Mindfulness Training Offers Some Benefits for OUD Patients on Buprenorphine

Rates of opioid use were similar for people with opioid use disorder prescribed buprenorphine who participated in mindfulness training versus a recovery support group, a randomized trial showed.

Among nearly 200 participants, opioid use was 13.4% for those in the Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) group compared with 12.7% for those in a recovery support group control curriculum (difference 0.6%, 95% CI -8.2% to 9.5%, P=0.89), reported Zev Schuman-Olivier, MD, of the Cambridge Health Alliance in Malden, Massachusetts, and colleagues.

Anxiety T scores were also similarly reduced across the groups (P=0.57), but the M-ROCC participants had a larger reduction in opioid craving compared with the recovery support group participants (-1.0, 95% CI -1.7 to -0.2, P=0.01, Cohen d = -0.5), they wrote in JAMA Network Open.

“The most important takeaway is that mindfulness-based programs showed similar levels of opioid use and anxiety reduction compared to the standard evidence-based best-practice group curriculum, and mindfulness actually outperformed the standard best-practice groups in reducing self-reported opioid craving,” Schuman-Olivier told MedPage Today, suggesting that “mindfulness should be strongly considered for patients experiencing residual cravings after starting buprenorphine.”

While buprenorphine is the first-line treatment for opioid use disorder, nearly half of patients who begin treatment discontinue it within 6 months, often due to comorbid substance use, psychiatric symptoms such as anxiety, and opioid craving, the authors noted.

Previous meta-analyses of mindfulness programs for mental health and substance use disorders suggested that such programs often outperformed passive controls, but have similar results to evidence-based interventions for substance use and anxiety outcomes, they added.

Asked why mindfulness may have reduced cravings, Schuman-Olivier said for people who regularly use substances, every sensation and emotion becomes linked to the desire to use.

“You feel sad, you want to use. You feel bad, you want to use. You feel uncomfortable, you feel pain, you want to use,” he said. “So, the body signals that link to all the natural emotions, as well as to pain and hunger, [and they] all get connected and linked up to the signal of craving.”

Helping people see these connections allows them to de-link those homeostatic need states with substance use cravings, and to enjoy natural reward signals, he noted.

This study, conducted from January 2021 to September 2023, included 196 adults prescribed buprenorphine for opioid use disorder (mean age 41, 60.7% women, 91.8% white). They were randomized 1:1 and blinded to assignments throughout participation. All study procedures were conducted virtually.

The researchers described the M-ROCC program as a 24-week, motivationally adaptive, trauma-informed, mindfulness-based group curriculum. Participants had a 30-minute informal check-in and a 60-minute intervention group each week. Body scan techniques, mindfulness breathing, meditation practices, and “urge surfing” (paying attention to what a craving feels like as it is happening, then watching it pass without reacting) were all used during sessions.

“You can’t actually fight cravings without making them worse, but you can be with them … then they kind of lose their power over you,” Schuman-Olivier explained.

The recovery support group control curriculum used four evidence-based substance use disorder-focused non-mindfulness approaches and was time and attention matched. It involved 8 weeks of group-building orientation followed by 16 weeks of evidence-based treatment techniques for substance use disorders, including cognitive behavioral therapy, motivational interviewing, community reinforcement, and 12-step facilitation.

The primary outcome of the study was the number of 2-week periods with both self-reported and biochemically confirmed abstinence from illicit opioid use during study weeks 13 to 24.

A major limitation to the study was its reliance on a predominantly white sample. While mirroring trends in buprenorphine treatment engagement, the study still had fewer Black participants than expected, Schuman-Olivier said.

In addition, participants were required to have stable buprenorphine doses for at least 30 days, which may have resulted in relatively low levels of baseline residual craving and possibly less opioid use.

Still, the findings should encourage more providers to incorporate trauma-informed mindfulness programs into their treatment, Schuman-Oliver noted. Most private addiction programs already offer them, but they aren’t yet available in general community opioid use disorder treatment programs.

Future research should include adaptive, accessible, and culturally relevant versions of the intervention tailored to communities of color, for whom overdose rates have risen in recent years, he said.