Multimethod feasibility evaluation of smoking cessation intervention for patients receiving opioid agonist therapy

Among patients receiving opioid agonist therapy, 85% are active tobacco smokers. Despite the significant impact of smoking-related pulmonary diseases on disability and mortality in this population, less than 10% successfully quit smoking with current interventions. The study aimed to evaluate the feasibility of integrating a smoking cessation intervention at outpatient clinics for persons receiving opioid agonist treatment. The specific outcomes were the feasibility of integration, intervention acceptability, participant retention, and the trial's impact on smoking behaviour.

We conducted a 12-week feasibility study among patients receiving OAT (n = 25) in 2021 in Bergen, Norway. The feasibility outcomes were evaluated using qualitative semi-structured interviews and quantitative data collected at study visits during the pilot intervention period.

Participants reported that intervention was acceptable as it was easily accessible and provided for free at their local OAT clinic. Participants attended a median of 9 out of 12 weekly study visits and 40% of the participants completed all 12 weeks. The median number of cigarettes was reduced from 70 (range 31-175) to 26 (range 6-50) during the intervention period for those who attended all 12 study visits. One participant reported quitting smoking. The participants stressed that the possibility to individually choose smoking medication and tapering regimen was important for the acceptability of the intervention.

Participant retention and qualitative results support the feasibility of the tested intervention, indicating that implementing integrated smoking cessation treatments in opioid agonist therapy clinics was feasible and acceptable to patients. The low number of participants quitting indicated low feasibility for smoking cessation. Simultaneously, the more than halving of the number of cigarettes smoked suggests that the progression of the intervention should have a reduction in the number of cigarettes smoked as the primary aim. However, the impact of this intervention requires thorough evaluation through a sufficiently powered randomised controlled trial.