Aims This study examined the feasibility and efficacy of behavioral incentives for reducing cigarette smoking among pregnant methadone-maintained patients. Methods Participants (N=102) were randomly assigned to: 1) contingent behavioral incentives (CBI: n=42); 2) non-contingent behavioral incentives (NCBI: n=28); or 3) treatment as usual (TAU: n=32). Baseline carbon monoxide (CO) levels were calculated for each participant. Subsequently, breath samples were tested three times weekly to measure changes in smoking behavior. CBI participants received incentives for target reductions from baseline: any reduction (week 1); 10% reduction (weeks 2-4), 25% reduction (weeks 5-7), 50% reduction (weeks 8-9), 75% reduction (week 10-11); abstinence (CO<4ppm) (week 12 until delivery). NCBI participants received incentives independent of smoking CO measurement results. TAU participants received no incentives, the standard treatment at the program. Results CBI condition participants submitted significantly lower mean CO values than the NCBI and TAU conditions over the course of the intervention (p<.0001). Nearly half (48%) of the CBI participants, met the 75% smoking reduction target and one third (31%) met the abstinence target at week 12. In contrast, none of the NCBI met either the 75% or abstinence target. Only 2% of the TAU participants met the 75% reduction and none of the TAU participants met the abstinence target. These smoking behavior reductions did not yield significant differences in birth outcomes. Conclusions Cigarette smoking may be significantly reduced among pregnant, methadone-maintained women through the use of contingent reinforcement for gradual reductions in breath carbon monoxide levels.

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Results support high rates of smoking with little change during pregnancy among opioid-dependent patients, regardless of the type of agonist medication received. These findings are consistent with evidence that suggests nicotine effects, and interactions may be similar for buprenorphine compared with methadone. The outcomes further highlight that aggressive efforts are needed to reduce/eliminate smoking in opioid-dependent pregnant women.