Novel research suggests quitting smoking may help alleviate opioid crisis

Smoking is recognized as a leading cause of preventable disability and death. New research shows that as smokers increase their daily number of cigarettes, they report higher rates of chronic pain, more prescription opioid use, severe work limitations due to pain, and poor mental health. A novel study in the American Journal of Preventive Medicine, published by Elsevier, details the results of an analysis of nationally representative data from the US Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS), revealing a strong link between smoking and opioid use and emphasizing the need for integrated treatment programs.

Summarizing key findings, the study’s authors William Encinosa, PhD, Didem Bernard, PhD, and R. Burciaga Valdez, PhD, MHSA, Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, and the McCourt School of Public Policy, Georgetown University, say, "Our research shows that adults who smoke 11-20 cigarettes per day use five times more prescription opioids than adults who never smoked. Adults who smoke more than a pack of cigarettes a day use almost three times as many opioids than adults who smoke 11-20 cigarettes per day. Thus, integrating smoking cessation programs into substance use treatments would be a prudent way of reducing prescription opioid use."

The team of researchers analyzed data from 2013 to 2021 from MEPS and the Centers for Disease Control and Prevention’s National Health Interview Survey. Findings show that although only 37% of the population has ever smoked, smokers account for 69% of annual prescription opioid use. Heavy smokers, just 12% of the population, use as many opioids as the 63% who have never smoked. Smokers also report higher rates of chronic pain, severe work limitations due to pain, and poor mental health.

This paper reports the first nationally representative estimates of the association between smoking, pain, and opioid use and how it has persisted from the height of opioid prescription use in 2013 to the recent low in 2021.

Opioid dispensing rates have declined from 81.3 prescriptions per 100 people in 2012 to 43.3 per 100 people in 2020. Many policy factors have led to this decline in opioid prescriptions, such as pill mill laws, state caps on the number of prescriptions per patient, state prescription drug monitoring systems, and the Centers for Disease Control and Prevention guidelines for chronic pain treatment, addressing the concern that high dosages and long-term use of opioids for chronic pain can lead to opioid use disorder and its adverse health outcomes. Despite this decline, there are still prescription opioid hotspots in the US.

The researchers conclude, "Combining smoking cessation with substance abuse treatment could be crucial in addressing the opioid epidemic. Many states and localities are attempting to ban various types of cigarettes. Our research shows that any resulting smoking cessation from these bans may also contribute to easing the opioid crisis."

Notes for editors

The article is “Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health,” by William Encinosa, PhD, Didem Bernard, PhD, and R. Burciaga Valdez, PhD, MHSA (https://doi.org/10.1016/j.amepre.2024.07.010). It appears online in advance of the American Journal of Preventive Medicine, volume 67, issue 6 (December 2024), published by Elsevier.

The article is openly available for 30 days at https://www.ajpmonline.org/article/S0749-3797(24)00249-6/fulltext.

Full text of this article is also available to credentialed journalists upon request; contact Eileen Leahy, at +1 732 406 1313 or [email protected]. Journalists wishing to interview the authors should contact William Encinosa, PhD, at [email protected].

The study was funded by the Agency for Healthcare Research and Quality.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

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