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Opioid antagonists for smoking cessation.

S David1, T Lancaster, L F Stead

  • 1Department of Family Medicine, Brown University School of Medicine, Memorial Hospital of Rhode Island, Providence, Rhode Island, USA. Sean_David@Brown.Edu

The Cochrane Database of Systematic Reviews
|November 1, 2001
PubMed
Summary

Opioid antagonists like naltrexone show no significant effect on long-term smoking cessation based on limited trials. More research is needed to determine their efficacy for helping smokers quit.

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Area of Science:

  • Addiction research
  • Pharmacology
  • Nicotine dependence

Background:

  • Nicotine's reinforcing effects are mediated by neurotransmitter release.
  • Smokers report pleasure, relaxation, and relief from negative affect.
  • Opioid antagonists are investigated for attenuating smoking's rewarding effects.

Purpose of the Study:

  • To evaluate the efficacy of opioid antagonists, specifically naloxone and naltrexone, in promoting long-term smoking cessation.

Main Methods:

  • Systematic search of Cochrane Tobacco Addiction Group trials register and Medline.
  • Included randomized controlled trials with a minimum of 6 months follow-up for smoking abstinence.
  • Meta-analysis using a fixed effects model for pooled data.

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Main Results:

  • Two naltrexone trials met criteria; neither showed a significant difference in quit rates compared to placebo.
  • Pooled analysis revealed no significant effect of naltrexone on long-term abstinence (OR 1.34, 95% CI 0.49, 3.63).
  • No long-term follow-up data were available for naloxone or buprenorphine.

Conclusions:

  • Limited data preclude confirming or refuting naltrexone's efficacy for smoking cessation.
  • Confidence intervals are wide, suggesting potential for both benefit and harm.
  • Larger trials are necessary to definitively assess naltrexone's effectiveness in smoking cessation.