A vicious trifecta of overprescribing doctors, the spread of deeply potent forms of illicit fentanyl and the psychological toll of COVID-19 has produced jaw-dropping leaps in opioid-related drug overdoses in America, according to the most recent data from the Centers for Disease Control and Prevention.
But this week, researchers at the University of Utah’s College of Social Work have published the results of a study that gives cause for hope by showing that a powerful method for managing pain and curbing opioid misuse lies right under the nose.
The college’s Center on Mindfulness and Integrative Health Intervention Development has concluded the first large-scale clinical trial that demonstrates a unique Mindfulness-Oriented Recovery Enhancement (MORE) program can reduce both opioid misuse and chronic pain among people who are prescribed opioid pain relievers.
The study followed 250 adults with chronic pain on long-term opioid therapy who met the criteria of misusing opioids. Half the participants were randomly assigned to a standard psychotherapy group, the other half were placed in a mindfulness group. Each group attended respective two-hour weekly sessions for eight consecutive weeks and were given daily therapeutic homework assignments. During a nine-month follow-up period researchers measured participants’ symptoms of depression, anxiety and pain, along with misuse behaviors and cravings.
“I am amazed not only by how powerful this is in terms of MORE being twice as powerful as standard, supportive therapy, but I was also amazed at how long lasting the effect was. The fact that not only did treatment effects last nine months after therapy ended, but that the effect kept growing stronger over time. That is really remarkable,” said Dr. Eric Garland, a leading expert on mindfulness and founder of the U.’s Center on Mindfulness.
Researchers determined that 45% of mindfulness patients were no longer misusing opioids and that 36% had cut their opioid use in half, making patients’ receiving mindfulness treatment twice as likely to stop misusing opioids than counterparts in standard psychotherapy.
The study comes on the heels of a victory from a different front in the opioid battle after last week’s settlement requiring four of America’s largest drugmakers to pay out $26 billion over 20 years for their role in exacerbating the opioid crisis, the second-largest multistate agreement in U.S. history with 52 states and thousands of local governments signing on, including 27 Utah counties.
Utah is set to receive $266 million over the next 18 years with $133 million dispersed to the state and $133 million disseminated among the participating local entities. The money will be spent to support treatment, recovery, harm reduction, expand needed services, and other strategies to address the opioid epidemic, and will be overseen by the Utah Opioid Task Force.
Utah Attorney General Sean Reyes, who helped litigate the lawsuit, says the settlement is an achievement but not a solution.
“To be clear, this settlement is not about trying to recover money for the loss of life. All the money in the world could not properly recompense the suffering and loss Utahns have endured. Instead, this money will help us immediately assist those in the cycle of addiction and prevent many of our own friends and family from ever heading down this tragic path in the future,” Reyes said in an official statement.
Yet two Utah counties — San Juan and Grand counties — declined to participate in the settlement, describing the deal as Scroogelike and akin to “spitting in the face” of rural communities decimated by drugmaker malfeasance, according to San Juan County Attorney Kendall Laws.
Grand County Attorney Christina Sloan said the deal is a slight to rural Utah and pointed a finger at Reyes for failing to negotiate stronger terms for small counties.
“The attorney general promised to take care of rural Utah and to acknowledge the unique impact the opioid crisis has cost us, but has failed to do so with this settlement,” Sloan told the Deseret News in an email.
It remains to be determined if the opioid task force will distribute settlement funds to mindfulness recovery programs, but the success of Garland’s clinical trial makes the case that funding mindfulness programs could have sizable impacts on a population whose opioid struggles commonly intersect with a host of hardships.
“It’s a serendipitous moment. When the state of Utah and other states are looking for effective solutions to halt the opioid crisis, and looking to invest their money wisely in treatments that work, we now have one with MORE,” said Garland, a prolific author on mindfulness studies.
Despite these victories, addiction and misuse are not likely to disappear because opioids continue to play an important role in pain treatment for health issues like cancer. And with the probability of long-term opioid use jumping quickly with just five days of consumption, the risk of addiction and its devastating toll remains high, making additional management options like mindfulness critical.
The mindfulness program’s ultimate impact on the misuse endemic will depend on its capability to integrate with larger institutional health care services, as studies show that people suffering from substance addiction are often reluctant to seek treatment due to stigma, geographic availability and cost.
The challenge is heightened by the fact that substance misuse is traditionally viewed as a social or criminal problem, which is why prevention and treatment services are not typically considered a responsibility of mainstream health care systems, resulting in fewer and costlier options for those in need of help.
For these reasons mindfulness advocates are hopeful that the study from the Center on Mindfulness and Integrative Health Intervention Development will facilitate a shift in health care paradigms.
“My deep aspiration for this work is that conducting a really rigorous large-scale trial like this will hopefully pave the way to making mindfulness a part of traditional standard health care, just a part of the way that we help people who are suffering from pain and addictions,” Garland said.
“Opioid misuse remains a massive public health concern. And I think a lot of that is being driven by ineffectively treated pain, unrelieved pain, and not only physical pain, but also an epidemic of unrelieved emotional pain and mental health problems stemming from the really big social problems. And economic problems that we have in this country,” Garland said. “We need a multipronged approach, and I think MORE and the therapeutic power of mindfulness is a part of that.”