Category: Opioids

Results from a research study on Mindfulness-Oriented Recovery Enhancement have been covered as a research spotlight on the webpage of the National Institutes of Health – National Center for Complementary and Integrative Health (NCCIH). This randomized controlled pilot study, funded by NCCIH, tested the effects of MORE among individuals receiving medication assisted treatment (MAT) for opioid use disorder (OUD). Participants received 112 random assessments delivered by smartphone over the course of 8 weeks of treatment with MORE or treatment as usual (TAU). Compared to TAU, participants in the MORE intervention reported a 50% reduction in the intensity of their opioid cravings, as well as significantly greater self-control over cravings. In addition, participants reported significant improvements in pain unpleasantness, stress, and positive emotions. Although participants in TAU received more than 6 hours of therapy per week, the effects of MORE were evident above and beyond that intensive degree of treatment, suggesting that MORE may be a useful adjunct to community-based MAT. The full study results were published in the flagship addictions journal Drug and Alcohol Dependence.

I participated in the invitation-only NIH meeting “Contributions of Social and Behavioral Research in Addressing the Opioid Crisis” on March 5-6, 2018 (for a link to the webcast of the entire meeting, click here).  This meeting was part of the series of NIH meetings on Cutting Edge Science to End the Opioid Crisis.  The goals of this meeting were to: 1) specify the key social and behavioral science findings that can be brought to bear immediately to address the opioid crisis and 2) identify critical short-term research priorities that have to the potential to improve the opioid crisis response. The meeting participants represented some of the most accomplished researchers involved in the social and behavioral research relevant to the opioid crisis as well as senior leaders of various federal agencies and national organizations. I was tremendously honored to be invited as a subject matter expert to present my research to inform real-world policy and practice initiatives to address the opioid crisis.

I spoke on a panel entitled “Incorporating Nonpharmacologic Approaches to the Treatment of Opioid Abuse and Chronic Pain Management” along with luminaries in the pain research field including Francis Keefe (Duke University), Dennis Turk (University of Washington), and Dan Cherkin (Kaiser Permanente). In my talk, I discussed my research on Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for chronic pain and opioid misuse, and emphasized hedonic dysregulation (e.g., anhedonia) as a pathogenic process in opioid misuse/addiction and a key mechanistic target for novel behavioral therapies.

We presented our work to federal administrators including Francis Collins (Director of the National Institutes of Health), Nora Volkow (Director of the National Institute on Drug Abuse), Eliseo Pérez Stable (Director of the National Institute on Minority Health and Health Disparities), William Riley (Director of the Office of Behavioral and Social Science Research), David Shurtleff (Acting Director of the National Center for Complementary and Integrative Health), David Atkins (Director of Health Services Research and Development Service, U.S. Department of Veteran Affairs), and Sherry Ling (Deputy Chief Medical Officer of the Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services).

Areas of focus at the meeting included discussion of 1) Sociocultural and Socioeconomic Underpinnings of the Opioid Crisis in the United States; 2) Behavioral and Social Factors Preventing Opioid Initiation and Mitigating the Transition from Acute to Chronic Opioid Use; 3) Incorporating Nonpharmacologic Approaches to the Treatment of Opioid Abuse and Chronic Pain Management; 4) Prevention, Treatment and Recovery: Challenges and Barriers to Implementation; and 5) Effective Models of Integrated Approaches.

To summarize the meeting, research leaders and healthcare policy makers were highly focused on implementation and dissemination of evidence-based interventions and practices to target opioid misuse in chronic pain patients and to prevent/treat opioid addiction among those who have transitioned to illicit opioid use. There was much emphasis on the role of negative affect (e.g., despair), suicidality, and trauma as precipitants and correlates of opioid addiction, and the role of social support and meaningful engagement as protective factors against opioid addiction. Non-pharmacologic approaches (specifically, mindfulness and cognitive-behavioral therapy) were directly highlighted as empirically supported means of treating chronic pain and preventing opioid addiction. Finally, there was much discussion of the need to advance integrative treatment models that combine medication assisted treatment (e.g., buprenorphine, methadone) with behavioral interventions (e.g., mindfulness, exercise/physical therapy) to stop the crisis.

I was particularly struck by the framing of the opioid crisis as a “disease of despair” driven by socioeconomic disparity and disenfranchisement. Early in the morning on March 5, Nobel Prize winning economist Angus Deaton presented his work showing that mortality by opioids, alcohol, and suicide is differentially elevated in U.S. counties struck by structural inequalities. If opioid misuse and addiction are diseases of despair, then therapies like Mindfulness-Oriented Recovery Enhancement that aim to enhance joy and meaning in life may be a key part of the much-needed multifaceted solution to the greatest public health crisis of our era.