More than 80% of people with opioid use disorder (OUD) smoke cigarettes, and most of them have tremendous difficulty quitting. Varenicline and other anti-smoking medications can be successful when people follow a proper dosage schedule. Unfortunately, people with OUD generally have challenges sticking with drug regimens, so there’s a need for strategies to bolster their smoking cessation efforts.

In a paper published online on August 28 in Addiction, Shadi Nahvi, M.D., M.S., and colleagues compared two approaches for delivering varenicline to patients with OUD who smoke cigarettes: directly observed therapy (DOT), in which a nurse gave the medication at the patient’s opioid treatment program; or self-administered varenicline. DOT significantly increased adherence to the proper dosing schedule compared to self-administration. Using DOT as a part of patients’ opioid treatment programs may help ensure that they receive comprehensive care—for their opioid use as well as for other health challenges they face, including difficulty quitting smoking.

Dr. Nahvi is an associate professor of medicine and of psychiatry and behavioral sciences at Einstein, and an attending physician at Montefiore Health System.