Perceived risk, attitudes, and behavior of cigarette smokers and nicotine vapers receiving buprenorphine treatment for opioid use disorder during the COVID-19 pandemic

Streck, Joanna M.; Kalkhoran, Sara; Bearnot, Benjamin; Gupta, Priya S.; Kalagher, Kelly M.; Regan, Susan; Wakeman, Sarah; Rigotti, Nancy A.

BACKGROUND: Cigarette smoking may increase the risk of COVID-19 complications, reinforcing the urgency of smoking cessation in populations with high smoking prevalence such as individuals with opioid use disorder (OUD). Whether the COVID-19 pandemic has altered perceptions, motivation to quit, or tobacco use among cigarette smokers and nicotine e-cigarette vapers with OUD is unknown. METHODS: A telephone survey was conducted in March-July 2020 of current cigarette smokers or nicotine vapers with OUD who were stable on buprenorphine treatment at five Boston (MA) area community health centers. The survey assessed respondents’ perceived risk of COVID-19 due to smoking or vaping, interest in quitting, quit attempts and change in tobacco consumption during the pandemic. RESULTS: 222/520 patients (43%) completed the survey, and 145 were asked questions related to COVID-19. Of these, 61% smoked cigarettes only, 13% vaped nicotine only, and 26% were dual users. Nearly 80% of participants believed that smoking and vaping increased their risk of COVID-19 infection or complications. Smokers with this belief reported an increased interest in quitting (AOR 4.6, 95% CI:1.7-12.4). Overall, 49% of smokers and 42% of vapers reported increased interest in quitting due to the pandemic; 24% and 20%, respectively, reported attempting to quit since the pandemic. However, 35% of smokers and 27% of vapers reported increasing smoking and vaping, respectively, during the pandemic. CONCLUSIONS: Most patients with OUD believed that smoking and vaping increased their vulnerability to COVID-19, half reported increased interest in quitting, but others reported increasing smoking and vaping during the COVID-19 pandemic.