Is there any clinical evidence that continuous tobacco use after buprenorphine and naloxone (Suboxone) treatment for opioid addiction encourages relapse?—TIM KRENIK, MSPAS, PA-C, Albuquerque, N.M.

Cigarette smokers do appear to have higher rates of relapse after treatment for opioid addiction than nonsmokers, although the reasons for this are not clear. Anecdotally, I know of patients who—although they remain smokers—have conquered opioid addiction and remained “clean” for years. Some cite fear of opioid relapse as a reason for not quitting, but as more and more drug rehabilitaiton centers become smoke-free, it is clear that terminating all addictions at once is possible (if not preferable).—Reuben W. Zimmerman, PA-C (141-3)

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