Tobacco addiction and smoking status in heroin addicts under methadone vs. buprenorphine therapy

Int J Environ Res Public Health. 2012 Mar;9(3):932-42. doi: 10.3390/ijerph9030932. Epub 2012 Mar 16.


Aims of the present investigation were: (i) to assess the prevalence of current smokers and relative smoking status among a large number of heroin addicts attending opioid-substitution therapy prevalence; (ii) to evaluate the relationship between the type (methadone, buprenorphine) and dosage of opioid substitution therapy and nicotine dependence. Three hundred and five (305) heroin addicts under opioid-substitution therapy were recruited at five Addiction Units. All participants completed a questionnaire assessing sociodemographic information, type and dose of opioid-substitution therapy, smoking history and status, Fagerström Test for Nicotine Dependence (FTND), and the Zung Self-Rating Depression scale (SDS). 298 subjects, out of 305 (97.2%) were smokers, with an average of 20.5 cigarette/day and a median FTND of 6. Our data confirmed the high prevalence of smokers among heroin addicts, the highest described in the literature to date among heroin addicts under substitution therapies, without any significant difference between methadone vs. buprenorphine therapy groups. There was no correlation between dose of methadone or buprenorphine and average number of cigarettes/day. Patients in substance abuse treatment very frequently smoke cigarettes and often die of tobacco-related diseases. Substance abuse treatment programs too often ignore tobacco use. We hope that these findings will help to incorporate smoking cessation in substance abuse treatments.

Keywords: buprenorphine; heroin; methadone; opioid substitution therapy; tobacco smoking.

MeSH terms

  • Adult
  • Buprenorphine / therapeutic use
  • Female
  • Heroin Dependence / drug therapy*
  • Heroin Dependence / epidemiology*
  • Humans
  • Italy / epidemiology
  • Male
  • Methadone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Narcotics / therapeutic use
  • Opiate Substitution Treatment*
  • Smoking / epidemiology*
  • Tobacco Use Disorder / epidemiology*


  • Narcotic Antagonists
  • Narcotics
  • Buprenorphine
  • Methadone