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Cited by 176Opioid Use Disorder TreatmentMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial

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Garland, Eric L., Hanley, Adam W., Nakamura, Yoshio, Barrett, John W., Baker, Anne K., Reese, Sarah E., Riquino, Michael R., Froeliger, Brett +1 more·2022·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2022.0033PMC PMC8886485
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Abstract

IMPORTANCE: Successful treatment of opioid misuse among people with chronic pain has proven elusive. Guidelines recommend nonopioid therapies, but the efficacy of mindfulness-based interventions for opioid misuse is uncertain. OBJECTIVE: To evaluate the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) for the reduction of opioid misuse and chronic pain. DESIGN, SETTING, AND PARTICIPANTS: This interviewer-blinded randomized clinical trial enrolled patients from primary care clinics in Utah between January 4, 2016, and January 16, 2020. The study included 250 adults with chronic pain receiving long-term opioid therapy who were misusing opioid medications. INTERVENTIONS: Treatment with MORE (comprising training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy (control condition) across 8 weekly 2-hour group sessions. MAIN OUTCOMES AND MEASURES: Primary outcomes were (1) opioid misuse assessed by the Drug Misuse Index (self-report, interview, and urine screen) and (2) pain severity and pain-related functional interference, assessed by subscale scores on the Brief Pain Inventory through 9 months of follow-up. Secondary outcomes were opioid dose, emotional distress, and ecological momentary assessments of opioid craving. The minimum intervention dose was defined as 4 or more completed sessions of MORE or supportive group psychotherapy. RESULTS: Among 250 participants (159 women [63.6%]; mean [SD] age, 51.8 [11.9] years), 129 were randomized to the MORE group and 121 to the supportive psychotherapy group. Overall, 17 participants (6.8%) were Hispanic or Latino, 218 (87.2%) were White, and 15 (6.0%) were of other races and/or ethnicities (2 American Indian, 3 Asian, 1 Black, 2 Pacific Islander, and 7 did not specify). At baseline, the mean duration of pain was 14.7 years (range, 1-60 years), and the mean (SD) morphine-equivalent opioid dose was 101.0 (266.3) mg (IQR, 16.0-90.0 mg). A total of 203 participants (81.2%) received the minimum intervention dose (mean [SD], 5.7 [2.2] sessions); at 9 months, 92 of 250 participants (36.8%) discontinued the study. The overall odds ratio for reduction in opioid misuse through the 9-month follow-up period in the MORE group compared with the supportive psychotherapy group was 2.06 (95% CI, 1.17-3.61; P = .01). At 9 months, 36 of 80 participants (45.0%) in the MORE group were no longer misusing opioids compared with 19 of 78 participants (24.4%) in the supportive psychotherapy group. Mixed models demonstrated that MORE was superior to supportive psychotherapy through 9 months of follow-up 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). Participants in the MORE group reduced their opioid dose to a greater extent than those in the supportive psychotherapy group. The MORE group also had lower emotional distress and opioid craving. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, among adult participants in a primary care setting, the MORE intervention led to sustained improvements in opioid misuse and chronic pain symptoms and reductions in opioid dosing, emotional distress, and opioid craving compared with supportive group psychotherapy. Despite 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02602535.

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  • A large-scale randomized controlled trial found that Mindfulness-Oriented Recovery Enhancement reduced the occurrence of opioid misuse by 45%, nearly tripling the effect of standard supportive therapy (OR = 2.94).

    “a recently completed large-scale RCT demonstrating that MORE reduced occurrence of opioid misuse by 45%, nearly tripling the effect (OR = 2.94) of standard supportive therapy (Garland, Hanley, Nakamura, et al., 2022)”

    From To be aware, or to accept, that is the question: Differential roles of awareness of automaticity and pain acceptance in opioid misuse (2023) · cites this paper as Garland, Hanley, Nakamura, et al., 2022

    The Results > Outcomes section reports that MORE reduced opioid misuse compared with supportive psychotherapy in a trial of 250 adults. But 45.0% is the proportion of MORE participants who were no longer misusing opioids at nine months, not a 45% reduction in occurrence; the reported between-group odds ratio is 2.06, not 2.94. The indexed copy provides no page number for this passage. (LLM, conf=0.90)

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References 53 · Cited by 176

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Authors
Garland, E. L., Hanley, A. W., Nakamura, Y., Barrett, J. W., Baker, A. K., Reese, S. E., Riquino, M. R., Froeliger, B., & Donaldson, G. W.
Affiliations
  • University of Utah (US)
  • Duke University (US)
  • University of Montana (US)
  • University of Kansas (US)
  • University of Missouri (US)
Corresponding author
Garland, Eric L.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2022-04-01
Volume
182
Issue
4
Pages
407
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2022.0033
PMC
PMC8886485
OpenAlex
W4214671105
Cited by
176
References
53
Citations by year
2026: 39 · 2025: 37 · 2024: 41 · 2023: 32 · 2022: 25 · 2021: 2
FWCI
29.80
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Internal Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KU ScholarWorks (The University of Kansas) (submittedVersion, cc-by)
Funders
National Institute on Drug Abuse (R01DA042033)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
Mindfulness-Oriented Recovery Enhancement, opioid misuse, chronic pain, long-term opioid therapy, mindfulness-based interventions, opioid craving, pain intensity, opioid dose reduction, primary care, addiction treatment, cognitive reappraisal, emotional distress
MeSH terms
COVID-19, Adult, Analgesics, Opioid, Female, Humans, Middle Aged, Opioid-Related Disorders, Primary Health Care, Psychotherapy, Group, Pandemics, Chronic Pain, Mindfulness

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