Pregnant Smokers Receiving Opioid Agonist Therapy Have an Elevated Nicotine Metabolite Ratio: A Replication Study

Abstract Introduction Pregnant women exposed chronically to opioids smoked more cigarettes per day (CPD) and had a higher nicotine metabolite ratio (NMR), 3-hydroxycotinine/cotinine, a biomarker of nicotine metabolism and clearance, than those not receiving opioids. We examined CPD and NMR in a group of pregnant smokers, a quarter of whom were receiving opioid agonist therapy (OAT). Aims and Methods Pregnant smokers recruited to participate in a placebo-controlled trial of bupropion for smoking cessation provided a blood sample for measurement of NMR. Results Half (52.4%) of the 124 women with NMR data were African American. OAT-treated women (n = 34, 27.4%; 27 receiving methadone and 7 buprenorphine) were more likely to be white (79% vs. 30%, p < .001) and to have a lower mean PHQ-9 total score (2.91 [SD = 2.83] vs. 4.83 [SD = 3.82], p = .007). OAT-treated women reported smoking more CPD (9.50 [SD = 5.26] vs. 7.20 [SD = 3.65], p = .005) and had higher NMR (0.78 [SD = 0.36] vs. 0.56 [SD = 0.25], p = .001) than the non-OAT-treated group. In a linear regression analysis adjusting for race, depression severity, and CPD, NMR was greater in the OAT group (p = .025), among whom the daily methadone-equivalent dosage correlated with NMR (Spearman’s ρ = 0.49, p = .003). Conclusions Consistent with the findings of Oncken et al. (2019), we found that OAT smokers smoked more and had higher NMR than non-OAT smokers. As higher NMR is associated with a reduced likelihood of smoking cessation, the effects on NMR of both pregnancy and OAT could contribute to a lower smoking cessation rate in pregnant smokers receiving chronic opioid therapy. Implications We replicated the finding that the NMR is significantly greater among pregnant smokers receiving OAT than those not receiving this treatment for opioid use disorder. Furthermore, we found that the dosage of the OAT was significantly associated with the NMR level. These findings may contribute to a poorer response to smoking cessation treatment in pregnant women treated with OAT, particularly those receiving high-dose therapy, and raise the question of whether novel approaches are needed to treat smoking in this subgroup of pregnant smokers.

Download Full-text

Opioid Use and Rate of Nicotine Metabolism Among Pregnant Smokers

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz073 ◽

2019 ◽

Vol 22 (6) ◽

pp. 1046-1050 ◽

Cited By ~ 3

Author(s):

Cheryl Oncken ◽

Erin L Mead ◽

Ellen A Dornelas ◽

Chia-Ling Kuo ◽

Heather Z Sankey ◽

...

Keyword(s):

Smoking Cessation ◽

Clinical Significance ◽

Methadone Maintenance ◽

Nicotine Metabolism ◽

Opioid Use ◽

Pregnant Smokers ◽

Metabolite Ratio ◽

Race Ethnicity ◽

Opioid Users ◽

Nicotine Metabolite Ratio

Abstract Introduction Smokers who use opioids smoke more cigarettes per day (CPD) than non-opioid users, which could be due to the effects of opioids on nicotine metabolism. Moreover, nicotine metabolism increases during pregnancy, potentially making quitting more difficult for pregnant smokers. We examined nicotine metabolism and its association with opioid use (OU) and CPD in pregnant smokers. Methods We recruited pregnant women who smoked at least 5 CPD for a clinical trial of smoking cessation. Plasma nicotine metabolite ratio (NMR; trans-3′-hydroxycotinine (3HC)/cotinine)—a biomarker of nicotine metabolism—OU (involving methadone, buprenorphine, fentanyl, oxycodone, or tramadol), and CPD were assessed at baseline. We used linear regression to examine the associations between log-transformed NMR, OU, and CPD, adjusting for race/ethnicity and menthol smoking. Results Among 129 pregnant smokers, 25 (19%) were opioid users; most were maintained on methadone (n = 14). Compared to non-OU smokers, OU smokers had higher median CPD (10.0 vs. 7.0, p = .0007), serum 3HC (81.0 vs. 42.0 ng/mL, p = .0001), and NMR (0.63 vs. 0.43, p < .0001). In addition, methadone-maintained smokers had a higher median NMR than non-OU smokers (0.66 vs. 0.43, p = .0004). Adjusting for covariates, log-transformed NMR was greater in OU smokers (p = .012), specifically methadone-maintained smokers (p = .024), than non-OU smokers. Conclusions Our preliminary results show that OU is associated with a higher NMR in pregnant smokers. A larger study sample is needed to replicate this finding, examine potential mechanisms, and determine its clinical significance. Implications Among pregnant smokers, we observed that nicotine metabolism was significantly faster among opioid users—the majority of whom were on methadone maintenance—compared to nonusers, which could have implications for smoking cessation. Further studies are needed to replicate this finding, evaluate potential mechanisms, and determine its clinical significance.

Download Full-text

Medicaid Coverage of Methadone Maintenance and the Use of Opioid Agonist Therapy Among Pregnant Women in Specialty Treatment

Medical Care ◽

10.1097/mlr.0000000000000803 ◽

2017 ◽

Vol 55 (12) ◽

pp. 985-990 ◽

Cited By ~ 14

Author(s):

Marcus A. Bachhuber ◽

Pooja K. Mehta ◽

Laura J. Faherty ◽

Brendan Saloner

Keyword(s):

Pregnant Women ◽

Methadone Maintenance ◽

Agonist Therapy ◽

Opioid Agonist ◽

Medicaid Coverage ◽

Opioid Agonist Therapy

Download Full-text

High-dose intravenous hydromorphone for patients who use opioids in the hospital setting: time to reduce the barriers

Harm Reduction Journal ◽

10.1186/s12954-021-00533-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Laura E. Labonté ◽

Samantha Young

Keyword(s):

Setting Time ◽

Healthcare Providers ◽

Hospital Setting ◽

High Dose ◽

Agonist Therapy ◽

Hospital Discharges ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Hospital Policies ◽

Major Factors

AbstractIndividuals who use opioids have higher rates of hospitalization compared to the general population. Insufficiently treated withdrawal and pain are major factors contributing to high rates of self-initiated hospital discharges (also referred to as leaving against medical advice) in this population. While injectable opioid agonist therapy is limited or unavailable in the majority of Canadian communities, intravenous hydromorphone (IV HM) is widely available in the hospital setting and high-dose IV HM may be a useful treatment adjunct to improve comfort and engagement in inpatient care for some individuals who use opioids. However, major barriers to its use exist including lack of comfort amongst healthcare providers and hospital policies restricting administration. In this commentary, we highlight the potential usefulness of high-dose IV HM as a treatment adjunct for individuals who use opioids in the hospital setting and advocate for expanded hospital policies to facilitate its use.

Download Full-text

Implementation of Group Prenatal Care for Pregnant Women on Opioid-agonist Therapy at a Community-based Substance Use Treatment Clinic

Delaware Journal of Public Health ◽

10.32481/djph.2018.05.008 ◽

2018 ◽

Vol 4 (3) ◽

pp. 38-41

Author(s):

Elizabeth Zadzielski ◽

MBA FACOG ◽

Michelle Drew ◽

Stephanie Rogers ◽

Yukiko Washio

Keyword(s):

Substance Use ◽

Prenatal Care ◽

Pregnant Women ◽

Substance Use Treatment ◽

Group Prenatal Care ◽

Agonist Therapy ◽

Opioid Agonist ◽

Community Based ◽

Opioid Agonist Therapy ◽

Treatment Clinic

Download Full-text

Improving Opioid Agonist Therapy

PsycEXTRA Dataset ◽

10.1037/e582872006-001 ◽

2003 ◽

Keyword(s):

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

Download Full-text

Emotion Regulation Difficulties and Social Control Correlates of Smoking among Pregnant Women Trying to Quit

10.31234/osf.io/q5pgn ◽

2018 ◽

Author(s):

Jennifer Fillo ◽

Kimberly E. Kamper-DeMarco ◽

Whitney C. Brown ◽

Paul R. Stasiewicz ◽

Clara M. Bradizza

Keyword(s):

Smoking Cessation ◽

Emotion Regulation ◽

Negative Affect ◽

Social Control ◽

Pregnant Women ◽

Nicotine Dependence ◽

Low Income ◽

Withdrawal Symptoms ◽

Smoking During Pregnancy ◽

Pregnant Smokers

Approximately 15% of US women currently smoke during pregnancy. An important step toward providing effective smoking cessation interventions during pregnancy is to identify individuals who are more likely to encounter difficulty quitting. Pregnant smokers frequently report smoking in response to intrapersonal factors (e.g., negative emotions), but successful cessation attempts can also be influenced by interpersonal factors (i.e., influence from close others). This study examined the association between emotion regulation difficulties, positive and negative social control (e.g., encouragement, criticism), and smoking cessation-related variables (i.e., smoking quantity, withdrawal symptoms) among pregnant smokers. Data were drawn from the pretreatment wave of a smoking cessation trial enrolling low-income pregnant women who self-reported smoking in response to negative affect (N = 73). Greater emotion regulation difficulties were related to greater smoking urges (b = 0.295, p = .042) and withdrawal symptoms (b = 0.085, p = .003). Additionally, more negative social control from close others was related to fewer smoking days (b = -0.614, p = .042) and higher smoking abstinence self-efficacy (b = 0.017, p = .002). More positive social control from close others interacted with negative affect smoking (b = -0.052, p = .043); the association between negative affect smoking and nicotine dependence (b = 0.812, p < .001) only occurred at low levels of positive social control. Findings suggest that emotion regulation difficulties may contribute to smoking during pregnancy by exacerbating women's negative experiences related to smoking cessation attempts. Negative social control was related to lower smoking frequency and greater confidence in quitting smoking, suggesting that it may assist pregnant smokers' cessation efforts. Positive social control buffered women from the effects of negative affect smoking on nicotine dependence.

Download Full-text