Mindfulness-Oriented Recovery, Methadone Treatment Linked to Less Drug Use

Nina. A. Cooperman, PsyD

Credit: Rutgers Addiction Research Center

Mindfulness-Oriented Recovery Enhancement (MORE) plus methadone treatment is associated with significantly less return to drug use and methadone treatment dropout for patients with opioid use disorder than those receiving methadone treatment only, according to a new study.¹

The opioid crisis affects an estimated of 10.1 million individuals who either just misuse opioids or have developed an opioid use disorder.² Currently, methadone treatment—the oldest and most widely used medication for opioid use disorder—does not target emotion dysregulation, pain, and reward processing deficits that are components of opioid use disorder.1 Half of the people who begin methadone treatment quit within a year, and within 6 months, half of the people in the methadone treatment program continued or returned to opioid use or other illicit drugs.

Because of methadone treatment’s low adherence, investigators of a new study, led by Nina. A. Cooperman, PsyD, from Rutgers Robert Wood Johnson Medical School, compared methadone treatment with the telehealth MORE plus usual care.

“In this RCT, MORE plus usual care demonstrated efficacy for addressing drug use, pain, and depression and improving MT retention and adherence in a racially diverse, low-income sample,” the investigators wrote. “Based on the findings from this study and prior trials of MORE, large-scale, phase 3 clinical trials that compare MORE with other interventions are warranted.”

The phase 2 randomized clinical trial, conducted from August 2020 – June 2022, took place in 5 clinics in New Jersey. The 154 participants, with 57% female (n = 88) and a mean age of 48.5 years old, all received methadone treatment and faced chronic pain. Over half of the participants were white (52%; n = 80), 40% were Black (n = 62) and 20% Hispanic (n = 20). Most of the participants (86%) were unemployed, and 23% did not have a high school diploma. At baseline, in the past 30 days, 42% used heroin (n = 65), 25% used cocaine (n = 38), and 33% used marijuana (n = 50).

Also, at baseline, participants used drugs a mean of 15 days in the past 30 days. Reported pain included back pain (23%) and arthritis (20%)—and pain was, on average, moderate pain.

The investigators considered methadone treatment as the usual care, containing medication and counseling. Participants who received MORE plus usual care had 8 weekly, 2-hour telehealth group sessions addressing mindfulness, reappraisal, and savoring. The primary outcomes were return to drug use and methadone treatment dropout over 16 weeks. Other outcomes included days of drug use, methadone adherence, pain, depression, and anxiety.

Patients who received MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.59; 95%; CI, 0.37 – 0.90; P = .02) and methadone treatment dropout (HR, 0.41; 95%; CI, 0.18 – 0.96; P = .04) than patients receiving only usual care.

Slightly more participants in the usual care group (57.1%; n = 44) than the MORE plus usual care group (50.6%; n = 39) returned to drug use. Also, 22.1% (n = 17) participants in usual care and 13% (n = 20) in MORE plus usual care dropped out of methadone treatment. Summarily, more patients with MORE plus usual care (95.5%) maintained methadone adherence at the 16-week follow-up than those with usual care only (83.6%) (P = .05).

The zero-inflated models demonstrated participants with MORE plus usual care had significantly fewer days of drug use (ratio of means = 0.58; 95%; CI, 0.53 – 0.63; P < .001) than participants with usual care alone. Also, patients with MORE plus usual care had more pain reduction from a 5.79 at baseline to 5.17 at week 16. But for usual care only, pain only reduced from 5.19 at baseline to 4.96 at week 16. Similar results were found when examining for depression—the MORE plus usual care group had reduced depression scores from 22.52 at baseline to 18.98 at 16 weeks. Though, in the usual care group, depression scores reduced from 22.65 at baseline to 20.03 at week 16.

Then, anxiety scores also decreased in the MORE group (reducing from 25.5 at baseline to 23.45 at 16 weeks) while increasing in the usual care-only group (reducing from 23.27 at baseline to 24.07 at 16 weeks), but the data did not reach significance (P = .09).

“The trial demonstrated that, not only is MORE plus usual care feasible and acceptable when implemented remotely, it led to significant therapeutic effects on drug use, MT retention, methadone adherence, pain, and depression among a racially diverse, low-income sample with OUD and chronic pain,” the investigators wrote. “These findings are consistent with our pilot study of in-person MORE in MT27 and suggest that integration of MORE into MT settings could improve addiction treatment outcomes and quality of life among people receiving [medication for opioid use disorder].”

References

1. ^{Cooperman NA, Lu SE, Hanley AW, et al. Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial. JAMA Psychiatry. Published online December 7, 2023. doi:10.1001/jamapsychiatry.2023.5138}
2. ^{American Society of Addiction Medicine. Opioid addiction 2016 facts & figures. 2017. Accessed January 2, 2024. https://www.asam.org/docs/defaultsource/advocacy/opioid-addiction-disease-factsfigures.pdf}