Patterns of smoking and methadone dose in drug treatment patients.

Cigarette smoking prevalence is very high, and cessation rates are very low, among people in methadone treatment. This may in part be due to interactions between methadone administration and cigarette smoking. The present study explores relationships between methadone dose timing and smoking rates. Twenty methadone patients, over a period of 19 days, used electronic cigarette packs to record their smoking patterns and called a voice mailbox daily to report their methadone dose and timing. The average proportion of daily cigarettes smoked was calculated for 2-hr blocks preceding and following methadone dose administration. For all participants, peak smoking rates occurred after methadone administration. Participants smoked a greater proportion of cigarettes in their first 2-hr block after methadone dosing (M = 0.368, SD = 0.135) than during their first 2-hr block of smoking of the day (M = 0.245, SD = 0.010; S = 85.5, p     

Cocaine use can increase cigarette smoking: Evidence from laboratory and naturalistic settings.

Two studies examined the effects of cocaine use on cigarette smoking. Study 1 was conducted with 10 healthy volunteers under controlled laboratory conditions. Participants received double-blind doses of intranasal cocaine HCI (100 mg) or placebo in separate sessions, with each being followed by a 3-hr period of monitored cigarette smoking. Latency to the first cigarette and the mean interval between cigarettes was significantly shorter and the total number of cigarettes smoked was greater after cocaine than placebo administration. Study 2 was conducted by using urine specimens from 9 ambulatory cocaine-dependent patients. Urine cotinine (nicotine metabolite) levels on days when urinalysis testing indicated recent cocaine use were compared with levels on days when urinalysis testing indicated no recent use. Cotinine levels were significantly higher on cocaine-positive days, indicating that cocaine use was associated with greater cigarette smoking. Overall results provide evidence that acute cocaine administration can increase cigarette smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of acute and chronic nicotine on responses maintained by primary and conditioned reinforcers in rats.

There is growing recognition that nonnicotine factors, such as the sensory stimuli associated with smoking, can play a critical role in the maintenance of cigarette smoking. However, little is known about the effects of nicotine on responding maintained by these stimuli, which are assumed to be conditioned reinforcers. The authors used an animal model to examine the acute and chronic effects of nicotine on responses maintained by food and conditioned reinforcers (i.e., lights) and responses in the absence of programmed consequences (i.e., extinction). During the acute phase, 4 male rats received 5 doses of subcutaneous nicotine. One dose of nicotine was then administered for a minimum of 60 days. Food-maintained and extinction responses did not significantly increase during the acute phase; however, food-maintained responses did increase during the chronic phase. Relative to vehicle, intermediate doses increased responses maintained by conditioned reinforcers during both phases. The results suggest that nicotine enhances responding maintained by conditioned reinforcers and possibly by food. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interest in smoking cessation among methadone maintained outpatients

The prevalence of cigarette smoking among opiate abusers is extremely high and tobacco related diseases are a major factor associated with morbidity and mortality for this group. Yet, many treatment providers remain reluctant to address smoking cessation with their clients due in part to the belief that substance abusers are not interested in quitting smoking. The present study examined self-reported interest in smoking cessation among methadone maintenance clients (N = 120) in four clinics in Los Angeles. Fifty-eight percent of subjects rated themselves as 'Somewhat' or 'Very Interested' in a smoking cessation program. Overall subjects appeared to accurately perceive the personal risks from tobacco smoking. In conclusion we find that clients in methadone maintenance treatment programs evidence a high level of interest in quitting smoking and may well be suited for a highly structured smoking cessation intervention.     

Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy

This review discusses the known cardiovascular effects of smoking and the effects of nicotine without tobacco smoke and interprets the available data on cardiovascular risk during nicotine replacement therapy (NRT). Nicotine gum and patches are now approved for over the counter sale in the United States. Smokers with cardiovascular disease are advised to seek physician counseling before using nicotine products, but information regarding the safety of these products in such patients is not readily available to most physicians. Nicotine may contribute to cardiovascular disease, presumably by hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release. However, there are many potential cardiovascular toxins in cigarette smoke other than nicotine. The doses of nicotine obtained by regular cigarette smoking generally exceed those delivered by NRTs, and the cardiovascular effects of nicotine are, in general, more intense when delivered rapidly by cigarette smoking than the slower delivery by transdermal nicotine or nicotine gum. Because the dose-cardiovascular response relation for nicotine is flat, the effects of cigarette smoking in conjunction with NRT are similar to those of cigarette smoking alone. Cigarette smoking increases blood coagulability, a major risk factor for acute cardiovascular events, whereas transdermal nicotine does not appear to do so. Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk. At worst, the risks of NRT are no more than those of cigarette smoking. The risks of NRT for smokers, even for those with underlying cardiovascular disease, are small and are substantially outweighed by the potential benefits of smoking cessation.     

Effects of daily caffeine intake on smoking behavior in the natural environment.

The effects of changes in daily caffeine intake on cigarette smoking were investigated. Forty cigarette smokers consumed caffeine ad lib on a baseline day then consumed controlled multiple doses of caffeine (100 mg and 500 mg per day) for two-day trials. Smokers recorded the number of cigarettes consumed, and measurements of expired-air carbon monoxide and salivary cotinine concentration were obtained to estimate smoke and nicotine intake. Baseline caffeine intake averaged 449 mg per day, with wide variations among participants. The 5-fold change in caffeine dose on treatment days did not affect any measure of smoking behavior in these participants. Results suggest that daily caffeine intake has little influence on cigarette smoking in the natural environment. Coffee drinking and cigarette smoking are commonly associated behaviors, although the links between them are not yet understood. Results raise doubts that the influence of coffee drinking on smoking, if any, can be attributed to the effects of caffeine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between cigarette smoking, oral contraceptives, and plasma vitamins A, E, C, and plasma triglycerides and cholesterol

Plasma vitamins A, E, and C, plasma triglycerides and cholesterol, and leukocyte vitamin C were examined in young healthy adult females who were cigarette and/or oral contraceptive users. It was found that cigarette smoking slightly increased the levels of vitamin A, triglycerides, and cholesterol while oral contraceptives significantly increased these plasma lipids. The effects of cigarette smoking and oral contraceptives on these substances were additive. Neither cigarette smoking nor oral contraceptives had any significant effect on plasma vitamins E and C. Oral contraceptives slightly decreased the level of leukocyte vitamin C in the cigarette smokers. Cigarette smoking did not impart and acute effect on these parameters.     

Induction with levomethadyl acetate: safety and efficacy

BACKGROUND: Levomethadyl acetate hydrochloride (known as LAAM) is a mu-opioid agonist approved for the treatment of opioid dependence. Clinical trials comparing LAAM and methadone have reported lower patient retention rates during LAAM induction; however, this may reflect dose and schedule differences. Few studies have systematically examined LAAM dose induction. This study compared induction with 3 different LAAM dosage levels. METHODS: In a randomized, double-blind trial, male and female opioid-dependent patients (N = 180) were assigned to 1 of 3 LAAM doses. The low-dose (25 mg) induction was constant from the onset of treatment, the medium-dose (50 mg) induction lasted 7 days, and the high-dose (100 mg) induction lasted 17 days. Safety and efficacy were assessed on retention, urinalysis and self-reported drug use, symptoms, and patient ratings of medication adequacy. RESULTS: The high-dose group had significantly fewer illicit opioid-positive urine samples in weeks 3 and 4 as compared with the low-dose group. The high-dose group had significantly lower self-reported heroin craving in weeks 2 and 3. All groups demonstrated significant decreases in illicit drug use, withdrawal symptoms, and depression. There were no between-group differences in retention; however, there was a trend (P = .08) for lower retention and a greater number of agonist adverse effects were observed in the high-dose group. Overall, LAAM doses were well tolerated by most patients. CONCLUSION: Induction with low and medium LAAM doses can be safely and effectively achieved within 7 days. Induction with higher LAAM doses can be safely achieved within 17 days, but may result in greater rates of patient dropout and opioid agonist adverse effects. Therefore, higher doses should be approached more slowly.     

Clinical pharmacology of buprenorphine: ceiling effects at high doses

OBJECTIVE: The purpose of this study was to characterize the acute effects of buprenorphine, an opioid partial mu-agonist, across a wide range of doses in comparison to methadone. METHOD: Healthy adult male volunteers, who had experience with but were not physically dependent on opioids, participated while residing on a closed research unit. Four subjects received buprenorphine (0, 1, 2, 4, 8, 16, and 32 mg sublingually and five subjects received methadone (0, 15, 30, 45, and 60 mg orally) in ascending order at 1-week intervals. Physiologic, subjective, and behavioral measures were monitored for 96 hours after drug administration. RESULTS: Both drugs produced typical opioid agonist effects (positive mood, sedation, respiratory depression, and miosis), some of which persisted for 24 to 48 hours. A plateau was observed for the dose effects of buprenorphine on subjective measures and respiratory depression. Pharmacokinetic data revealed that plasma concentrations of buprenorphine were linearly related to dose, indicating no limits on sublingual absorption in this dose range. CONCLUSIONS: This study shows a plateau on buprenorphine effects, consistent with its partial agonist classification, and that single doses of buprenorphine up to 70 times the recommended analgesic dose are well tolerated by nondependent humans.     

Are supplementary services provided during methadone maintenance really cost-effective?

OBJECTIVE: Previous research has suggested that support services supplementing methadone maintenance programs vary in their cost-effectiveness. This study examined the cost-effectiveness of varying levels of supplementary support services to determine whether the relative cost-effectiveness of alternative levels of support is sustained over time. METHOD: A group of 100 methadone-maintained opiate users were randomly assigned to three treatment groups receiving different levels of support services during a 24-week clinical trial. One group received methadone treatment with a minimum of counseling, the second received methadone plus more intensive counseling, and the third received methadone plus enhanced counseling, medical, and psychosocial services. The results at the end of the trial period have been published elsewhere. This article reports the results of an analysis at a 6-month follow-up. RESULTS: The follow-up analysis reaffirmed the preliminary findings that the methadone plus counseling level provided the most cost-effective implementation of the treatment program. At 12 months, the annual cost per abstinent client was $16,485, $9,804, and $11,818 for the low, intermediate, and high levels of support, respectively. Abstinence rates were highest, but modestly so, for the group receiving the high-intensity, high-cost methadone with enhanced services intervention. CONCLUSIONS: This study suggests that large amounts of support to methadone-maintained clients are not cost-effective, but it also demonstrates that moderate amounts of support are better than minimal amounts. As funding for these programs is reduced, these findings suggest a floor below which supplementary support should not fall.     

Cigarette use among migrant and nonmigrant Mexican American youth: A socialization latent-variable model.

A self-report survey of cigarette use among 10th- and 12th-grade Mexican American students found no differences in rates of use by migrant status. Male students reported higher levels of lifetime, experimental, and daily smoking than female students, and 12th-grade students reported higher levels of daily smoking than 10th-grade students. A socialization model of cigarette use based on peer cluster theory was evaluated using structural equation methods, examining the effects of family strength, family tobacco use, school adjustment, religious identification, and peer tobacco associations. The basic latent-structure socialization model was supported in all groups, but final models including specific effects identified both unique and common relationships by gender and migrant status. Common patterns across groups suggest that completely different prevention programs may not be necessary for these youth. However, program elements based on subtle group differences may serve to tailor prevention efforts and make them more effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multiple-component treatment approach to smoking reduction.

Compared the effectiveness of a package treatment program to reduce cigarette smoking with a single treatment condition (rapid smoking), a nonspecific treatment condition, and an untreated control condition. 60 volunteer smokers (mean age 29.4 yrs) participated. Following the treatment and posttesting sessions, another factor was introduced. One third of the Ss in each of the 3 treatment conditions were randomly assigned to specific booster (e.g., additional rapid-smoking) sessions, nonspecific booster sessions, or no booster sessions. Since the principal issue in the treatment of smoking is the maintenance rather than the induction of change, emphasis was placed on follow-up smoking levels 3 and 6 mo after the termination of treatment. The package condition produced substantially higher abstinence rates (45%) and lower percentages of baseline smoking (41%) after 6 mo than the other treatment and control conditions. No reliable effects due to booster sessions were found. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingent monetary reinforcement of smoking reductions, with and without transdermal nicotine, in outpatients with schizophrenia.

This study was conducted to examine the effects of contingent monetary reinforcement (CM) for smoking reduction, with and without transdermal nicotine, on cigarette smoking in individuals with schizophrenia. Fourteen outpatients participated in each of 3 conditions: (a) CM combined with 21 mg transdermal nicotine, (b) CM combined with placebo patch, and (c) noncontingent reinforcement combined with placebo patch. Each condition lasted 5 days. Carbon monoxide levels were measured 3 times daily, and nicotine withdrawal symptoms were measured once daily in each condition. Results indicated that CM reduced smoking but that 21 mg transdermal nicotine did not enhance that effect. These results offer further evidence supporting the efficacy of CM for reducing smoking among people with schizophrenia, but higher doses of nicotine replacement therapy, or another pharmacotherapy, may be needed to enhance that effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-dose transdermal nicotine and naltrexone: Effects on nicotine withdrawal, urges, smoking, and effects of smoking.

Although treatment with transdermal nicotine replacement (TNR) has improved smoking abstinence rates, higher doses of TNR could improve effects on urge to smoke, nicotine withdrawal, and reinforcement from smoking, and naltrexone might further reduce reinforcement and urges. A laboratory investigation with 134 smokers using a 3 × 2 parallel-group design evaluated the effects of TNR (42-mg, 21-mg, or 0-mg patch) as crossed with a single dose of naltrexone (50 mg) versus placebo on urge to smoke, withdrawal, and responses to an opportunity to smoke (intake, subjective effects) after 10 hr of deprivation. Urge and withdrawal were assessed both prior to and after cigarette cue exposure. Only 42 mg TNR, not 21 mg, prevented urge to smoke, heart rate change, and cue-elicited increase in withdrawal. Both 21 and 42 mg TNR blocked cue-elicited drop in heart rate and arterial pressure. Naltrexone reduced cue-elicited withdrawal symptoms but not urges to smoke or deprivation-induced withdrawal prior to cue exposure. Neither medication significantly affected carbon monoxide intake or subjective effects of smoking except that 42 mg TNR resulted in lower subjective physiological activation. No interaction effects were found, and no results differed by gender. Results suggest that starting smokers with 42 mg TNR may increase comfort during initial abstinence, but limited support is seen for naltrexone during smoking abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking behavior in offspring of heart disease patients: A response to cognitive dissonance.

Offspring of heart disease patients, with their variety of health concerns, were compared to a control group with respect to cigarette smoking behavior. Contrary to common-sense expectations, a significantly greater proportion of both male and female offspring were current smokers, and smoked to a greater degree (heavy) than control Ss. The MMPI, however, did not discriminate between Ss on the basis of smoking behavior. In accordance with previous research, it was theorized that the differences observed could be attributed to the higher state of cognitive dissonance associated with cigarette smoking in the offspring group. The fact that a relationship existed between quitting and age, for male and female offspring, suggests that more research is required to study the effects of extreme states of cognitive dissonance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heroin craving and drug use in opioid-maintained volunteers: Effects of methadone dose variations.

Recent data indicate that opioid agonist and antagonist challenges decrease and increase (respectively) heroin craving in physically dependent individuals. This study investigated effects of methadone dose variations on craving and new drug use in 18 outpatients who were given money contingencies. In Phase 1, volunteers were told in different test sessions that methadone dose would increase, decrease, or stay the same; drug-abstinence contingencies were suspended for 24 hr. Craving significantly increased and new heroin use marginally increased (relative to maintenance dose) only when a dose reduction was paired with a dose decrease instruction. In Phase 2 (detoxification), craving and heroin use significantly increased as methadone dose decreased. Thus, loss of μ-receptor agonist effect increased craving and risk of relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transdermal nicotine-induced tobacco abstinence symptom suppression: Nicotine dose and smokers' gender.

An aversive tobacco abstinence syndrome, thought to reflect an underlying level of nicotine dependence, contributes to cigarette smokers' failed quit attempts. Nicotine replacement therapy (NRT) suppresses tobacco abstinence, but high relapse rates suggest room for improvement. Improving NRT's efficacy might begin with identifying factors that influence tobacco abstinence symptom suppression. Two such factors are smokers' gender and NRT dose. The purpose of this study was to determine the dose-related effects of transdermal nicotine (TN) on tobacco abstinence symptoms in 75 men and 53 women who regularly smoked cigarettes but who had abstained from smoking for at least 8-12 hr. Participants completed 4 double-blind, randomized 6.5-hr laboratory sessions that differed by TN dose (0, 7, 21, or 42 mg). Each session included blood sampling for plasma nicotine level, measurement of heart rate, participants' ratings of tobacco abstinence symptoms and effects of nicotine, and psychomotor performance. Increases in plasma nicotine level were related to TN dose and were independent of gender. TN-induced abstinence symptom suppression was dose-related for items assessing craving and urge to smoke and largely was independent of gender. TN increased heart rate and ratings of aversive side effects (e.g., nausea, lightheadedness) in a dose-related manner, and women were more sensitive at higher doses. Results from this laboratory study support the continued use of TN as a pharmacotherapy. Higher doses may ameliorate some abstinence symptoms, although the side effect profile, at least in the short term, may limit effectiveness, especially for women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of nicotine dose and nicotine dose expectancy on the cognitive and subjective effects of cigarette smoking.

This study investigated the independent and interactive effects of nicotine dose and nicotine dose expectancy on smoking outcomes using a 2 (given nicotine vs. placebo) × 2 (told nicotine vs. placebo) Balanced Placebo Design (BPD). Smokers (N = 148) completed the Rapid Visual Information Processing Task (RVIP) and measures of smoking urge, mood, and cigarette ratings (e.g., satisfying) after smoking a nicotine or placebo cigarette crossed with instructions that the cigarette contained either nicotine or no nicotine. Nicotine cigarettes (0.6 mg nicotine) produced better sustained attention performance than placebos as indicated by RVIP reaction time, hits, and sensitivity (A′). Nicotine cigarettes also produced better mood and greater rewarding subjective effects of the cigarettes on 11 of 11 dimensions compared to placebos. Nicotine instructions resulted in fewer RVIP false alarms, better mood, and greater rewarding subjective effects of the cigarettes on 9 of 11 dimensions compared to placebo instructions. Nicotine dose by nicotine dose expectancy interactions were also observed for urge and tension-anxiety, such that the dose expectancy manipulation produced differential effects only among those who smoked placebo cigarettes. In contrast a significant interaction for self-reported vigor-activity demonstrated that the dose expectancy manipulation produced effects only among those who smoked nicotine cigarettes. This study provides additional evidence that nicotine improves cognitive performance, and provides initial evidence that denicotinized cigarettes smoked under the guise that they contain nicotine influence cognitive performance, albeit with less robust effects than nicotine. These data may inform the development of expectancy-based interventions for tobacco dependence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical study of total intravenous anesthesia with droperidol, fentanyl and ketamine--effects of nicardipine, diltiazem and nifedipine on intraoperative hypertension

The purpose of the study was to explore the relationship between the exposure of adolescents in the seventh and eighth grades to cigarette advertising and their being smokers. A survey questionnaire given to 602 adolescents assessed their exposure to cigarette advertising and provided measures of their smoking behavior, demographic characteristics, and some psychosocial variables. The results indicated that exposure to cigarette advertising and having friends who smoked were predictive of current smoking status. Adolescents with high exposure to cigarette advertising were significantly more likely to be smokers, according to several measures of smoking behavior, than were those with low exposure to cigarette advertising. The findings extend previous research identifying factors that may play a role in the initiation and maintenance of smoking among adolescents.     

Individual differences in the subjective effects of the first cigarette of the day: A self-report method for studying tolerance.

Some smokers are more sensitive than others to the subjective effects of cigarettes, especially the first cigarette of the day. This report explored self-reported subjective effects to the first cigarette of the day and examined the extent to which heaviness of smoking and years smoking are associated with subjective effects. In 3 independent samples (ns?=?254, 116, 86), self-reports of light-headedness from the first cigarette of the day decreased with increasing heaviness of smoking and increasing number of years smoking, suggesting that differences in responses were due to differences in chronic tolerance. Because measures of the subjective effects of drugs are useful in the study of drug response variability, this self-report item on light-headedness should be included in further research on individual differences in the subjective effects of cigarette smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)