Transcript No Slide Title

Addressing Nicotine Dependence in
Drug Treatment
Kimber Paschall Richter, PhD, MPH
Robert M. McCool, MS
University of Kansas School of Medicine, Kansas City
Thanks to:
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KC Area Methadone Clinics
KU Methadone Clinic
 Paseo Clinic
 KCTC
 DRD-KC
 Bridgeway Recovery
 Rodgers South
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NIDA
Robert Wood Johnson Foundation
CSAT OPAT
Active Drug Users CAN Quit Smoking
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16,661 participants, NHSDA
1,465 used and illicit drug past month
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Most were occasional marijuana users
Most (71%) current users smoke
1 IN 5 (21%) current users were FORMER smokers
Quit rate of 23% (% of “ever” smokers that have quit)
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Compared to about 50% quit rate in general population
People in Treatment CAN Quit, Too
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550 participants, KC Metro Methadone Survey
84% patients participated
Most (77%) smoke cigarettes
11% were FORMER smokers, 11% NEVER smokers
Quit rate of 12%
Why Quit?
I see my grandparents, my relatives that have all
got emphysema. …They can’t go to the mall.
They can’t go to dinner. … And I think why
should I keep doing this shit to me. [Noah]
I don’t want to get hurt and I don’t want to hurt
anyone else. … I have three babies. …I am falling
asleep with cigarettes in my hand and that is the
reality that I need to stop smoking. [KCTC,
unidentified]
Patients That Smoke Pay the Price
Addictions patients that continue to smoke die
from tobacco related illnesses
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11-year longitudinal study of 845 addictions patients:
51% of deaths were related to tobacco
24-year follow-up of 405 patients from ‘60s: death
rate of smokers 4X that of non-smokers
Can We Help MORE Quit?
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24 studies
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(Sussman 2002)
9 inpatient, 5 newly “sober”, 5 sober several years, 3 teen
inpatients, 2 opioid/cocaine outpatient
Generally small sample sizes, descriptive
Outcomes
Inpatient no higher than 12% abstinent, 6 months
 Outpatient as high as 25%, 1 year
 Sober several years – up to 46% abstinent, 1 year
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2003 study: Past alcohol problems do not predict worse smoking
cessation outcomes (Hughes et al.)
Helping Methadone Patients Quit
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Shoptaw et al., 2002
2X2 design, 175 patients
 12 weeks of treatment
 all got patches, were assigned to a mix of relapse prevention
and contingency management
 up to 36% quit during treatment, most relapsed afterwards
 tobacco free=drug free
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Ongoing studies
Clinical Trials Network patch study (Malcolm Reid, PI)
 Rhode Island Patch Study (Michael Stein, PI)
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Breathe Easy (Ongoing pilot study, Richter et al.)
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28 patients from 5 local clinics
Dual pharmacotherapy, counseling
Bupropion – 7 weeks
 Nicotine gum – 12 weeks
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20% were quit at 6 months
Excellent attendance – 85% of all appointments
were made, 2 lost to follow up
Who Treats Patients, Why & Why Not?
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Which clinics provide services, what services do they
provide?
What clinics do/don’t provide services
 Understand barriers, benefits for clinics
 Understand covert/overt pro-smoking forces
 How well clinics adhere to guidelines for treating nicotine
dependence (5 A’s)
 Help policymakers support clinics
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Services Provided, Past 30 Days
70
60
50
40
30
20
10
0
Most Important Barrier to Providing
Smoking Cessation Services
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Staff not trained
Patients not interested
Other drug treatment
more important
Not enough staff
Clinic does not receive
reimbursement
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Staff are too busy
Staff smoke cigarettes
Smoking treatment is
ineffective
Other
Name 3 Clinic Benefits From Providing
Smoking Cessation Services
 Improve
health of all
 Permit more comprehensive services
 Improve drug treatment
 Monetary/financial benefits for clinic/patient
 Cleanliness, Aesthetics
 Improved education for clinic or patient
 No benefit or unclear benefit
Total comments = 593
Lessons Learned
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People in recovery CAN quit smoking
Methadone clinics DO help with quitting
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But not routinely
There ARE barriers to offering services
There are also BENEFITS to offering services
Recommendations
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Need culture change to create more support &
encouragement for quitting
Regulatory agencies could require/encourage clinics to
>in some way< address nicotine addiction among
stable patients
Methadone clinics need CEUs – offer Nicotine
Dependence Treatment Training!
Could find clinics that are already doing it, empower
them to disseminate programs