Treating tobacco use disorder in pregnant women in medication-assisted treatment for an opioid use disorder: a systematic review

J Subst Abuse Treat. 2015 May;52:40-7. doi: 10.1016/j.jsat.2014.12.002. Epub 2014 Dec 22.


Smoking is associated with adverse effects on pregnancy and fetal development, yet 88-95% of pregnant women in medication-assisted treatment for an opioid use disorder smoke cigarettes. This review summarizes existing knowledge about smoking cessation treatments for pregnant women on buprenorphine or methadone, the two forms of medication-assisted treatment for opioid use disorder indicated for prenatal use. We performed a systematic review of the literature using indexed terms and key words to capture the concepts of smoking, pregnancy, and opioid substitution and found that only three studies met search criteria. Contingency management, an incentive based treatment, was the most promising intervention: 31% of participants achieved abstinence within the 12-week study period, compared to 0% in a non-contingent behavior incentive group and a group receiving usual care. Two studies of brief behavioral interventions resulted in reductions in smoking but not cessation. Given the growing number of pregnant women in medication-assisted treatment for an opioid use disorder and the negative consequences of smoking on pregnancy, further research is needed to develop and test effective cessation strategies for this group.

Keywords: 5 As; Cigarette smoking; Contingency management; Incentives; Motivational enhancement; Opioid; Pregnancy.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Behavior Therapy / methods*
  • Buprenorphine / therapeutic use
  • Female
  • Humans
  • Methadone / therapeutic use
  • Opiate Substitution Treatment / methods
  • Opioid-Related Disorders / complications
  • Opioid-Related Disorders / drug therapy*
  • Pregnancy
  • Smoking Cessation / methods*
  • Tobacco Use Disorder / complications
  • Tobacco Use Disorder / psychology
  • Tobacco Use Disorder / therapy*
  • Treatment Outcome


  • Analgesics, Opioid
  • Buprenorphine
  • Methadone