A novel mindfulness-based intervention has demonstrated significant promise in reducing opioid cravings among individuals with opioid use disorder, according to a new randomized clinical trial published in JAMA Network Open. The study found that participants in the mindfulness program experienced a 67% reduction in opioid cravings compared to a 44% reduction in the control group.
The research evaluated the Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) program against a standard recovery support program, involving 196 adults who were prescribed buprenorphine for opioid use disorder. The 24-week intervention combined weekly 60-minute group sessions with 30-minute informal check-ins.
Treatment Structure and Approach
"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," explains Dr. Zev Schuman-Olivier, assistant professor of psychiatry at Harvard Medical School and study investigator.
The M-ROCC program utilized a trauma-informed curriculum that integrated mindfulness and self-compassion practices. Dr. Schuman-Olivier describes it as "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."
Key Findings and Clinical Outcomes
While the study demonstrated impressive results in craving reduction, other outcomes showed more modest effects. The opioid use rates during weeks 13-24 were similar between groups, with 13.4% in the M-ROCC group and 12.7% in the recovery support group. Both interventions achieved significant reductions in anxiety scores, with the recovery support group showing a 10-point decrease and the M-ROCC group showing a 9-point decrease from baseline.
Mechanism of Action
The researchers propose several mechanisms behind the intervention's effectiveness in reducing cravings. "Craving involves interoceptive processing, and several mindfulness practices may impact craving by enhancing healthy interoceptive awareness and correcting interoceptive dysregulation," the research team explains. They also note that mindfulness appears to enhance self-regulation capacity and improve emotion regulation, helping to break the connection between negative emotions and substance use cravings.
Implementation Potential
The intervention shows promising flexibility in its delivery format. "These mindfulness groups can be implemented in primary care both in-person or provided through live-online video groups," notes Dr. Schuman-Olivier, highlighting the program's adaptability to various clinical settings.
Study Limitations and Future Directions
The researchers acknowledge several limitations, including lower-than-expected enrollment of Black participants, which may affect the generalizability of the results. The study also lacked a control group receiving no behavioral treatment.
Looking forward, Dr. Schuman-Olivier emphasizes the need for further research: "We need to study the best ways to implement mindfulness-based interventions during buprenorphine treatment, including 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."
