Mindfulness treatment program reduces cravings in those with opioid addiction

Key takeaways:

• Mean opioid craving was reduced by 67% in the mindfulness-based intervention.
• Anxiety was also significantly reduced from baseline to 24 weeks in both treatment groups.

An online-based mindfulness treatment program significantly reduced opioid craving among participants with opioid use disorder, results from a randomized clinical trial published in JAMA Network Open showed.

Nevertheless, the treatment did not substantially reduce opioid use, anxiety or use of benzodiazepine or cocaine vs. a recovery support intervention, researchers noted.

“Primary care providers should take away that prescribing buprenorphine is a first-line treatment for [opioid use disorder], and there is great value in a group-based opioid treatment approach,” Zev Schuman-Olivier, MD, an assistant professor of psychiatry at Harvard Medical School, told Healio. “PCPs can encourage people with [opioid use disorder] who still have residual craving symptoms while being prescribed a stable dose of buprenorphine.”

According to Schuman-Olivier and colleagues, mindfulness training interventions, which “[appear] to increase individuals’ capacities for self-regulation through enhanced attentional control, cognitive control, emotion regulation and self-related processes,” are an increasingly popular treatment for substance use disorders.

The trial compared the effectiveness of the Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) program vs. a recovery support program among 196 adults prescribed buprenorphine for opioid use disorder.

The 24-week M-ROCC program consisted of a 30-minute informal check-in and a weekly 60-minute intervention group. The program used a trauma-informed curriculum broken up into three components. “[It] includes a warm mindfulness approach that integrates mindfulness and self-compassion in a way that supports patients to learn how to courageously and warmly be with present moment experience with curiosity, openness and acceptance,” Schuman-Olivier said.

In comparison, the recovery support program’s curriculum used four evidence-based substance abuse disorder-focused nonmindfulness approaches, such as cognitive behavioral therapy and community reinforcement.

The number of 2-week periods with both self-reported and biochemically confirmed abstinence from illicit opioid use during study weeks 13 to 24 served as the study’s primary outcome, with secondary outcomes measuring changes in opioid craving, anxiety and benzodiazepine and cocaine use.

Researchers reported an opioid use rate of 13.4% (95% CI, 6.2%-20.5%) in the M-ROCC group and 12.7% (95% CI, 7.5%-18%) in the recovery support group from weeks 13 to 24, a 0.6% difference that lacked statistical significance.

Benzodiazepine and cocaine use also did not significantly differ between the two groups.

The researchers found that mean anxiety scores from baseline to 24 weeks decreased by 10 (95% CI, 12 to 8) among recovery support group participants and 9 (95% CI, 11.7 to 6.3) among M-ROCC participants, with no significant between-group differences.

M-ROCC participants experienced a 67% reduction in mean opioid craving at 24 weeks compared with a 44% reduction among recovery support group participants, representing a significant differential reduction (1; 95% CI, 1.7 to 0.2).

Schuman-Olivier and colleagues wrote that multiple intervention mechanisms may explain the positive effects.

“Craving involves interoceptive processing, and several mindfulness practices (eg, body scan) may impact craving by enhancing healthy interoceptive awareness and correcting interoceptive dysregulation,” they added. “Mindfulness enhances self-regulation capacity and improves emotion regulation, thereby reducing reactivity to negative affect and breaking associations between negative affect and substance use craving.”

Schuman-Olivier highlighted the flexibility of the intervention, noting that these mindfulness groups “can be implemented in primary care both in-person or provided through live-online video groups.”

The researchers acknowledged that the study enrolled fewer Black participants than expected, which possibly hurt the general applicability of the results; the trial also lacked a control group with no behavioral treatment.

“We need to study the role of group vs. individual interventions during buprenorphine treatment,” Schuman-Olivier told Healio. "We need to study the best ways to implement mindfulness-based interventions during buprenorphine treatment, including with cultural adaptations to ensure the training is culturally relevant to Black, Indigenous and Latino communities, in which studies have shown recent increases in the proportion of opioid overdoses.”