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

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 \u3c .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\u27s 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

Nicotine Replacement and Behavioral Therapy for Smoking Cessation in Pregnancy

This study examines whether adding nicotine replacement therapy (NRT) to cognitive behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation

Nicotine Replacement and Behavioral Therapy for Smoking Cessation in Pregnancy

Abstract Background This study examines whether adding nicotine replacement therapy (NRT) to cognitive behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation. Methods An open-label randomized trial (Baby Steps, n = 181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7-weeks post-randomization, 38-weeks gestation, and 3-months postpartum. Results Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy timepoints (after 7 weeks: 24% vs 8%, p = 0.02; at 38-weeks gestation: 18% vs 7%, p =0.04), but not at 3-months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an independent Data and Safety Monitoring Board when an interim analysis found a greater rate of negative birth outcomes in the CBT+NRT arm than in the CBT arm. At the final analysis the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), adjusted for prior history of preterm birth. Conclusions The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine the safety and to confirm the efficacy of NRT use during pregnancy

Immunogenicity and Smoking Cessation Outcomes for a Novel Nicotine Immunotherapeutic

NicVAX®, a nicotine vaccine (3’AmNic-rEPA), has been clinically evaluated to determine if higher antibody concentrations are associated with higher smoking abstinence rates and if doses and frequency of administration are associated with increased antibody response. This randomized, double-blinded, placebo-controlled multicenter clinical trial (N=301 smokers) tested 200 and 400 µg doses administered 4 or 5 times over 6 months compared to placebo. 3’AmNic-rEPA recipients with the highest serum anti-nicotine antibody response (top 30% by AUC) were significantly more likely to attain 8 weeks continuous abstinence from weeks 19 through 26 than the placebo recipients (24.6% vs. 12.0%, p=0.024, OR=2.69, 95% CI, 1.14–6.37). The 5 injection 400 µg dose regimen had the greatest antibody response and had significantly higher abstinence rates than placebo. This study demonstrates proof-of-concept that 3’AmNic-rEPA elicits antibodies to nicotine and is associated with higher continuous abstinence rates, justifying its further development as a treatment for nicotine dependence

Smoking in Pregnancy: An Ongoing Challenge

First paragraph: Maternal smoking during pregnancy carries significant risks to mother infant and child. Smoking during pregnancy is associated with an increased risk of ectopic pregnancy, placental previa and abruption, preterm premature rupture of membranes, fetal growth restriction, preterm delivery, oral facial clefts, and sudden infant death syndrome. One of the most measurable effects of smoking is approximately doubling the risk of delivering a low birth weight infant. This special issue of the journal highlights the continued risks of smoking in pregnancy and the importance of policies and interventions to address this issue, despite the progress that has been made in reducing smoking in pregnancy in some countries. New data on risks, incidence, interventions and women’s own perspectives are highlighted. Together the included papers provide new data examining key issues in the field, from a wide range of countries.Output Type: Editoria

Management of smoking in pregnant women

Background: Smoking is the most important preventable cause of adverse outcomes in pregnancy. However, most smokers who become pregnant continue to smoke and most of those who quit relapse after delivery.\ud \ud Objective: This article explores the relationship between smoking and pregnancy, and reviews the evidence for best practice intervention by general practitioners.\ud \ud Discussion: Continuing to smoke during pregnancy is strongly associated with socioeconomic disadvantage, mental illness and Aboriginal and Torres Strait Islander populations. Quitting is more difficult for these groups and interventions assist only sixin every 100 pregnant smokers to quit. Behavioural counselling is the first-line treatment. Nicotine replacement therapy (NRT) can be offered if the smoker is unable to quit without it, although its efficacy is uncertain. Adequate doses of nicotine and good adherance may be required for the best results. The use of NRT in pregnancy is likely to be less harmful than continuing to smoke. Women should be encouraged to quit smoking before becoming pregnant

Concurrent Brief versus Intensive Smoking Intervention during Alcohol Dependence Treatment

Alcohol dependent smokers (N = 118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-minute counseling session with 5 min follow-up. Intensive intervention consisted of three one-hour counseling sessions plus eight weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath CO, was significantly higher for intensive (27.5%) versus brief (6.6%) treatment at one month post quit date but not at six months when abstinence rates fell to 9.1% and 2.1%. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short term tobacco abstinence, other, perhaps more intensive smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers