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Randomized Controlled Trial
.2014 Jun 13;9(1):9.
doi: 10.1186/1940-0640-9-9.

Rationale and design of a randomized controlled trial of varenicline directly observed therapy delivered in methadone clinics

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Randomized Controlled Trial

Rationale and design of a randomized controlled trial of varenicline directly observed therapy delivered in methadone clinics

Shadi Nahvi et al. Addict Sci Clin Pract..

Abstract

Background: Tobacco cessation medication adherence is one of the few factors shown to improve smoking cessation rates among methadone-maintained smokers, but interventions to improve adherence to smoking cessation medications have not yet been tested among methadone treatment patients. Methadone clinic-based, directly observed therapy (DOT) programs for HIV and tuberculosis improve adherence and clinical outcomes, but have not been evaluated for smoking cessation. We describe a randomized controlled trial to evaluate whether a methadone clinic-based, directly observed varenicline therapy program increases adherence and tobacco abstinence among opioid-dependent drug users receiving methadone treatment.

Methods/design: We plan to enroll 100 methadone-maintained smokers and randomize them to directly observed varenicline dispensed with daily methadone doses or treatment as usual (self-administered varenicline) for 12 weeks. Our outcome measures are: 1) pill count adherence and 2) carbon monoxide-verified tobacco abstinence. We will assess differences in adherence and abstinence between the two treatment arms using repeated measures models.

Discussion: This trial will allow for rigorous evaluation of the efficacy of methadone clinic-based, directly observed varenicline for improving adherence and smoking cessation outcomes. This detailed description of trial methodology can serve as a template for the development of future DOT programs and can guide protocols for studies among opioid-dependent smokers receiving methadone treatment.

Trial registration: clinicaltrials.govNCT01378858.

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Figure 1
Figure 1
Example mDOT varenicline pill trays. A. Methadone clinic visits 3 days per week.B. Methadone clinic visits 6 days per week. This figure illustrates mDOT varenicline pill box labels indicating observed and take-home varenicline doses, according to subjects’ methadone clinic schedule.
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