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Contingency management for tobacco smoking during opioid addiction treatment: a randomised pilot study
  1. Tom Stephen Ainscough1,2,
  2. Leonie S Brose1,2,
  3. John Strang2,
  4. Ann McNeill1,2
  1. 1 UK Centre for Tobacco and Alcohol Studies, UK
  2. 2 IoPPN, King’s College London, London, UK
  1. Correspondence to Mr Tom Stephen Ainscough; thomas.ainscough{at}


Introduction Smoking rates among individuals in treatment for opioid addiction are close to five times that of the general public. Moreover, drug-addicted smokers have a premature mortality rate four times greater than drug-addicted non-smokers. The aim of this pilot study was to investigate whether contingency management (CM) can be successfully added to evidence-based stop smoking treatment in individuals undergoing treatment for opioid addiction and assess preliminary evidence for its impact.

Participants Forty tobacco smokers currently undergoing treatment for opioid addiction.

Intervention Escalating with reset CM as an adjunct to standard smoking cessation treatment. Financial incentives will be administered over a 5-week period for either biochemically verified abstinence from smoking or attendance at the clinic. Participants will be randomised to conditions stratified on current levels of smoking (high or low).

Objectives and analyses To assess whether a CM intervention can be successfully added to standard stop smoking services treatment, in patients undergoing outpatient treatment for opioid addiction. This will be measured as the number of people completing the 5 weeks of the intervention.

Ethics and dissemination Ethics approval for the study was granted on the 16 June 2016 by the London—city and east (reference 16/LO/0990) ethics committee. The pilot study was retrospectively registered on in January 2017 (ID: NCT03015597). A SPIRIT checklist and figure are available for this protocol. It is planned that the results of this study will be published in an academic journal.

  • addicton
  • tobacco
  • smoking
  • opiates
  • contingency management

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  • Contributors TSA was responsible for the design of the study with input from AM, LSB and JS. TSA is responsible for the recruitment of participants and for the collection, and analysis of participant data with input from AM and LSB.

  • Funding This work was funded as part of TSA’s PhD studentship by the Medical Research Council and the Institute of Psychiatry, Psychology and Neuroscience (MRC/IoP Excellence Studentship). LSB is funded by a Cancer Research UK (CRUK)/ BUPA Foundation Cancer Prevention Fellowship (C52999/ A19748). LSB and AM are members of the UK Centre for Tobacco and Alcohol Studies, a UK Clinical Research Collaboration Public Health Research: Centre of Excellence. Funding from the Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Social Research Council and the National Institute for Health Research under the auspices of the UK Clinical Research Collaboration is gratefully acknowledged 35 (MR/K/K023195/1). Neither the funding bodies nor study sponsors had any role in study design; collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication.

  • Competing interests JS has contributed to UK guidelines which include consideration of the potential role of contingency management in the management of addiction problems (NICE, 2007; chaired by JS), and JS also chaired the broader-scope pan-UK working group preparing the 2007 and 2017 editions of the ‘Orange Book’ (‘Guidelines on the Management of Drug Misuse & Dependence’) for the UK Departments of Health, providing guidance on management and treatment of drug dependence and misuse, which include guidance on possible inclusion of contingency management. JS’s institution has received support and funding from the Department of Health (England) and National Treatment Agency (England), and JS and JS’s institution have provided funded consultancy advice on possible novel addiction treatments, products and formulations to a range of pharmaceutical companies but these do not have any connection to the intervention being investigated in this paper. JS’s employer (King’s College London) has registered intellectual property on a novel buccal naloxone with which JS is involved, and JS has been named in a patent registration by a pharmaceutical company as inventor of a potential novel concentrated nasal spray, but these do not have any connection to the work being reported in this paper. A fuller account of JS’s interests is at is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London and is an NIHR Senior Investigator.

  • Ethics approval London—city and east.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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