Evaluation of E-Cigarette Use in Opioid-Dependent Patients in
                    Maintenance Treatment

Josef Rabl; Michael Specka; Udo Bonnet; Özge Irtürk; Fabrizio Schifano; Norbert Scherbaum

doi:10.1055/a-2414-5867

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2025; 58(02): 88-94
DOI: 10.1055/a-2414-5867

Original Paper

Evaluation of E-Cigarette Use in Opioid-Dependent Patients in Maintenance Treatment

Josef Rabl

¹Johannesbad Kliniken Fredeburg GmbH, Schmallenberg, Germany

,

Michael Specka

²LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

,

Udo Bonnet

²LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

³Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany

,

Özge Irtürk

²LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

,

Fabrizio Schifano

⁴University of Hertfordshire, Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, Hatfield, Hertfordshire, UK

,

Norbert Scherbaum

²LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

› Author Affiliations

Abstract

Introduction As tobacco smoking decreases, the use of e-cigarettes is on the rise. There is a debate whether switching from smoking to the use of e-cigarettes might represent a harm reduction strategy for those who smoke tobacco heavily, a habit often observed in individuals with opioid dependence. The present study investigated the prevalence and patterns of tobacco smoking and e-cigarette use in patients in opioid maintenance treatment (OMT) and whether e-cigarette use contributed to the cessation of smoking tobacco.

Methods In 2014 (n=84) and in 2021 (n=128), patients from two OMT clinics of a psychiatric university hospital were interviewed

Results In both surveys, patients presented with a comparable average age (45.6 vs. 46.9 years of age), gender distribution (mainly male 71.4 vs. 75.8%), and length of OMT history (median: 66 vs. 55 months). The lifetime prevalence of e-cigarette use (45.2% in 2014 and 38.3% in 2021) was much higher than the current prevalence (4.9% and 7.8%, respectively). Few patients reported either a complete switch from smoking to the use of e-cigarettes (2014, n=1 vs. 2021, n=2) or the achievement of abstinence from smoking after a temporary use of e-cigarettes (2014, n=2 vs. 2021, n=1).

Discussion No increase in the use of e-cigarettes was observed in these groups of patients undergoing OMT. Presumably, harm reduction strategies relating to the use of e-cigarettes in this group need to be supported by motivational interventions. Given the high morbidity and mortality due to smoking, OMT clinics should offer professional help in reducing smoking.

Keywords

opioid maintenance treatment - opioid dependence - nicotine dependence - e-cigarette - harm reduction

Full Text

References

References
1 Frazer K, Callinan JE, McHugh J. et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016; 2: CD005992
2 Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res 2015; 4: 327-338
3 Ng M, Freeman MK, Fleming TD. et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 2014; 311: 183-192
4 Organization WH. WHO global report on trends in prevalence of tobacco smoking 2000-2025. World Health Organization; 2018 https://www.who.int/publications/i/item/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2025-third-edition
5 Flor LS, Reitsma MB. et al. The effects of tobacco control policies on global smoking prevalence. Nat Med 2021; 27: 239-243
6 German Center for Addiction Issues. Lengerich: Pabst; 2023 Yearbook Addiction https://www.monitor-versorgungsforschung.de/en/news/dhs-jahrbuch-sucht-2023-veroeffentlicht/?cookie-state-change=1725947835950
7 Bjørnestad ED, Vederhus JK, Clausen T. High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders. BMC Psychiatry 2022; 22: 649
8 Vlad C, Arnsten JH, Nahvi S. Achieving smoking cessation among persons with opioid use disorder. CNS Drugs 2020; 34: 367-387
9 van Amsterdam J, van den Brink W. The effect of alcohol use on smoking cessation: A systematic review. Alcohol 2023; 109: 13-22
10 Kotz D. DEBRA study – Deutsche Befragung zum Rauchverhalten | German Study on Tobacco Use. DEBRA study. 2023 https://www.debra-study.info/
11 Dai H, Leventhal AM. Prevalence of e-cigarette use among adults in the United States, 2014-2018. JAMA 2019; 322: 1824-1827
12 Vardavas CI, Filippidis FT, Agaku IT. Determinants and prevalence of e-cigarette use throughout the European Union: A secondary analysis of 26 566 youth and adults from 27 Countries. Tobacco Control 2015; 24: 442-448
13 Gali K, Kastaun S, Pischke CR. et al. Trends and consumption patterns in the use of e-cigarettes among adolescents and young adults in Germany (the DEBRA study). Addict Behav 2022; 133: 107375
14 Chapman SLC, Wu LT. E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison. J Psychiat Res 2014; 54: 43-54
15 Brown J, West R, Beard E. et al. Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers. Addict Behav 2014; 39: 1120-1125
16 Owusu D, Huang J, Weaver SR. et al. Patterns and trends of dual use of e-cigarettes and cigarettes among U.S. adults, 2015–2018. Prev Med Rep 2019; 16: 101009
17 Gordon T, Karey E, Rebuli ME. et al. E-cigarette toxicology. Annu Rev Pharmacol Toxicol 2022; 62: 301-322
18 Canistro D, Vivarelli F, Cirillo S. et al. E-cigarettes induce toxicological effects that can raise the cancer risk. Sci Rep 2017; 7: 2028
19 McNeill A, Brose LS, Calder R. et al. E-cigarettes: An evidence update. Public Health England 2015; 3: 14-15
20 National Academies of Sciences Engineering, Medicine. Public Health Consequences of E-Cigarettes. Stratton K, Kwan LY, Eaton DL, editors. Washington, DC: The National Academies Press; 2018. 2018 https://nap.nationalacademies.org/catalog/24952/public-health-consequences-of-e-cigarettes
21 Foster JA. Consideration of vaping products as an alternative to adult smoking: A narrative review. Subst Abuse Treat Prev Policy 2023; 18: 67
22 Hartmann-Boyce J, Lindson N, Butler AR. et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022; 11: CD010216
23 Siegel MB, Tanwar KL, Wood KS. Electronic cigarettes as a smoking-cessation tool: Results from an online survey. Am J Prev Med 2011; 40: 472-475
24 Pinho-Gomes AC, Owen L, Carmona C. et al. Spotlight on tobacco guidance: NICE public health guidance update. J Public Health 2022; 44: e388-e390
25 Zhuang YL, Cummins SE, Sun JY. et al. Long-term e-cigarette use and smoking cessation: A longitudinal study with US population. Tobacco Control 2016; 25: i90-i95
26 Pisinger C, Dagli E, Filippidis FT. H et al. ERS and tobacco harm reduction. Eur Respir J 2019; 54: 1902009 Available from https://erj.ersjournals.com/content/54/6/1902009
27 Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 2005; 14: 106-123
28 Weinberger AH, Chaiton MO, Zhu J. et al. Trends in the prevalence of current, daily, and nondaily cigarette smoking and quit ratios by depression status in the U.S.: 2005–2017. Am J Prev Med 2020; 58: 691-698
29 Cicero TJ, Ellis MS, Kasper ZA. Polysubstance use: A broader understanding of substance use during the opioid crisis. Am J Public Health 2020; 110: 244-250
30 Gallus S, Lugo A, Liu X. et al. Who smokes in Europe? Data from 12 European countries in the TackSHS survey (2017–2018). J Epidemiol 2021; 31: 145-151
31 McClure EA, Acquavita SP, Dunn KE. et al. Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities. J Subst Abuse Treat 2014; 46: 194-201
32 Parker MA, Weinberger AH, Villanti AC. Quit ratios for cigarette smoking among individuals with opioid misuse and opioid use disorder in the United States. Drug Alcohol Depend 2020; 214: 108164
33 Lewer D, Tweed EJ, Aldridge RW. et al. Causes of hospital admission and mortality among 6683 people who use heroin: A cohort study comparing relative and absolute risks. Drug Alcohol Depend 2019; 204: 107525
34 Lewer D, Cox S, Hurst JR. et al. Burden and treatment of chronic obstructive pulmonary disease among people using illicit opioids: Matched cohort study in England. BMJ Med 2022; 1: e000215
35 Gsellhofer B, Küfner H, Voigt M. et al. European Addiction Severity Index EuropASI. Manual für training und durchführung. Hohengehren: Schneider; 1999
36 IBM. IBM Corp. Released 2013. IBM SPSS statistics for windows, version 22.0. Armonk, NY: IBM Corp; 2013
37 Kotz D, Böckmann M, Kastaun S. The use of tobacco, E-cigarettes, and methods to quit smoking in Germany. Dtsch Arztebl Int 2018; 115: 235-242
38 World Health Organization. WHO report on the Global Tobacco Epidemic. Geneva: World Health Organization; 2019
39 McKeganey N, Dickson T. Why don’t more smokers switch to using E-cigarettes: The views of confirmed smokers. Int J Environ Res Public Health 2017; 14: 647
40 Custodio L, Malone S, Bardo MT. et al. Nicotine and opioid co-dependence: Findings from bench research to clinical trials. Neurosci Biobehav Rev 2022; 134: 104507
41 Zinkernagel C, Naef MR, Bucher HC. et al. Onset and pattern of substance use in intravenous drug users of an opiate maintenance program. Drug Alcohol Depend 2001; 64: 105-109
42 Bryant J, Bonevski B, Paul C. et al. Developing cessation interventions for the social and community service setting: A qualitative study of barriers to quitting among disadvantaged Australian smokers. BMC Public Health 2011; 11: 493
43 Wilson A, Guillaumier A, George J. et al. A systematic narrative review of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups (2010–2017. ). Expert Rev Respir Med 2017; 11: 617-630
44 Castaldelli-Maia JM, Camargos de Oliveira V, Irber FM. et al. Psychopharmacology of smoking cessation medications: Focus on patients with mental health disorders. Int Rev Psychiatry 2023; 35: 397-417
45 Vinci C. Cognitive behavioral and mindfulness-based interventions for smoking cessation: A review of the recent literature. Curr Oncol Rep 2020; 22: 58
46 Pratt SI, Ferron JC, Brunette MF. et al. E-cigarette provision to promote switching in cigarette smokers with serious mental illness – A randomized trial. Nicotine Tob Res 2022; 24: 1405-1412
47 Vardavas Cl. European Tobacco Products Directive (TPD): Current impact and future steps. Tob Control 2022; 31: 198-201