Current Tobacco Product Use and Cessation Behaviors Among People Who Use Opioids: Implications for Integrated Harm Reduction Services.

INTRODUCTION: Tobacco use, particularly cigarette smoking, is disproportionately high among people who use opioids (PWUO). Although harm reduction programs provide trusted, low-barrier, and repeated contact with PWUO, tobacco cessation support is not routinely integrated into these settings. We assessed current use of different forms of tobacco products and smoking cessation behaviors among PWUO and considered implications for integrating tobacco cessation into harm reduction services. METHODS: We conducted a cross-sectional survey among PWUO attending a syringe service program (SSP) in New Haven, Connecticut (N=200) between November 2025 and March 2026. We used questionnaires adopted from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to assess current tobacco product use (i.e., cigarettes, e-cigarettes, cigars, smokeless tobacco, and pipes). We used descriptive statistics to report current tobacco product use, cessation-related behaviors, and other participant characteristics. RESULTS: Participants had a mean age of 46.9 (± 10.9) years, 66.5% (n=133) were male, and 65.5% (n=131) were currently homeless. Most participants screened positive for opioid dependence (92.0%, n=184), and 65.0% (n=130) were currently receiving prescribed medication for opioid addiction. Nearly all participants [97.5% (n=195)] reported current use of any tobacco product. Prevalence of current use of each tobacco product was as follows: cigarettes (96.0%, n=192), e-cigarettes (73.5%, n=147), cigars (29.5%, n=59), smokeless tobacco (18.5%, n=37), and pipes (16.5%, n=33). Among current smokers, 87.5% (n=168/192) reported interest in quitting, and 37.5% (n=72/192) reported a past-year quit attempt. CONCLUSIONS: This study demonstrated a high prevalence of tobacco use among PWUO, while most current smokers reported interest in quitting. Integrating tobacco cessation support into harm reduction programs, such as SSP and addiction treatment settings, represents a critical, yet underutilized, opportunity to address this unmet need and improve health outcomes in this vulnerable population.