Mindfulness cuts dropout and relapse in opioid addiction treatment. A new study tested Mindfulness-Oriented Recovery Enhancement (MORE) given alongside methadone treatment. It led to better recovery than methadone treatment alone.
Summary: Opioid addiction is not rare in patients who get these drugs for chronic pain. Methadone is an opioid painkiller. Doctors use it to help these patients overcome opioid addiction. But every treatment has significant dropout and relapse rates. A new study shows that mindfulness therapy, even done remotely, can help more patients succeed.
Telehealth Mindfulness Oriented Recovery Enhancement (MORE) works alongside standard medical treatment. Together, they give better recovery rates in patients treated for opioid addiction. And the benefits of opioid addiction treatment with mindfulness go well beyond lower dropout and relapse rates.
Many patients with chronic pain get opioids. Many of them become addicted. They start seeking the drugs. Even after the prescription stops, they keep using street opioids. Many of these patients get methadone. It is a much safer opioid and is also used for chronic pain. But not every patient gains from it.
It is no secret that the human side of care matters. It shapes recovery from chronic pain and from opioid addiction. That is why results differ so much from clinic to clinic. Some doctors see more clearly the value of talk therapy and other drug-free tools.
Here is the remarkable part. Mindfulness therapy can be done remotely. It can be part of a clinic’s telehealth services. Patients do not have to come to the clinic, which is a major hurdle for many. In fact, you can get opioid use disorder (OUD) treatment without leaving the privacy of your home.
Does mindfulness help people stay in opioid addiction treatment?
The study ran in JAMA Psychiatry. It tested methadone treatment (MT) plus telehealth Mindfulness-Oriented Recovery Enhancement (MORE) against MT alone. It looked at opioid use disorder (OUD) and chronic pain. It was a randomized clinical trial run from August 2020 to June 2022 at five clinics in New Jersey. It included 154 people. Their average age was 48.5 years, and most were female (57%).
The control group got standard MT, with medication and counseling. The other group got MT plus MORE. That meant eight weekly, two-hour telehealth sessions. They taught mindfulness, reappraisal (seeing a stress in a new light), and savoring (soaking up good moments). The main outcomes were return to drug use and dropping out of MT over 16 weeks. Other outcomes were days of drug use, taking methadone as prescribed, pain, depression, and anxiety.
Results showed that participants in the MORE plus usual care group had a significantly lower rate of return to drug use (hazard ratio [HR], 0.58). A hazard ratio compares risk; the lower it is, the lower the risk. They also had less MT dropout (HR, 0.41) than the usual care group. In the MORE group, 50.6% of people returned to drug use. In the usual care group, 57.1% did. Dropout was also lower in the MORE group (13.0%) than in the usual care group (22.1%).
The MORE group also had significantly fewer days of drug use. More of them took methadone as prescribed: 95.5%, against 83.6% in the usual care group. Pain and depression also fell significantly more in the MORE group. In the MORE group, average pain fell from 5.79 at the start to 5.17 at 16 weeks. In the usual care group, it fell from 5.19 to 4.96. Depression scores dropped from 22.52 to 18.98 in the MORE group. They dropped from 22.65 to 20.03 in the usual care group.
Anxiety scores fell in the MORE group and rose in the usual care group. But the difference was not statistically significant. Overall, MORE cut opioid use and helped people stick with methadone. It also eased pain and depression. So mindfulness-based care could boost the results of methadone treatment for OUD.
Is mindfulness worth adding to methadone treatment?
Adding mindfulness to methadone could be a safe way to make treatment work better. It cuts dropout and relapse. It also lowers anxiety and depression. Sometimes the gains are modest. But mindfulness is a safe therapy with many health benefits. And once a patient learns it, the benefits can last for life.
Frequently asked questions
What is Mindfulness-Oriented Recovery Enhancement (MORE)?
MORE is a mindfulness therapy used alongside medical treatment for opioid addiction and chronic pain. It teaches three skills: mindfulness, reappraisal and savoring. In the study on this page, patients on methadone had eight weekly, two-hour sessions by telehealth. That was on top of their usual medication and counseling.
Does mindfulness reduce relapse in opioid addiction?
Yes. The randomized trial included 154 adults on methadone. In the mindfulness group, 50.6% returned to drug use. In the usual-care group, 57.1% did. Treatment dropout fell from 22.1% to 13.0%. The mindfulness group also had fewer days of drug use. More of them took methadone as prescribed (95.5% vs. 83.6%).
Can mindfulness therapy for addiction be done online?
Yes. The mindfulness sessions in this study were done fully by telehealth. They still lowered relapse and dropout. That matters, because getting to a clinic is a major hurdle for many patients. Mindfulness can be part of a clinic’s telehealth services. Once a patient learns it, the practice can go on for life.
Does mindfulness help with pain and depression during methadone treatment?
In this trial, pain and depression both improved more in the mindfulness group. Pain ratings fell from 5.79 to 5.17, against 5.19 to 4.96 with usual care. Depression scores dropped from 22.52 to 18.98, against 22.65 to 20.03 with usual care. Mindfulness is a safe therapy with many health benefits.
Source:
Cooperman, N. A., Lu, S.-E., Hanley, A. W., Puvananayagam, T., Dooley-Budsock, P., Kline, A., & Garland, E. L. (2024).
Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain:
A Randomized Clinical Trial. JAMA Psychiatry, 81(4), 338-346. https://doi.org/10.1001/jamapsychiatry.2023.5138
Related reading
Methadone Reduces Treatment Dropout More Than Buprenorphine · Chronic Pain and Opioid Use Disorder · Chronic Groin Pain After Hernia Surgery: A New Approach
Sources
- Cooperman NA, Lu SE, Hanley AW, et al. Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2024;81(4):338-346. PMID 38061786 · DOI 10.1001/jamapsychiatry.2023.5138.