Treatment Of Nicotine Dependence Research Articles

Participation in Tobacco Cessation Programs Among Medicaid Managed Care Enrollees in Florida.

Background/Objectives: Tobacco use remains a significant public health issue, particularly among individuals with low incomes, including Medicaid recipients who often face multiple barriers to quitting. This study aimed to identify barriers, from the perspective of Medicaid managed care organizations (MCOs), influencing Medicaid recipient participation in tobacco cessation programs. Methods: Focus group interviews were conducted with Florida Medicaid MCOs to elicit processes for case identification, outreach, referral, program participation, and incentives. Answers were synthesized into themes. Results: Medicaid recipients were primarily identified through nicotine dependency claim codes or Health Risk Assessments (HRAs). Individuals were referred to state and local community tobacco cessation programs through text messaging and outreach by MCO case managers. The MCOs identified the following as barriers: primary care physicians (PCPs) with limited knowledge about cessation programs and pharmacologic treatments for nicotine dependence, low availability of health coaches, long wait times for entry into cessation programs, weak coordination between MCOs and cessation programs, and insufficient incentives for individuals for program participation. Suggested strategies to overcome barriers were continuing medical education (CME) for PCPs about tobacco cessation programs and prescription therapies, increasing the training of health coaches, more investment in quitlines, increasing data sharing between MCOs and cessation programs, and increasing incentives for individuals. Conclusions: These findings highlight the importance of engaging MCOs in discussions about policy and program improvements, as their insights can drive meaningful changes in how tobacco cessation and other preventive health programs are structured and implemented. Targeted interventions are needed to enhance tobacco cessation program participation among Medicaid recipients.

The Effect of a Caffeine and Nicotine Combination on Nicotine Withdrawal Syndrome in Mice.

Nicotine dependence is an important cause of excessive exposure to tobacco combustion compounds in most smokers. Nicotine replacement therapy is the main method to treat nicotine dependence, but it still has its shortcomings, such as the inability to mitigate withdrawal effects and limited applicability. It has been hypothesized that a combination of low-dose nicotine and caffeine could achieve the same psychological stimulation effect as a high dose of nicotine without causing nicotine withdrawal effects. To establish a model of nicotine dependence, male C57BL/6J mice were subcutaneously injected four times a day with nicotine (2 mg/kg) for 15 days and fed with water containing nicotine at the same time. They were randomly divided into four groups. After 24 h of withdrawal, different groups were injected with saline, nicotine (0.25 mg/kg or 0.1 mg/kg), or nicotine (0.1 mg/kg) and caffeine (20 mg/kg). Behavioral and physiological changes were evaluated by an assessment of physical signs, open field tests, elevated plus maze experiments, forced swimming tests, hot plate tests, and new-object-recognition tests. The changes in dopamine release in the prefrontal cortex (PFC) and ventral tegmental area (VTA) in the midbrain were analyzed using ELISA. The results showed that a combination of caffeine and nicotine could effectively relieve nicotine withdrawal syndrome, increase movement ability and pain thresholds, reduce anxiety and depression, enhance memory and cognitive ability, and increase the level of dopamine release in the PFC and VTA. Thus, caffeine combined with nicotine has potential as a stable and effective treatment option to help humans with smoking cessation.

The potential feasibility of tobacco-focused medication therapy management in pharmacies affiliated with Federally Qualified Health Centers: Perspectives of pharmacists

BackgroundTobacco-focused medication therapy management (MTM) interventions executed in pharmacies located in Federally Qualified Health Centers (FQHC) may provide an innovative means to reach smokers with low incomes and reduce health disparities. However, greater understanding of the intervention’s potential feasibility in this setting is needed. ObjectiveTo inform the feasibility of implementing an MTM program to address tobacco and nicotine dependence in the FQHC setting by assessing the experience and perceptions of pharmacists working in pharmacies associated with FQHCs. MethodsA convergent mixed methods approach was used to assess indicators associated with the domains of the Consolidated Framework for Implementation Research (CFIR). Pharmacists from FQHC-based pharmacies in the Southeast United States completed surveys (n = 24) and interviews (n = 15). Quantitative data were summarized descriptively. Qualitative data were content coded. ResultsQuantitative and qualitative data were mapped across all 5 CFIR domains. Pharmacists report high rates of tobacco and nicotine use among their patients and that addressing their use is important. A total of 62.5% of pharmacists had some or a great deal of experience with tobacco and nicotine dependence. Quantitative and qualitative data demonstrate that the pharmacists and their FQHCs would support MTM efforts focused on tobacco and nicotine dependence. Qualitative findings highlight that pharmacists view an MTM intervention as aligning with their current workflow. Quantitative and qualitative data highlight how factors related to pharmacists’ engagement in introducing tobacco and nicotine dependence treatment programs to patients, the electronic medical record, time, staffing, and patient-level barriers could impact the feasibility of an MTM intervention focused on tobacco and nicotine dependence. ConclusionFindings suggest an MTM intervention focused on tobacco and nicotine dependence has the potential to be feasible within FQHC-based pharmacies. Considerations related to training, staffing, time, identifying participants, and supporting participant engagement must be taken into account to support its implementation.

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.

Management of nicotine dependence in patients with psychiatric disorders - recommendations of the Polish Psychiatric Association - part I.

Smoking and nicotine dependence are still one of the main reasons for a number of serious and life-shortening somatic diseases. At the same time, they are more prevalent in mentally ill individuals than in the general population. This work, which constitutes the first part of recommendations of the Polish Psychiatric Association, presents the scale of the phenomenon in the general population and among people with psychiatric disorders, diagnostic criteria of nicotine dependence and nicotine withdrawal. It discusses the impact of smoking and exposure to cigarette smoke on the development and course of psychiatric disorders as well as on the treatment of psychiatric disorders, including interactions between nicotine and psychotropic medications. Many psychiatric patients can reduce smoking or achieve complete abstinence if they are offered adequate motivation and therapeutic support. Contrary to popular belief, smoking cessation and nicotine dependence treatment do not negatively affect the symptoms of psychiatric disorders; patients' mental conditions can improve following smoking cessation therapy. The best results in terms of maintaining abstinence are achieved with a treatment approach that combines pharmacotherapy with psychotherapeutic intervention integrated into routine psychiatric care.

Management of nicotine dependence in patients with psychiatric disorders - recommendations of the Polish Psychiatric Association - part II.

The development of treatment methods for nicotine dependence has progressed slowly because people with psychiatric disorders are usually excluded from participating in clinical trials. There are several therapeutic options to support smoking cessation, including psychological and pharmacological interventions, which should be offered to smokers with mental disorders. The first step in helping tobacco smokers and nicotine-dependent individuals is the assessment of smoking intensity and confirmation of nicotine dependence. Currently, we have several methods of treating nicotine dependence - starting from education and psychotherapy, through pharmacotherapy and replacement therapy, and ending up with obtaining gradual progress with the application of harm reduction. Pharmacological treatment options include nicotine replacement therapy, varenicline or bupropion. The effectiveness of such interventions can be improved by providing anti-smoking therapy under psychiatric treatment and promoting harm reduction as an acceptable initial therapeutic goal. The harm reduction strategy is an approach that should be taken into account individually, particularly in the case of individuals unable to stop smoking, patients with limited insight into their illness, patients experiencing an exacerbation of their illness and persistently uncooperative patients. In this paper, recommendations of the Polish Psychiatric Association on the diagnostics and different treatment methods for nicotine dependence in patients with psychiatric disorders are presented.

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.