Exploring Nicotine Dependence Among People Using Methamphetamine During Methadone Maintenance Treatment in Vietnam

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Introduction: Cigarette smoking is common among individuals with substance use disorders and those undergoing addiction treatment. Cigarette use is highly comorbid with methamphetamine use, and among individuals who co-use methamphetamine and opioids, nicotine dependence may further complicate smoking cessation efforts. This study examines nicotine dependence levels and associated factors among people who use methamphetamine undergoing methadone maintenance treatment (MMT) in Vietnam. Methods: This cross-sectional analysis utilized baseline data from 667 participants enrolled in a randomized controlled trial designed to evaluate the effectiveness of various combinations of behavioral evidence-based interventions for methamphetamine use among patients on MMT in Vietnam (STAR-OM R01DA050486). Data on levels of nicotine dependence and other covariates including demographic, health status, treatment characteristics and substance use were collected. Nicotine dependence was measured using the Fagerström Test for Nicotine Dependence, with a score of 6 or higher indicating high dependence. Logistic regression estimated the association between nicotine dependence and various psychosocial and behavioral factors. Results: Overall, 96.7% of the participants were current smokers with 247 of them (38.3%) exhibiting high nicotine dependence. Greater severity of methamphetamine withdrawal symptoms (OR: 1.03; 95% CI: 1.01-1.05) and a high risk of depression, anxiety or stress (OR: 1.76; 95% CI: 1.14-2.72) were associated with increased odds of high nicotine dependence. Conversely, older age at onset of methamphetamine use was associated with lower odds of high nicotine dependence. Conclusions: Cigarette smoking was highly prevalent among individuals using methamphetamine during MMT, with many exhibiting high nicotine dependence. Providing smoking cessation support with efforts to manage methamphetamine withdrawal symptoms, could help improve cessation outcomes.