Mindfulness Therapy More Effective Than Psychotherapy for Opioid Misuse

A mindfulness-based intervention may be more effective than supportive psychotherapy in reducing opioid misuse and comorbid chronic pain in the primary care setting.

Researchers conducted a randomized clinical trial including 250 adults with chronic pain who were misusing their long-term opioid medications. All participants were recruited from primary care clinics in Utah from January 4, 2016, to January 16, 2020.

Participants were randomized to receive weekly, 2-hour group sessions of Mindfulness-Oriented Recovery Enhancement (MORE, n = 129) or supportive group psychotherapy (n = 121) for 8 weeks. The primary outcomes included opioid misuse (assessed by the Drug Misuse Index) and pain severity and pain-related functional interference (assessed by Brief Pain Inventory scores).

A total of 81.2% (n = 203) of patients completed the minimum intervention dose of 4 or more completed sessions, and 36.8% (n = 92 of 250) discontinued the study.

The results indicate that 45.0% (n = 36 of 80) of participants in the MORE group were no longer misusing opioids at the 9-month follow up, compared with 24.4% (n = 19 of 78) of the supportive psychotherapy group. Throughout the follow-up period, the overall odds ratio for reduction in opioid misuse in the MORE group was 2.06 (95% CI, 1.17-3.61; P = .01), corresponding to a risk difference of 0.15.

MORE treatment was also superior to supportive psychotherapy for pain severity (between-group effect, 0.49; 95% CI, 0.17-0.81; P = .003) and pain-related functional interference (between-group effect, 1.07; 95% CI, 0.64-1.50; P < .001) throughout the follow-up period. Participants of the MORE group had higher reductions in opioid use, and lower emotional distress and opioid craving than participants in the supportive psychotherapy group.

 “[D]espite attrition caused by the COVID-19 pandemic and the vulnerability of the sample, MORE appeared to be efficacious for reducing opioid misuse among adults with chronic pain,” the researchers concluded.

—Leigh Precopio

Reference:

Garland EL, Hanley AW, Nakamura Y, et al. Mindfulness-oriented recovery enhancement vs supportive group therapy for co-occurring opioid misuse and chronic pain in primary care: a randomized clinical trial. JAMA Intern Med. Published online February 28, 2022. doi:jamainternmed.2022.0033