Treatment tips

Are tobacco use + OUD connected?

Understanding the connection between OUD and tobacco use is crucial to developing effective treatment protocols for patients. Learn more about it here!

Ophelia team
Tobacco + OUD
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Fact checked by
Nicole Martin, NP

It’s common for patients with opioid use disorder (OUD) to use other non-opioid drugs. Alcohol, methamphetamine, and cocaine are some of the drugs these patients may use alongside opioids. Perhaps surprisingly, there is also a strong relationship between tobacco and OUD. Understanding the connection between OUD and tobacco use is crucial to developing effective treatment protocols for patients. 

The relationship between tobacco use + OUD

People with OUD are five times more likely than those in the general population to smoke cigarettes. These patients tend to smoke more than smokers without OUD and have higher nicotine dependency levels. Of those involved in opioid treatment programs, 83–95% of patients currently use nicotine products like tobacco. Starting smoking young (before 14 years old) is also positively associated with opioid use and opioid use disorders

Nicotine addiction and opioid addiction affect overlapping pathways in the brain, and some evidence shows these two addictions reinforce one another. Tobacco smokers with OUD experience more severe opioid cravings and anxiety than those who use opioids but do not smoke. 

Experts still debate whether tobacco acts as a gateway drug, pushing people toward substance use disorders like OUD. Still, tobacco use is associated with experiencing stronger physical pain, which could lead tobacco smokers to be more likely candidates for prescription opioids.  

Treating OUD + tobacco dependency

Despite these alarming statistics, there is little research into the best interventions to help patients with OUD stop smoking. Patients describe using cigarettes after taking opioids to enhance the effect of those drugs, which suggests helping patients tackle OUD could also help them quit tobacco products. 

When patients seek treatment for OUD, that’s an opportunity to also provide nicotine intervention programs to those who need them. These patients may not seek treatment for nicotine dependence alone, but OUD treatment providers can start that conversation as part of their treatment plans. 

Evidence suggests that treating tobacco addiction and other substance use disorders like OUD simultaneously is very beneficial to patients. They are 25% more likely to maintain their recovery from substance use disorders if they address their tobacco use simultaneously. In other words, OUD treatment providers cannot ignore nicotine dependency in patients. They must create a comprehensive treatment plan for each patient that also accounts for factors like nicotine dependency. Comprehensive treatment plans include nicotine patches, Nicorette® gum and lozenges, Wellbutrin®, and Chantix®.  

Barriers to simultaneous treatment

There are some barriers to treating nicotine dependency in OUD treatment settings, however. One concern is that tobacco users with OUD will be less likely to seek opioid addiction treatment if they must also address their tobacco use. Enforcing tobacco-free policies is a challenge for these care providers, and some worry that patients will be more likely to relapse in OUD treatment if they try to quit tobacco simultaneously. 

OUD care providers are also not necessarily trained in treating nicotine dependence or addiction. They may not have the knowledge or resources necessary to help patients effectively address their tobacco use during OUD treatment. Less than 40% of opioid treatment programs (OTPs) currently offer counseling for smoking cessation, and even fewer provide pharmacotherapy. 

Many healthcare providers even believe it’s not possible to help patients stop smoking while treating other substance use disorders. Some providers will directly or indirectly condone tobacco use during treatment. However, there is no evidence to suggest that smoke-free policies or treatment to stop smoking negatively impact patients’ outcomes in inpatient substance use treatment settings.  

Risks of using tobacco during OUD treatment

Using tobacco while pursuing OUD treatment could make patients’ treatment journeys more difficult. One study from Duke University Medical Center compared outcomes of in-treatment smokers, non-smokers, and smokers who weren’t permitted to smoke during opioid use treatment. Those who smoked during treatment experienced stronger opioid cravings than the other two groups. The in-treatment smokers were also less likely to complete the treatment and craved cigarettes more than the smokers who weren’t allowed to smoke. 

People in OUD who start or keep using tobacco are more likely than non-smokers to experience a relapse. Another study showed smokers with OUD smoked more cigarettes while taking buprenorphine—one of the FDA-approved medications for OUD treatment (important safety information). 

Medications for addiction treatment (MAT) typically refer to the three prescription drugs approved to treat OUD: buprenorphine, methadone, and naltrexone. However, there are also medications like varenicline (Chantix®) that can help patients who are addicted to nicotine curb cravings. Before combining any prescription or illicit drugs, patients should consult their care teams to make sure there won’t be any adverse interactions.  

Ideally, patients would not smoke tobacco during OUD treatment. If a patient has a nicotine dependency or plans to smoke during treatment, their care providers need to know that information. The same is true if the patient wants to pursue smoking and OUD treatment at the same time. Either way, the patient’s OUD treatment plan must address nicotine use for any patients who use or habitually smoke tobacco. 

Access convenient, comprehensive OUD treatment

Increasing access to effective opioid use disorder treatment is a key component of tackling the opioid crisis. Ophelia is committed to that goal. 

Ophelia provides telehealth OUD treatment to patients all over the country. It’s the gold standard of care without the barriers associated with accessing in-person treatment. If you’re a candidate, your Ophelia care team will create a comprehensive treatment plan that fits your needs and goals. 

You don’t have to travel, talk to medical providers in person, or worry about scheduling appointments during the workweek. Ophelia’s approach to OUD treatment is helping patients like you on your own terms to achieve the outcome you want. Find out if you’re a candidate today.


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