TY - JOUR
T1 - Low incidence of adverse events following varenicline initiation among opioid dependent smokers with comorbid psychiatric illness
AU - Nahvi, Shadi
AU - Wu, Bryan
AU - Richter, Kimber P.
AU - Bernstein, Steven L.
AU - Arnsten, Julia H.
N1 - Funding Information:
This work was supported by the National Center for Research Resources grant UL1 RR025750 to Dr. Nahvi, and the National Institute on Drug Abuse grants K23 DA025736 to Dr. Nahvi, and R25 DA023021 to Drs. Nahvi and Arnsten. The funding sources had no further role in the study design; data collection, analysis, or interpretation; manuscript preparation; or the decision to submit the paper for publication.
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Background: Most drug treatment patients smoke cigarettes, yet few data exist on the prevalence and outcomes of varenicline treatment among smokers with comorbid substance use and psychiatric disorders. Methods: We reviewed all patient charts of opioid-dependent smokers prescribed varenicline between May 2006 and December 2009 in two urban methadone clinics that also provide on-site medical and psychiatric care. We assessed prevalence, adverse events, and effectiveness of varenicline treatment in this cohort. Results: We identified 575 smokers among 690 patients (83.3%), and assessed 82 courses of varenicline treatment prescribed to 70 smokers. Both cardiovascular risk factors and psychiatric illness were highly prevalent among those prescribed varenicline: hypertension, 51%; hyperlipidemia, 23%; diabetes, 20%; depression, 53%; anxiety, 30%; psychotic disorders, 10%; bipolar disorder, 8.6%. Of 82 varenicline courses, nine (11%) were discontinued due to adverse events and two due to depressive symptoms. One patient initiated new psychiatric medications within six months of initiating varenicline, but did not discontinue varenicline. There were no reports of suicidal ideation, agitation prompting clinical intervention, or psychiatric hospitalization. There were no incident cardiac or vascular events within six months of varenicline prescription. Some (8.6%) varenicline-treated smokers quit smoking, and cessation was significantly associated with varenicline treatment duration. Conclusions: Despite substantial comorbidity, opioid-dependent smokers receiving integrated substance abuse, medical and psychiatric care had few documented adverse events with varenicline treatment. Methadone patients will likely experience little harm and a great deal of benefit from treatment with varenicline for smoking cessation.
AB - Background: Most drug treatment patients smoke cigarettes, yet few data exist on the prevalence and outcomes of varenicline treatment among smokers with comorbid substance use and psychiatric disorders. Methods: We reviewed all patient charts of opioid-dependent smokers prescribed varenicline between May 2006 and December 2009 in two urban methadone clinics that also provide on-site medical and psychiatric care. We assessed prevalence, adverse events, and effectiveness of varenicline treatment in this cohort. Results: We identified 575 smokers among 690 patients (83.3%), and assessed 82 courses of varenicline treatment prescribed to 70 smokers. Both cardiovascular risk factors and psychiatric illness were highly prevalent among those prescribed varenicline: hypertension, 51%; hyperlipidemia, 23%; diabetes, 20%; depression, 53%; anxiety, 30%; psychotic disorders, 10%; bipolar disorder, 8.6%. Of 82 varenicline courses, nine (11%) were discontinued due to adverse events and two due to depressive symptoms. One patient initiated new psychiatric medications within six months of initiating varenicline, but did not discontinue varenicline. There were no reports of suicidal ideation, agitation prompting clinical intervention, or psychiatric hospitalization. There were no incident cardiac or vascular events within six months of varenicline prescription. Some (8.6%) varenicline-treated smokers quit smoking, and cessation was significantly associated with varenicline treatment duration. Conclusions: Despite substantial comorbidity, opioid-dependent smokers receiving integrated substance abuse, medical and psychiatric care had few documented adverse events with varenicline treatment. Methadone patients will likely experience little harm and a great deal of benefit from treatment with varenicline for smoking cessation.
KW - Adverse events
KW - Opioid dependence
KW - Smoking cessation
KW - Varenicline
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U2 - 10.1016/j.drugalcdep.2012.12.026
DO - 10.1016/j.drugalcdep.2012.12.026
M3 - Article
C2 - 23332438
AN - SCOPUS:84881665504
SN - 0376-8716
VL - 132
SP - 47
EP - 52
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
IS - 1-2
ER -