Correlation between state smoking rates and prescription opioid dispensing rates, pre and post pandemic, 2019 versus 2022. Notes: US states and DC. The fit lines are estimated by linear regressions. Sources: Authors’ calculations using BRFSS data and CDC-reported data. Credit: American Journal of Preventive Medicine (2024). DOI: 10.1016/j.amepre.2024.07.010

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 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, Ph.D., Didem Bernard, Ph.D., and R. Burciaga Valdez, Ph.D., 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.”