Tobacco Smoking, Nicotine Dependence, and Patterns of Prescription Opioid Misuse: Results From a Nationally Representative Sample

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. 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). 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. 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.