Novel research suggests quitting smoking may help alleviate opioid crisis
A trailblazing study in the American Journal of Preventive Medicine details the association between smoking and opioid use, emphasizing the need for integrated treatment programs
Ann Arbor, October 9, 2024 – Smoking is recognized as a leading cause of preventable disability and death. New research shows that as smokers increase their daily number of cigarettes, they report higher rates of chronic pain, more prescription opioid use, severe work limitations due to pain, and poor mental health. A novel study in the American Journal of Preventive Medicine, published by Elsevier, details the results of an analysis of nationally representative data from the US Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS), revealing a strong link between smoking and opioid use and emphasizing the need for integrated treatment programs.
Summarizing key findings, the study’s authors William Encinosa, PhD, Didem Bernard, PhD, and R. Burciaga Valdez, PhD, MHSA, Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, and the McCourt School of Public Policy, Georgetown University, say, "Our research shows that adults who smoke 11-20 cigarettes per day use five times more prescription opioids than adults who never smoked. Adults who smoke more than a pack of cigarettes a day use almost three times as many opioids than adults who smoke 11-20 cigarettes per day. Thus, integrating smoking cessation programs into substance use treatments would be a prudent way of reducing prescription opioid use."
The team of researchers analyzed data from 2013 to 2021 from MEPS and the Centers for Disease Control and Prevention’s National Health Interview Survey. Findings show that although only 37% of the population has ever smoked, smokers account for 69% of annual prescription opioid use. Heavy smokers, just 12% of the population, use as many opioids as the 63% who have never smoked. Smokers also report higher rates of chronic pain, severe work limitations due to pain, and poor mental health.
This paper reports the first nationally representative estimates of the association between smoking, pain, and opioid use and how it has persisted from the height of opioid prescription use in 2013 to the recent low in 2021.
Opioid dispensing rates have declined from 81.3 prescriptions per 100 people in 2012 to 43.3 per 100 people in 2020. Many policy factors have led to this decline in opioid prescriptions, such as pill mill laws, state caps on the number of prescriptions per patient, state prescription drug monitoring systems, and the Centers for Disease Control and Prevention guidelines for chronic pain treatment, addressing the concern that high dosages and long-term use of opioids for chronic pain can lead to opioid use disorder and its adverse health outcomes. Despite this decline, there are still prescription opioid hotspots in the US.
The researchers conclude, "Combining smoking cessation with substance abuse treatment could be crucial in addressing the opioid epidemic. Many states and localities are attempting to ban various types of cigarettes. Our research shows that any resulting smoking cessation from these bans may also contribute to easing the opioid crisis."
Journal
American Journal of Preventive Medicine
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health
Evidence of vaping’s harmful effects on blood vessels and the left ventricle of heart
Researchers develop smartphone-adaptable tools to determine the impact of nicotine-infused e-cigarettes
University of Southern California
A new study by researchers at the USC Viterbi School of Engineering, in collaboration with the Keck School of Medicine of USC, the Huntington Medical Research Institutes (HMRI) and UC Irvine, highlights the harmful effects of both electronic and standard cigarettes on cardiovascular health. In short, the researchers found that electronic cigarettes harm blood vessels while standard cigarettes impair the heart.
The study published in the Journal of the American Heart Association (JAHA) was led by Rashid Alavi, during his time as a mechanical engineering PhD student in the lab of Niema Pahlevan, the Gordon S. Marshall Early Career Chair in Engineering at USC and Fellow of the American Heart Association (FAHA), Pahlevan is a leading specialist in flow physics for application in medical diagnostics and treatment, and is recognized as an innovator in non-invasive measuring techniques to gain insights into heart health.
Titled “Adverse Cardiovascular Effects of Nicotine Delivered by Chronic Electronic Cigarettes or Standard Cigarettes Captured by Cardiovascular Intrinsic Frequencies,” the study applies an innovative fluid dynamics-based analysis technique to measure the impact of nicotine exposure via e-cigarette vapor and traditional cigarette vapor. Although the study was performed on animal models, it can also be applied to humans, as has been done in other applications including heart failure. For humans, one can use smartphone cameras to identify abnormalities in cardiovascular function.
Pahlevan explains how the process works. “For human applications, the smartphone camera captures images of the neck skin. Then an algorithm extracts vessel wall dilation from the skin vibrations recorded in the images. This dilation waveform mirrors the pressure waveform in large arteries, such as the carotid where wall viscoelasticity is minimal.”
Results: The results reveal that nicotine-containing electronic cigarettes negatively impact vascular function and left ventricle-arterial coupling. Traditional cigarettes were also found to significantly impair left ventricle contractile function. These findings demonstrate potential long-term consequences for cardiovascular health.
“Vaping with nicotine is causing accelerated aging of the vascular system,” said Pahlevan.
Impact: While electronic cigarettes with nicotine have gained popularity as a potential aid for quitting traditional smoking, their impact on cardiovascular health remained poorly understood – until now.
“People have this idea that e-cigarettes are much better than traditional cigarettes, so they quit traditional smoking and try e-cigarettes with nicotine. However, e-cigarettes with nicotine have so many adverse effects, so they need to be carefully considered,” said Pahlevan.
“The goal of this study was to raise awareness about vaping and its long-term effects on the cardiovascular system,” said Alavi, whose thesis was recognized for the top-4 thesis in the USC Viterbi Best PhD Dissertation Award and who is now the James Boswell Postdoctoral Fellow at Caltech and HMRI. “When the vessels become impaired, this will eventually impact the heart. We want to help people to make informed decisions about whether to use a substance or not, ” Alavi added.
A smartphone tool, adds Alavi, can also be used in the final application by people who vape to allow them to assess if they are at-risk.
The intrinsic frequency method which is a new fluid dynamics-based analysis technique 'is clearly very sensitive to capture abnormalities in the cardiovascular system, even more than some standard hemodynamic measures. In addition, it is exciting that this technique can be applied to cell-phone applications to assess the heart’s function,” said Dr. Robert Kloner, Chief Scientific Officer at HMRI, and Professor of Medicine (clinical scholar) at the Keck School of Medicine of USC.
This approach holds significant potential for human applications. By developing a new, cost-effective method for detecting cardiovascular damage using only carotid pressure waveform (neck pulse) measurements, the study paves the way for faster, easier and more widespread testing.
The next step is to test the tool in human clinical trials.
Full list of authors:
Rashid Alavi , PhD; Department of Aerospace and Mechanical Engineering, University of Southern California,
Wangde Dai, MD; Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California; and Cardiovascular Research, Huntington Medical Research Institutes, Pasadena, CA
Sohrab P. Mazandarani, MA; Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California,
Rebecca J. Arechavala , PhD; Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA
David A. Herman , PhD; Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA
Michael T. Kleinman, PhD; Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA
Robert A. Kloner , MD, PhD; Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California; and Cardiovascular Research, Huntington Medical Research Institutes, Pasadena, CA
Niema M. Pahlevan , PhD: Department of Aerospace and Mechanical Engineering, University of Southern California; and Division of Cardiovascular Medicine, Keck School of Medicine University of Southern California; and Cardiovascular Research, Huntington Medical Research Institutes, Pasadena, CA
Disclosures
N.M. Pahlevan holds equity in Ventric Health (Avicena LLC) and has a consulting agreement with Ventric Health (Avicena LLC).
Journal
Journal of the American Heart Association
Article Title
“Adverse Cardiovascular Effects of Nicotine Delivered by Chronic Electronic Cigarettes or Standard Cigarettes Captured by Cardiovascular Intrinsic Frequencies,”
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