Exploring tobacco, cannabis, and pain-related sleep disturbance among people with and without HIV enrolled in a tobacco smoking cessation trial.

Abstract

Few studies have evaluated the influence of cannabis use and pain-related sleep disturbance on tobacco smoking outcomes despite a greater prevalence of smoking among people with pain and cannabis use to manage pain. This study examined cannabis use and pain-related sleep disturbance in relation to end of treatment (EOT) tobacco smoking abstinence. Participants (N = 175; 42.3% HIV+; 57.7% HIV-) were treatment-seeking adults who completed a pre-quit laboratory phase assessing smoking related factors, then an 8-week cessation treatment. Cannabis use was measured via urine drug screen. Pain was measured with a single item (pain interference with sleep). Logistic regression models were used to test whether pain-related sleep disturbance and cannabis co-use predicted abstinence. Covariates included baseline pain, baseline cannabis use, and HIV status. EOT pain-related sleep disturbance was associated with lower odds of abstinence (OR=0.57, 95%CI: 0.37-0.89, p = 0.012). The cannabis use by pain-related sleep disturbance interaction was significant (OR=1.72, 95%CI: 0.29-3.15, p = 0.018), suggesting that pain-related sleep disturbance was associated with lower odds of abstinence among those not using cannabis (p = 0.012). This relationship was not significant among those using cannabis (p = 0.6). Pain-related sleep disturbance and cannabis use may be risk factors for return to use as pain-related sleep disturbance during a quit attempt was related to abstinence, and the additive effect of EOT cannabis use and pain-related sleep disturbance was associated with the highest odds of abstinence. Further evaluations of pain-related sleep disturbance and cannabis use are needed to understand individual and additive influences on smoking abstinence.