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Cited by 44Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesMindfulness and Compassion Interventions

Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial

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Cooperman, Nina A., Lu, Shou-En, Hanley, Adam W., Puvananayagam, Thanusha, Dooley-Budsock, Patricia, Kline, Anna, Garland, Eric L.·2024·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2023.5138PMC PMC10704342
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Abstract

Importance: Methadone treatment (MT) fails to address the emotion dysregulation, pain, and reward processing deficits that often drive opioid use disorder (OUD). New interventions are needed to address these factors. Objective: To evaluate the efficacy of MT as usual (usual care) vs telehealth Mindfulness-Oriented Recovery Enhancement (MORE) plus usual care among people with an OUD and pain. Design, Setting, and Participants: This study was a randomized clinical trial conducted from August 2020 to June 2022. Participants receiving MT for OUD and experiencing chronic pain were recruited at 5 clinics in New Jersey. Interventions: In usual care, participants received MT, including medication and counseling. Participants receiving MORE plus usual care attended 8 weekly, 2-hour telehealth groups that provided training in mindfulness, reappraisal, and savoring in addition to usual care. Main Outcomes and Measure: Primary outcomes were return to drug use and MT dropout over 16 weeks. Secondary outcomes were days of drug use, methadone adherence, pain, depression, and anxiety. Analyses were based on an intention-to-treat approach. Results: A total of 154 participants (mean [SD] age, 48.5 [11.8] years; 88 female [57%]) were included in the study. Participants receiving MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.58; 95% CI, 0.37-0.90; P = .02) and MT dropout (HR, 0.41; 95% CI, 0.18-0.96; P = .04) than those receiving usual care only after adjusting for a priori–specified covariates (eg, methadone dose and recent drug use, at baseline). A total of 44 participants (57.1%) in usual care and 39 participants (50.6%) in MORE plus usual care returned to drug use. A total of 17 participants (22.1%) in usual care and 10 participants (13.0%) in MORE plus usual care dropped out of MT. In zero-inflated models, participants receiving MORE plus usual care had significantly fewer days of any drug use (ratio of means = 0.58; 95% CI, 0.53-0.63; P < .001) than those receiving usual care only through 16 weeks. A significantly greater percentage of participants receiving MORE plus usual care maintained methadone adherence (64 of 67 [95.5%]) at the 16-week follow-up than those receiving usual care only (56 of 67 [83.6%]; χ 2 = 4.49; P = .04). MORE reduced depression scores and ecological momentary assessments of pain through the 16-week follow-up to a significantly greater extent than usual care (group × time F2,272 = 3.13; P = .05 and group × time F16,13000 = 6.44; P < .001, respectively). Within the MORE plus usual care group, EMA pain ratings decreased from a mean (SD) of 5.79 (0.29) at baseline to 5.17 (0.30) at week 16; for usual care only, pain decreased from 5.19 (0.28) at baseline to 4.96 (0.29) at week 16. Within the MORE plus usual care group, mean (SD) depression scores were 22.52 (1.32) at baseline and 18.98 (1.38) at 16 weeks. In the usual care–only group, mean (SD) depression scores were 22.65 (1.25) at baseline and 20.03 (1.27) at 16 weeks. Although anxiety scores increased in the usual care–only group and decreased in the MORE group, this difference between groups did not reach significance (group × time unadjusted F2,272 = 2.10; P= .12; Cohen d = .44; adjusted F2,268 = 2.33; P = .09). Within the MORE plus usual care group, mean (SD) anxiety scores were 25.5 (1.60) at baseline and 23.45 (1.73) at 16 weeks. In the usual care–only group, mean (SD) anxiety scores were 23.27 (1.75) at baseline and 24.07 (1.73) at 16 weeks. Conclusions and Relevance: This randomized clinical trial demonstrated that telehealth MORE was a feasible adjunct to MT with significant effects on drug use, pain, depression, treatment retention, and adherence. Trial Registration: ClinicalTrials.gov Identifier: NCT04491968

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Authors
Cooperman, N. A., Lu, S.-E., Hanley, A. W., Puvananayagam, T., Dooley-Budsock, P., Kline, A., & Garland, E. L.
Affiliations
  • Rutgers, The State University of New Jersey (US)
  • University of Utah (US)
  • Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2024-04-01
Volume
81
Issue
4
Pages
338
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2023.5138
PMC
PMC10704342
OpenAlex
W4389462296
Cited by
44
References
49
Citations by year
2026: 15 · 2025: 14 · 2024: 15
FWCI
11.22
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute on Drug Abuse (R01DA058621, R01DA057631, R01DA056537)
  • National Center for Complementary and Integrative Health (R33AT010109)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
Mindfulness-Oriented Recovery Enhancement, opioid use disorder, chronic pain, methadone maintenance treatment, telemedicine, mindfulness-based interventions, emotional dysregulation, relapse prevention, treatment discontinuation, cognitive reappraisal, savoring, depression, anxiety, addiction treatment, medication adherence, zero-inflated models
MeSH terms
Adult, Female, Humans, Male, Methadone, Middle Aged, Opioid-Related Disorders, Telemedicine, Chronic Pain, Mindfulness

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