Momentary Affect and Tobacco/Nicotine Craving in Young Adults.

Tobacco/nicotine use is commonly initiated during adolescence or young adulthood, which increases the likelihood of continued use into adulthood and related adverse health outcomes. Despite interest in cessation, achieving and maintaining abstinence is difficult among this population. Cravings are often a barrier to abstinence, which have been associated with intensity of affect at the moment level. Emotion differentiation involves the ability to distinguish between discrete emotion states, and previous work suggests it may moderate the effect of momentary affect on craving, which has never been explored among young adults who are smoking or vaping nicotine. In a sample of young adults (N = 37, observations = 2020, ages 18-25, 51% female, and 78% white) interested in quitting smoking or vaping, we used real-time, naturalistic data capture via mobile phones to examine the interaction of momentary affect and trait emotion differentiation on nicotine craving. Participants were prompted with four surveys per day for 35 days and asked to make a 48-h quit attempt on day 7. Multilevel models showed moments of higher-than-average momentary negative affect (NA; b = 0.39, p < .001), and positive affect (PA; b = 0.26, p = .001) were associated with greater levels of craving. NA emotion differentiation significantly moderated the associations between PA and craving (b = -0.63, p = .031) and NA and craving (b = -0.67, p = .003). Findings from this exploratory analysis suggest that for young adults engaging in a nicotine quit attempt, greater ability to differentiate NA weakens the momentary association between intense affect and craving. Results of this study show that the ability to differentiate between discrete emotional experiences may protect young adults against nicotine craving during moments of intense affective experience. These preliminary findings suggest that emotion differentiation, a modifiable construct, could be an important treatment target for individuals engaged in treatment for nicotine dependence.

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&lt;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.

The Roswell eND scale: Brief, valid assessment of nicotine dependence adults seeking to discontinue e-cigarette use

BackgroundMost adults who regularly use e-cigarettes or Electronic Nicotine Delivery Systems (ENDS) desire to discontinue use. ENDS use can result symptoms of nicotine withdrawal and dependence which can make it more difficult to discontinue use. Brief, valid assessment of nicotine dependence among adults who use ENDS is needed to guide treatment for nicotine dependence in this group. We sought to develop a brief, valid instrument to measure nicotine dependence among adults seeking to discontinue ENDS in a busy Quitline. MethodsIn this cross-sectional design, we examined content, construct, and concurrent validity of the Roswell ENDS Nicotine Dependence Scale (Roswell eND Scale) and the Penn State E-Cigarette Dependence Index (Penn State eCDI). Participants who called the New York Quitline from November 2019 to June 2020 seeking to discontinue ENDS use were invited to participate. Construct validity was examined with exploratory and confirmatory factor analyses. Instrument and factor scores were then correlated with cotinine, a biomarker of nicotine exposure. ResultsAll participants (n = 209) were highly dependent and co-used combustible cigarettes to varying degrees. Both instruments demonstrated content validity and construct validity, however only the 5-item Roswell eND Scale demonstrated criterion-related validity by showing a significant positive correlation with salivary cotinine levels. ConclusionsThe 5-item Roswell eND Scale can briefly and effectively assess nicotine dependence among treatment-seeking adults who co-use ENDS and cigarettes. These preliminary psychometric findings have the potential to be generalizable to other adults seeking to discontinue ENDS use, many of whom currently or formerly smoked cigarettes.

Effects of Dextromethorphan on Nicotine-Induced Reward, Behavioral Sensitization, Withdrawal Signs, and Drug Seeking-Related Behavior in Rats.

Tobacco products are addictive, with nicotine serving as the major addictive ingredient. Chronic tobacco use or chronic administration of nicotine alone results in both physiological and psychological dependence. Our previous studies indicated that dextromethorphan (DM) could effectively attenuate the dependence of morphine and methamphetamine. Thus, we further investigated the possible effects of DM on nicotine dependence. Conditioned place preference (CPP) test was used to examine nicotine-induced rewarding effects as well as the drug-seeking-related behavior in rats. Nicotine dependence was induced by continuous subcutaneous infusion of nicotine via an osmotic minipump for 7 days and abstinence was initiated by removal of the pump. Withdrawal signs were observed and quantified. Locomotor activity was measured to determine the behavioral sensitization induced by nicotine. To investigate the activity of mesolimbic dopaminergic neuronal activity in correlation with the effects of nicotine, the animals were sacrificed and the nucleus accumbens (NAc), dorsal striatum (DS), and medial prefrontal cortex (mPFC) were dissected and used to determine the contents of dopamine (DA) and its metabolites using high-performance liquid chromatography (HPLC). Our results showed that DM could suppress nicotine-induced rewarding effect and drug-seeking-related behavior. In addition, co-administration and post-treatment of DM could both attenuate nicotine withdrawal signs. Moreover, DM could suppress nicotine-induced behavioral sensitization. Neurochemical experiments show that co-administration and post-treatment of DM abolished nicotine-induced increase of the DA turnover rate in the mPFC, but not in the NAc and DS. The results suggest that DM has a great therapeutic potential in the treatment of nicotine dependence. Our results showed that DM could suppress nicotine-induced rewarding effect and drug-seeking-related behavior. In addition, co-administration and post-treatment of DM could both attenuate nicotine withdrawal signs. Moreover, DM could suppress nicotine-induced behavioral sensitization. Neurochemical experiments show that co-administration and post-treatment of DM abolished nicotine-induced increase of the DA turnover rate in the mPFC, but not in the NAc and DS. These results suggest that DM has a great therapeutic potential in the treatment of nicotine dependence.

Analysis of the effectiveness of smoking cessation in patients with pulmonary tuberculosis in a hospital setting

According to the WHO, tobacco use is currently the leading cause (16%) of all adult deaths. Studies conducted in many countries and in the Russian Federation have revealed the association between smoking and pulmonary tuberculosis (PT). Due to the negative impact of tobacco smoking on the course of tuberculosis and the effectiveness of treatment, there is a need to develop approaches to smoking cessation in patients with PT. Aim. To evaluate the effectiveness of the treatment of PT in smoking patients in combination with nicotine replacement therapy in an inpatient setting. Methods. The study included 27 patients with a confirmed diagnosis of PT. The inclusion criteria for the study were: age 18 years and older, patients who are currently active smokers, and a confirmed diagnosis of PT. The exclusion criteria were the presence of asthma and oncological diseases, unconfirmed diagnosis of PT, and earlier history of tobacco use. In the study group, an analysis of the smoking status was carried out. This status was based on the length of smoking period, number of cigarettes per day, and calculation of the smoking patient index. The degree of nicotine addiction, the presence of withdrawal symptoms, and the motivation of patients to quit smoking were assessed. The principle of nicotine dependence treatment was to prescribe nicotine-containing drugs in a dose depending on the degree of nicotine addiction. The duration of treatment was 12 weeks. Results. After 4 months of PT treatment, the cessation of bacterial excretion was detected 2 times more often, the closure of decay cavities in the lung tissue - 2.5 times more often, the relief of systemic inflammatory reactions - 2 times more often in patients who quit smoking than in patients who continue to smoke. Conclusion. This study showed that the treatment of PT in smokers was more effective in combination with nicotine replacement therapy for smoking cessation than when the patients continued to smoke.