When patients come to the Coleman Institute for Addiction Medicine to detox off various addictive substances such as heroin, fentanyl, Percocet®, Dilaudid®, Roxicet®, or any other derivatives of morphine, they aren’t feeling their best.

We generally ask people to stop using their short-acting opioid by 6:00 pm the evening before they arrive, and if they are coming to our clinic for a detox off longer-acting meds such as methadone or buprenorphine products, we ask them to stop using 48 hours before their arrival.

Most of our patients have already tried to stop using on their own, so even though they aren’t looking forward to this gap without medication, they know they can get through it. They also know that shortly after they come through our doors, we will be providing several medications to relieve their symptoms. (See blog: The Easiest Way EVER to Get Off Opioids)

Our patients are screened for their medical history so we can give them the safest detox possible. We review their medications and their health habits. It turns out that many patients, in addition to having a Substance Use Disorder (SUD) involving opioids or alcohol, are simultaneously addicted to cigarettes.

In my early days of working at the Coleman Institute, I would routinely tell people, “Don’t worry about the cigarettes for now. Let’s focus on the opioids (or alcohol). That’s the most important thing. I also won’t hassle you about flossing your teeth or eating more broccoli at the moment.”


But I have had a major sea change in this regard. The research robustly supports a very strong correlation between smoking cigarettes and relapsing.

And relapsing is the last thing patients who have gone through the rigorous process of detoxing want to go through again!

I’m referring to an article posted on the National Institute for Drug Addiction website last year.

The researchers analyzed data from two surveys done about 3 years apart, completed by over 5000 people with substance use disorders (SUD). When these people participated in the first survey, they were in remission. They had a follow-up survey about three years later.

The researchers found that people who smoked cigarettes at the initial interview and who were still smoking 3 years later were about 1.5 times more likely to use drugs and twice as likely to have SUD at follow-up than those who quit smoking.

And people who didn’t smoke at the initial interview, but started between interviews were almost 5 times more likely to report substance use at the follow-up compared with those who did not smoke! (I was really amazed at these numbers!)

Why does cigarette smoking have this correlation?

Dr. Heather L. Kimmel who works at the National Institute for Drug Addiction puts it this way, “Even though various substances have different pharmacological mechanisms, all drugs of abuse ultimately affect the same reward pathway. Abstinence from all of them will help the patient move to a new physiological state and, hopefully, a new mental state as well.”

According to the National Insitute for Drug Addiction, “Tobacco smoking can lead to lung cancer, chronic bronchitis, and emphysema. It increases the risk of heart disease, which can lead to stroke or heart attack. Smoking has also been linked to other cancers, leukemia, cataracts, and pneumonia. Smokeless tobacco increases the risk of cancer, especially mouth cancers.”

It just seems crazy to stop using opioids and continue to use tobacco.

So, if you book an opioid detox with me at the Coleman Institute, I will probably make a gentle suggestion that this might be the perfect time to release your hold on all substances keeping you from your perfect health. Just saying.

Joan R. Shepherd, FNP