Mindfulness Reduces Cravings in OUD, No Impact on Abstinence

Zev Schuman-Olivier, MD

Credit: Cambridge Health Alliance

A new study found that adults with opioid use disorder (OUD) receiving buprenorphine treatment who participated in mindfulness had significantly greater reductions in residual opioid craving than those without mindfulness training. However, M-ROCC was not more effective than a non-mindfulness evidence-based recovery support for reducing illicit opioids, benzodiazepines, or cocaine.¹

“…differential craving reductions among M-ROCC participants did not translate into significantly less opioid use than observed in the comparator intervention group,” wrote investigators, led by Zev Schuman-Olivier, MD, from Cambridge Health Alliance.

Risk factors for opioid relapse or treatment dropout during buprenorphine treatment include comorbid substance use disorder, anxiety, or residual opioid craving. A study reported that most patients discontinue buprenorphine treatment within 6 months.²

Recognizing the need to study both mindfulness and evidence-based approaches to address these comorbidities, investigators conducted a randomized clinical trial to compare the effects of the Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) with active control among adults receiving buprenorphine for OUD.¹

The trial was conducted via online platforms between January 21, 2021, and September 19, 2023. Participants, recruited from 16 US states and prescribed buprenorphine for OUD, were randomized 1:1 to either the M-ROCC or recovery support (control) arm. The sample included 196 participants (60.7% female; mean age, 41 years).

M-ROCC was a 24-week, motivationally adaptive, trauma-informed, mindfulness-based group curriculum where participants had a 30-minute informal check-in and a 60-minute intervention each week. Controls in the recovery support group used 4 evidence-based non-mindfulness approaches for substance use disorder.

The primary outcome was the number of 2-week periods of abstinence from illicit opioid use during study weeks 13 to 24. Self-reported and biochemically confirmed data determined this.

Opioid use was 13.4% (95% confidence interval; 6.2% to 20.5%) in the M-ROC group and 12.7% (95% CI, 7.5% to 18.0%) in the recovery support group, with a nonsignificant difference of 0.6% (95% CI, -8.2% to 9.5%; P = .89). The M-ROC and recovery support groups did not have significantly different benzodiazepine (22.1% vs 20.2; difference, 1.9%; 95% CI, -10.3% to -14.1%; P = .76) and cocaine use (8.4% vs 1.5%; difference, 6.9%; 95% CI, -2.4% to 16.3%; P = .15), respectively.

Participants had significant reductions in anxiety from baseline to week 24, with a large effect size, among participants in both the M-ROC (mean T score change of −9.0 (95% CI, −11.7 to −6.3; P < .001) and recovery support group (−10.0 (95% CI, −12.0 to −8.0; P < .001). The study found no significant interactions for specific weeks (P = .31), nor was there a significant difference between groups at week 24 (95% CI, 1.0; −2.4 to 4.3; P = .57).

The exploratory analysis showed the change in opioid craving over time was significant by the week (P < .001). At week 24, participants in the M-ROCC group had a greater reduction (-67%) in mean opioid cravings (-2.3; 95% CI, −2.9 to −1.7; P < .001) than participants in the recovery support group (−44%; −1.3; 95% CI, −1.9 to −0.8; P < .001). The analysis showed a significant differential reduction among the M-ROCC group compared with the recovery group (-1.0; 95% CI, -1.7 to -0.2; P = .01).

Investigators explained the differential reduction in opioid craving among M-ROCC participants could be due to the fact mindful savoring practices improve reward processing dysfunction by resensitizing people with OUD to natural signals. Craving involves interoceptive processing and mindfulness practices can improve craving by improving healthy interoceptive awareness.

“The impacts of a trauma-informed mindfulness-based group intervention during buprenorphine treatment on opioid use, substance use, and anxiety were similar to a recovery support group with a curriculum using evidence-based substance use treatment approaches,” investigators concluded. “While further research is required, the study suggests that mindfulness-based groups may be particularly useful for reducing craving among patients with OUD who are experiencing residual opioid craving during buprenorphine treatment.”

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. ^{Bell J, Burrell T. Retention and attendance with supervised buprenorphine treatment: a case-note review. Drug Alcohol Rev. 2006 Mar;25(2):161-5. doi: 10.1080/09595230500537647. PMID: 16627306.}