Tobacco smoking, nicotine dependence, and patterns of prescription opioid misuse: Results from a nationally representative sample

Introduction: The misuse of prescription opioid medications is a growing public health crisis. Given evidence of complex nicotine-opioid interactions, and initial support for the role of smoking status as a risk factor for prescription opioid misuse, a more detailed analysis of how current and historical patterns of smoking may influence misuse of prescription opioids is warranted. Methods: The current study is the first to test whether varying levels of current/historical smoking (current daily, current intermittent, former daily, never) and indices of smoking heaviness/nicotine dependence may be associated with greater likelihood of past-year prescription opioid misuse in the general population. Data were derived from the National Survey on Drug Use and Health (N = 24,348). Results: Consistent with hypotheses, after accounting for sociodemographic factors and major depressive/alcohol use disorders, both daily and intermittent smokers were greater than 3 times more likely to report past-year nonmedical prescription opioid use than were never smokers. In addition, daily smokers were observed to be nearly 5 times more likely, and intermittent smokers were nearly 3 times more likely, to have met past-year abuse/dependence criteria, relative to never smokers. Results further revealed positive associations between various indices of smoking heaviness/nicotine dependence and opioid medication misuse, and these findings remained largely consistent when analyses were stratified by gender. Conclusions: These findings indicate that smokers are not a homogeneous group with regard to risk for opioid misuse, and support the utility of comprehensive smoking assessment in the context of opioid-based treatment/tapering.