Nicotine maintenance for smokers in methadone treatment: a new direction

Patients of methadone maintenance treatment (MMT) exhibit an exceedingly high prevalence of tobacco use and disproportionately suffer from tobacco-related illnesses and mortality. A number of studies have sought to target MMT smokers with cessation interventions utilizing a variety of behavioral and pharmacological treatments. Such efforts have struggled to attain even modest rates of cessation at follow-up, suggesting a need for novel approaches. In an effort to accelerate this area of research, the current article proposes an alternative paradigm for MMT smokers: Nicotine Maintenance. The proposed model emphasizes five domains aimed at advancing the contextual fit between smoking cessation treatment and MMT: (1) A harm reduction and maintenance orientation; (2) a reconsideration of abstinence-oriented frameworks and techniques; (3) a longer-term perspective; (4) greater integration with the MMT treatment milieu; and (5) approaches that address the unique needs of MMT patients including shame, stigma, and the enhancement of treatment autonomy.