Can vaping nicotine help people on methadone stub out their final cigarette?

Overall cigarette smoking rates in Australia are almost half what they were in 1995 . But one group still finds it particularly hard to kick the habit, even if they want to quit: people in treatment for opioid dependence.

But help may soon be at hand. A NSW trial commencing this year will explore if e-cigarettes can make it easier for these smokers to give tobacco cigarettes the flick – for good.

Currently, around 14% of Australian adults smoke tobacco daily. Among those with problematic drug use or dependence, though, that rate jumps to 74%. And, according to a US review, it increases to 83% for people on methadone maintenance for opioid dependence. 

Unfortunately, current cessation techniques aren’t particularly effective for people in opioid dependence treatment programs.

This is partly because they usually have incredibly complicated life circumstances, says Adrian Dunlop, Director Drug & Alcohol Clinical Services for Hunter New England Local Health District and Conjoint Professor at the University of Newcastle.

“Their history of dependence can stretch back decades – and it’s often not just opiates. Around one-third of our patients also smoke cannabis with different degrees of severity and frequency.”

Often layered around drug use are issues such as trauma, unstable housing, poverty, domestic violence and a high prevalence of mood disorders – primarily anxiety and depression.

Most telephone counsellors simply don’t have the training and skills to work with this demographic, says behavioural scientist Professor Billie Bonevski, who is the Women in Science Chair at the University of Newcastle. “We’ve spoken to Quitline counsellors who have expressed low confidence in providing counselling to people with mental illness, or other addictions.”

Nicotine replacement therapy, in the form of gum and patches, isn’t popular among opioid dependence treatment patients either, she adds.

Still, quitting is important. On the face of it, cigarettes may appear to be the least of their worries but, as Bonevski points out, “the burden of illness due to tobacco-related causes is higher than their other drug-taking.”

Vaping to quit tobacco – for good

Even though the attempts of people in opioid dependence treatment to quit smoking tobacco are generally unsuccessful, the motivation is there, according to Dunlop. “Most have tried or want to try to stop,” he says.

Three recent studies from New Zealand and the United Kingdom showed tobacco smokers in the general population who switched to vaporised nicotine, delivered via e-cigarettes, were more than twice as likely to have quit smoking tobacco after a year of treatment compared to nicotine replacement therapy.

In 2019, Bonevski and Dunlop received a NSW Health Translational Research Grant to investigate whether e-cigarettes might also increase quit rates in people in opioid dependence treatment.

After obtaining approvals and notifying the Australian Therapeutic Goods Administration, they will begin recruiting around 570 smokers from six opioid dependence clinics across the State and randomly allocate patients to one of two groups.

The control group will receive current best-practice smoking cessation methods, such as nicotine replacement therapy and access to counselling services from their clinic and the Quitline.

Participants in the second group will have counselling support too, but also receive a nicotine vaping kit, comprising liquid nicotine and an e-cigarette, and training on how to use it.

“We’ll follow people three and six months later and see whether they made quit attempts, whether they’ve reduced the number of cigarettes that they’re smoking and whether they’re still using the products we gave them,” Bonevski says. “But the main outcome we’re interested in is if they’ve fully quit smoking.”

If vaporised nicotine succeeds where other smoking cessation options have struggled, the pair hopes to broaden the trial into widespread practice.

“E-cigarettes should be an acceptable model for providing nicotine to those people who find it hard to quit any other way,” Bonevski says. “They have such a hard life in many other ways, and we need to help any way that we can.”