Mindfulness Program Reduces Opioid Cravings During Buprenorphine Treatment

Mindfulness significantly reduced residual opioid craving during buprenorphine treatment compared with an active control, according to data published in JAMA Network Open. The findings show that mindfulness training groups could be recommended for those who have residual opioid cravings and are receiving maintenance therapy with buprenorphine, according to the study authors.¹

The findings show that mindfulness training groups could be recommended for those who have residual opioid cravings. | Image Credit: tooratanaubol | stock.adobe.com

The study was a randomized controlled trial that compared the Mindful Recovery Opioid Care Continuum (M-ROCC) group with a live-online group. M-ROCC is a 24-week motivationally responsive, trauma-sensitive, group-based opioid treatment program. M-ROCC had 3 components, including a 4-week orientation, a 4-week low-dose mindfulness group, and an intensive recovery-focused 16-week mindful behavior change program. Investigators evaluated the 2 programs for the number of biochemically confirmed opioid negative abstinent periods during the final six 2-week periods of the study, according to the clinical trial information.^1,2

The secondary outcomes of the study included levels of anxiety, levels of pain interference, and the number of positive oral fluid tests for benzodiazepine or cocaine during the final 12 weeks of the study. Other outcomes included 24-week intervention retention and mechanisms of self-regulation. Furthermore, exploratory outcomes included stigma, mindfulness, perceived stress, pain catastrophizing, interpersonal conflict, and shared identity within groups.²

Individuals in the study were residents of Massachusetts, Connecticut, Florida, Maine, New Hampshire, New York, Rhode Island, Texas, or Vermont and had a diagnosis of opioid use disorder (OUD) with a prescribed, stable dose of buprenorphine for at least 4 weeks. Patients also had less than 90 days of abstinence or OUD with a co-morbid anxiety or stress disorder. Patients were excluded if they had active psychosis, a history of bipolar I disorder, severe levels of mania, acute suicidality, or self-injurious behavior, according to the clinical trial data.²

There were 196 individuals included in the study, with 98 being randomized to either treatment group. Approximately 60.7% were female, 38.3% were male, and 0.5% were nonbinary. During the 13 to 24 weeks, mean illicit opioid non-abstinence time period was 13.4% in the M-ROCC group compared with 12.7% in the recovery support group, but the investigators noted that this was not statistically significant. During the same time period, benzodiazepine use did not differ between the two groups, at 22.1% and 20.2%, respectively, and similar results were shown for cocaine usage at 9.4% and 1.5%, respectively.¹

For anxiety, there were large reductions in the recovery group a with a mean T score change of −10.0 (95% CI, −12.0 to −8.0; P <.001; Cohen d = −1.3) compared with −9.0 (95% CI, −11.7 to −6.3; P <.001; Cohen d = −1.1) in the M-ROCC group. At 24 weeks, investigators observed no significant differences between both groups. Further, investigators found that mean opioid craving decreased by 44% in the recovery support group and 67% in the M-ROCC group.¹

There were no significant differences between the groups for adverse events, with 1 mild AE recorded in the M-ROCC group (pain during mindful movement practice), according to the study authors. The investigators concluded that even though there were no substantial differences for the mindfulness with substance use or anxiety outcomes, it did show reductions in opioid cravings.²

REFERENCES

1. Schuman-Olivier Z, Goodman H, Rosansky J, et al. Mindfulness Training vs Recovery Support for Opioid Use, Craving, and Anxiety During Buprenorphine Treatment: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(1):e2454950. doi:10.1001/jamanetworkopen.2024.54950

2. Effect of Mindfulness on Opioid Use and Anxiety During Primary Care Buprenorphine Treatment (R33 Phase) (Mindful-OBOT). ClinicalTrials.gov identification: NCT04278586. April 8, 2024. Accessed January 31, 2025. https://clinicaltrials.gov/study/NCT04278586