Tobacco smoking and opioid use disorders: A meta-analysis

Publication date: Available online 4 December 2018

Source: Addictive Behaviors

Author(s): Abdolhalim Rajabi, Mohsen Dehghani, Azadeh Shojaei, Mojtaba Farjam, Seyed Abbas Motevalian

Abstract

Background

Tobacco smoking has been shown a major risk factor for opioid use disorders in several observational studies, but the results are inconsistent. We conducted a systematic review and meta-analysis of observational studies to investigate the association between smoking behaviors and opioid use disorders.

Methods

We performed a systematic literature search of Medline, Embase, Scopus, ISI Web of Science, and Google Scholar through October 2017, using MeSH terms related to smoking, opioid, and opiate. The reference list of retrieved article was also examined. We calculated pooled odds ratio (ORs) with 95% confidence intervals (CIs) using fixed and random-effects models. Subgroup analyses was performed using participants and studies characteristics to assess the sources of heterogeneity.

Results

We identified 11 eligible observational studies (7 cohort and 4 population based cross-sectional studies) with 199,411 participants. The pooled OR of opioid use disorders was 3.18 (95% CI: 2.37–4.25) for current smoking compared with nonsmoking. Pooled OR for prevalent cases of opiate use disorders were 13.78 (95% CI: 6.81–27.89), pooled OR for prevalent cases of opioid use disorders were 3.15 (95% CI: 2.62–3.80) and pooled OR for incident cases of opiate use disorders were 1.86 (95% CI: 1.39–2.49). Opioid use disorders was positively associated with earlier age of onset tobacco smoking (pooled OR = 1.66; 95% CI: 1.33–2.07).

Conclusion

The results of present meta-analysis confirm that tobacco smoking is associated with opioid use disorders development. If the association between smoking and risk of opioid use disorders is causal or gateway public health efforts to reduce smoking could have a substantial effect on the worldwide burden of opioid use disorders.

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