Division of General Internal Medicine

Dr. Nahvi Awarded $3.4M NIH Grant to Promote Smoking Cessation Among Opioid Users

Shadi Nahvi, M.D., M.S.

The rate of smokers among opioid drug users is extremely high, and many suffer from tobacco-related diseases.  But studies have shown that giving up tobacco is not easy for smokers with opioid-use disorders (OUD).  Einstein researcher Shadi Nahvi, MD, MS, says that’s because a majority of trials evaluating smoking cessation programs rely on short-term interventions not tailored for the opiate-dependent population.

In March 2017, the National Institutes of Health (NIH) awarded Dr. Nahvi a $3.4 million R01 grant to conduct the first fully-powered trial to test directly observed therapy and long-term treatments among smokers with OUD.

“The overarching goal of my research is to optimize smoking cessation treatment for smokers with opioid use disorders, accounting for the unique challenges faced by these smokers,” said Dr. Nahvi, an Associate Professor of Medicine (General Internal Medicine) and of Psychiatry and Behavioral Sciences at Einstein. These include establishing initial abstinence, adhering to evidence-based cessation treatments, and maintaining abstinence once active treatments cease.

Dr. Nahvi and her team will conduct a 2 x 2 factorial, randomized, double-blind, placebo-controlled trial to test directly observed medication therapy and long-term treatment with varenicline (Chantix).  The study will recruit 450 smokers with OUD from community-based, outpatient opioid treatment programs to test the efficacy of directly observed varenicline therapy compared to self-administered varenicline therapy on smoking cessation milestones.

Other goals of the study will include testing the efficacy of long-term varenicline compared to short-term varenicline on smoking cessation milestones; and understanding the mechanism of smoking cessation by examining the impact of theory-guided psychological, social and pharmacogenetic factors on cessation milestones.

Collaborating with Dr. Nahvi on the study will be Einstein investigtors Julia Arnsten, MD, MPH (Co-I), Professor of Medicine (General Internal Medicine); of Epidemiology & Population Health; and of Psychiatry and Behavioral Sciences; Chief, Division of General Internal Medicine; and Director, Center for Comparative Effectiveness Research; and Moonseong Heo, PhD, (Statistician), Professor of Epidemiology & Population Health; as well as researchers from Fordham University, the University of Kansas, the University of Toronto, and the University of California San Francisco.

Early in her career, Dr. Nahvi became interested in doing research on smoking cessation interventions tailored to the HIV-positive and opiate-dependent population after she worked closely with a patient in Einstein's Division of Substance Abuse (DoSA) clinic, treating her depression and helping her initiate and maintain antiretroviral therapy for her HIV, only to see the same patient die of laryngeal cancer due to tobacco use. Losing this patient turned Dr. Nahvi's attention to the dearth of research on smoking cessation interventions tailored to the HIV-positive and opiate-dependent population, and helped her formulate a direction for her own work.

Dr. Nahvi previously conducted an observational study that assessed the effectiveness of varenicline, a prescription medication that reduces cravings and decreases the pleasurable effects of cigarettes and tobacco products, in treating a cohort of seventy  smokers with opioid use disorder. These smokers, who received integrated medical care and treatment of substance use disorders responded well to varenicline with few adverse effects, according to results of the study, published in the journal Drug and Alcohol Dependence.

A subsequent randomized, placebo-controlled trial of 112 patients tested the drug’s effectiveness as an aid to smoking cessation in methadone-maintained smokers delivered varenicline with in-person and telephone counseling and showed promising results (published in the journal Addiction), with a high long-term retention rate (90 percent at 24 weeks) and an overall reduction in smoking behavior.

Dr. Nahvi and her colleagues followed this trial with a randomized trial of directly observed varenicline therapy among 100 smokers with OUD. Compared to smokers taking varenicline on their own, those who received varenicline therapy on-site in their methadone program had higher rates of medication adherence, and higher rates of smoking cessation.

Patients receiving office-based buprenorphrine treatment for opioid dependence at a community health center also had high rates of tobacco use (a possible 89% of 319 surveyed). In an examination of tobacco use and smoking-cessation treatment patterns among these patients (published in the Journal of Substance Abuse Treatment, April 2014), Dr. Nahvi and colleagues observed that few of these patients were offered smoking cessation treatment, identifying a missed opportunity to impact their high tobacco use.

Dr. Nahvi's work has been recognized with numerous grants and awards and has helped provide smoking cessation training and program development throughout the Bronx. 

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