High prevalence of smoking and respiratory symptoms of patients on opioid substitution treatment

Abstract

Background: Tobacco and cannabis smoking has been linked to a range of adverse health consequences including impaired pulmonary function. In 2010, in Australia, the proportion of people smoking tobacco daily was 15%.The proportion who recently used cannabis was 15%.1 In addition, all opiate and opioid drugs depress respiratory function to some extent. In 2011, 46,446 opioid dependent people were receiving opioid substitution treatment (OST); 3,382 (7.3%) in Western Australia.2 Aims: To assess the prevalence of smoking tobacco and cannabis and of respiratory symptoms and lung function of patients receiving OST. Method: Participants (99 males, 50 females) were recruited from two OST clinics in Perth, WA. All patients considered suitable who were seen at the clinic between March 2009 and 2012 were invited to participate). Data were obtained on tobacco and cannabis use, asthma and other lung conditions, dyspnoea, cough and sputum. Lung function was assessed by spirometric testing. Findings: Mean age 40 years. Current tobacco smokers 87%; current cannabis smokers 42%. Mean cigarettes smoked daily 17 (SD 11). Mean joints smoked per day 6 (SD 8). 69% were on methadone, median dose 69 mg, (range 2–120 mg). Median dose of buprenorphine 16 mg (range 2–32 mg).Over a third (37%) had been diagnosed with asthma, 36% with bronchitis, 28% with pneumonia, 11% with pleurisy and 24% with other chest problems. 35% had a productive cough for three months in the past year., 46% were short of breath when walking. Mean FEV1 males 3.78 l (90.7% predicted), females 2.75 l (88.8% predicted). Mean FVC males 5.03 l (97.9% predicted), females 3.57 l (95.1% predicted). Conclusion: The overall reduction in smoking prevalence in Australia has not been achieved by patients receiving OST. Opioid dependent patients treated with OST may be particularly vulnerable to pulmonary and other related harms from tobacco smoking, their drug taking behaviours and the treatment they receive.