Adding Online Group Mindfulness Sessions to Medication Treatment Reduces Opioid Craving in People With Opioid Use Disorder

Adding an online group mindfulness intervention to a standard treatment for opioid use disorder was similar to adding an online evidence-based recovery support program when it came to reducing illicit opioid use, other substance use, and anxiety, but the mindfulness intervention resulted in greater reductions in opioid craving, according to a new study published in JAMA Network Open. The study was conducted by researchers at the Cambridge Health Alliance, McLean Hospital, Harvard University, and Tufts University and partially funded by the National Center for Complementary and Integrative Health through the Helping to End Addiction Long-term® Initiative or NIH HEAL Initiative® Behavioral Research to Improve Medication-Based Treatment (BRIM) program.

Treatment with the medication buprenorphine in people with opioid use disorder reduces illicit opioid use and the risk for opioid overdose, but research shows that most patients stop buprenorphine treatment—considered the first-line treatment for opioid use disorder—within 6 months. Risk factors for treatment dropout or opioid relapse in people receiving buprenorphine include an additional substance use disorder, anxiety, and residual opioid craving. The findings from the new study suggest that group mindfulness training sessions may help people who are receiving buprenorphine maintenance therapy and struggling with residual opioid craving. 

The study involved 196 participants recruited from 16 U.S. states who had been taking prescribed buprenorphine for opioid use disorder in an outpatient setting for at least 4 weeks. Participants were randomly assigned and blinded throughout the study to one of two entirely online live group interventions: Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) or a recovery support group control intervention that used four evidence-based non-mindfulness approaches focused on substance use disorders. 

Over 24 weeks, participants attended weekly 30-minute informal check-ins, during which they completed surveys and video-monitored toxicology tests, followed by 60-minute group sessions. The M-ROCC and control interventions were similar in time, duration, and attention. The M-ROCC intervention involved a 4-week orientation period, a 4-week low-dose mindfulness group, and an optional 16-week intensive mindful behavior change program. The intensive program included expanded training in mindfulness, behavior change skills, and recovery skills for opioid use disorders, such as mindful savoring and urge surfing. The recovery support group control intervention involved an 8-week orientation period and 16 weeks of evidence-based treatment techniques for substance use disorders, which included cognitive behavioral therapy, motivational interviewing, community reinforcement, and 12-step facilitation.

Opioid use did not differ between the two groups. It was 13.4 percent in the M-ROCC group and 12.7 percent in the recovery support group during weeks 13 to 24. No differences were seen between the two groups in benzodiazepine use or cocaine use during the same time. From the start of the study to week 24, both groups experienced large reductions in anxiety, with no difference between the two groups at week 24. The one significant difference between the groups was the reduction in opioid cravings. At week 24, the mean opioid craving decreased by 67 percent in the M-ROCC group and by 44 percent in the recovery support group. The authors say this difference may result from the effect that mindfulness can have on correcting reward processing dysfunction and interoceptive dysregulation.  

The findings suggest that M-ROCC should be considered for interested patients who are being treated with buprenorphine for opioid use disorder as a viable alternative to standard evidence-based treatment approaches, and that it can be encouraged for patients who have residual craving symptoms during treatment. The authors note more research is warranted to understand the differences between group and individual care, as well as which implementation factors, such as in-person versus telehealth delivery of interventions, may be most beneficial in group-based opioid use disorder treatment.