What mindfulness for opioid addiction looks like

November 9th, 2018

Chronic pain—or pain that exists every day for at least three months—is a serious problem for Americans, afflicting over 25 million adults, or 11.2% of the population. But the pain, itself, is no longer the only problem. Opioids, such as oxycodone (OxyContin) and hydrocodone (Vicodin), are used frequently as an antidote to chronic pain, but are highly addictive and their misuse has skyrocketed into what’s been called America’s 50-state epidemic. Over two and a half million Americans are estimated to have a problem with opioids—and in 2016, opioids were involved in the majority (66%) of drug overdose deaths, five times higher in than in 1999.

While pain levels have reportedly remained the same over the past two decades, the numbers of opioid medication prescriptions—sold to pharmacies, hospitals, and doctors’ offices—has quadrupled. Doctors prescribe opioids medications, a class of drugs that can effectively regulate pain, particularly following injury or surgery. But the risks of falling victim are high, making them the root of a catastrophic epidemic. The probability of long-term opioid use rises most sharply in the first days of therapy, especially after five days of taking the medication. And that number increases to about 13 percent for patients who first took the drugs for eight days or more. It only takes an initial 10-day opioid prescription for one in five patients to become a long-term user.

The standard treatment, once a diagnosis of opioid addiction is made (DSM-5 provides diagnostic criteria for the term “opioid use disorder”), involves the use of methadone and buprenorphine, part of a class of extended-release and long-acting opioids that are approved for the treatment of opioid addiction. Opioid addicts can safely take these medications for months or years. But this type of treatment is not without complications and controversy, and the overwhelming surge of addiction rates is prompting a much-needed examination of alternative treatments to curb the rate of misuse.

Enter mindfulness, which University of Utah professor, Eric Garland, Ph.D., has been researching as a therapeutic tool to target chronic pain and opioid use simultaneously. The results of a 2014 study led by Garland and published in the Journal of Consulting and Clinical Psychology showed that Mindfulness-Oriented Recovery Enhancement significantly decreased pain while simultaneously reducing opioid misuse by 63%. A follow-up study published by Garland and colleagues in the Journal of Behavioral Medicine, showed that for a sample of chronic pain patients who had been misusing opioids and who subsequently underwent the mindfulness intervention, the more their brains were activated by natural, healthy rewards and positive experiences—such as a beautiful sunset, an affectionate animal, and delicious foods—the less they craved opioids. These results, along with additional studies showing MORE’s potential impact on heart-rate variability, have initiated a quest for more research on the effects of mindfulness on chronic pain and opioid addiction, bringing Garland $23 million in grants, awarded by the NIH, the Department of Defense (DOD), and the Patient-Centered Outcomes Research Institute (PCORI).

Caren Osten Gerszberg/Mindful