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A new Ottawa study suggests that cutting the rate of smoking among the poor and homeless can also reduce their use of street drugs, including opioids such as heroin and fentanyl.
The study, conducted by researchers at The Bridge Engagement Centre, enlisted 80 inner-city residents in Ottawa. It offered them free nicotine replacement therapies — patches, gum or inhalers — along with peer support, mental health counselling and life skills training in a comprehensive approach to their addictions and the issues that fuel them.
“We need to understand that opioid addiction does not occur in isolation,” said research scientist Dr. Smita Pakhalé, lead author of the study.
“All these social determinants are intertwined: mental health issues, poverty, housing, food insecurity, trauma. All of these are related to addictions. So you need an approach that addresses the whole person rather than just the opioid, or just the cigarette, or just their diabetes.”
Pakhalé, a respirologist at The Ottawa Hospital, is also director of The Bridge, a Murray Street community research and drop-in centre where the study was conducted.
The six-month study found that participants who stayed in the program cut their daily cigarette use from an average of 20.5 a day to 9.3. What’s more, participants also reported an 18.8 per cent decline in their use of illicit drugs. The study was published in the online open access journal, BMJ Open.
The use of opioids such as heroin (6.3 per cent), oxycontin (3.8 per cent) and fentanyl (2.6 per cent) all declined among those who cut their smoking.
Pakhalé said the study suggests that smoking cessation offers a potential gateway for treating people who have multiple addictions. Tobacco and opioids both act on the brain’s reward centres.
“It’s not black magic: There is neurobiology at play,” she said. “Tobacco is the king of addiction, it’s the strongest addiction, and it causes structural changes in your brain, in the receptors, and it amplifies the response.”
Similar pathways exist for opioids, and one addiction reinforces the other, Pakhalé said.
Tara Finnessy, 50, took part in the tobacco cessation study at The Bridge and later became a peer counsellor. Finnessy said she started smoking at the age of nine, and was addicted by the time she was 11. Her addictions escalated and she became dependent on cocaine, then heroin, after the tragic death of her partner. She has been on methadone for the past 15 years.
Finnessy said the smoking cessation program offered her a positive feedback loop. “When I was able to see that I could reduce my nicotine intake, that gave me a good feeling, and the more I reduced, the better I felt,” she said. “I thought that if I could do that, why can’t I reduce my drinking?”
Finnessy said she stopped smoking for a year but has recently returned to the habit. “Unfortunately, I started again, but I’m still working on trying to quit.”
Smoking is endemic among homeless and marginalized populations. A 2013 study of 858 drug users in inner city Ottawa found that 96 per cent of them smoked cigarettes on a daily basis compared to about nine per cent of the city’s general population.
Research also showed that the vast majority of inner city smokers want to quit, yet there’s a persistent belief that smoking is a minor problem for them compared to housing, mental health and other addiction issues.
“That translates into a disproportionate amount of disease and premature death — preventable deaths — in this population,” said Pakhalé, who has also launched a study to examine the effectiveness of e-cigarettes as a smoking cessation tool.
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The study, conducted by researchers at The Bridge Engagement Centre, enlisted 80 inner-city residents in Ottawa. It offered them free nicotine replacement therapies — patches, gum or inhalers — along with peer support, mental health counselling and life skills training in a comprehensive approach to their addictions and the issues that fuel them.
“We need to understand that opioid addiction does not occur in isolation,” said research scientist Dr. Smita Pakhalé, lead author of the study.
“All these social determinants are intertwined: mental health issues, poverty, housing, food insecurity, trauma. All of these are related to addictions. So you need an approach that addresses the whole person rather than just the opioid, or just the cigarette, or just their diabetes.”
Pakhalé, a respirologist at The Ottawa Hospital, is also director of The Bridge, a Murray Street community research and drop-in centre where the study was conducted.
The six-month study found that participants who stayed in the program cut their daily cigarette use from an average of 20.5 a day to 9.3. What’s more, participants also reported an 18.8 per cent decline in their use of illicit drugs. The study was published in the online open access journal, BMJ Open.
The use of opioids such as heroin (6.3 per cent), oxycontin (3.8 per cent) and fentanyl (2.6 per cent) all declined among those who cut their smoking.
Pakhalé said the study suggests that smoking cessation offers a potential gateway for treating people who have multiple addictions. Tobacco and opioids both act on the brain’s reward centres.
“It’s not black magic: There is neurobiology at play,” she said. “Tobacco is the king of addiction, it’s the strongest addiction, and it causes structural changes in your brain, in the receptors, and it amplifies the response.”
Similar pathways exist for opioids, and one addiction reinforces the other, Pakhalé said.
Tara Finnessy, 50, took part in the tobacco cessation study at The Bridge and later became a peer counsellor. Finnessy said she started smoking at the age of nine, and was addicted by the time she was 11. Her addictions escalated and she became dependent on cocaine, then heroin, after the tragic death of her partner. She has been on methadone for the past 15 years.
Finnessy said the smoking cessation program offered her a positive feedback loop. “When I was able to see that I could reduce my nicotine intake, that gave me a good feeling, and the more I reduced, the better I felt,” she said. “I thought that if I could do that, why can’t I reduce my drinking?”
Finnessy said she stopped smoking for a year but has recently returned to the habit. “Unfortunately, I started again, but I’m still working on trying to quit.”
Smoking is endemic among homeless and marginalized populations. A 2013 study of 858 drug users in inner city Ottawa found that 96 per cent of them smoked cigarettes on a daily basis compared to about nine per cent of the city’s general population.
Research also showed that the vast majority of inner city smokers want to quit, yet there’s a persistent belief that smoking is a minor problem for them compared to housing, mental health and other addiction issues.
“That translates into a disproportionate amount of disease and premature death — preventable deaths — in this population,” said Pakhalé, who has also launched a study to examine the effectiveness of e-cigarettes as a smoking cessation tool.
查看原文...
