Importance: Approximately 85% of individuals receiving opioid agonist therapy for opioid dependence smoke tobacco. Despite the significant health risks associated with smoking-related diseases, there has been limited evaluation of smoking interventions tailored to this population.

Question: Can an integrated intervention combining nicotine replacement and brief behavioral support reduce the number of cigarettes smoked among patients receiving opioid agonist therapy?

Findings: In this randomized clinical trial including 259 participants, twice as many participants in the intervention group halved the number of cigarettes smoked compared with the control group, a significant difference.

Meaning: The findings suggest that providing nicotine replacement and brief behavioral support alongside opioid agonist therapy at clinics is effective in helping patients reduce the number of cigarettes smoked.