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MORE for Opioid Use Disorder and Chronic Pain

Opioid use disorder (OUD) continues to pose a significant public health issue, with millions of individuals in the U.S. alone struggling with opioid misuse. Though medication assisted therapies such as methadone maintenance treatment are effective for managing OUD, a large proportion of individuals with OUD in methadone maintenance treatment relapse. One reason for this relapse is due to the high prevalence of chronic pain among this population. Integrating interventions that simultaneously address OUD and chronic pain with methadone maintenance treatment could serve to reduce risk of relapse. Dr. Cooperman and colleagues (2021) sought to examine Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for chronic pain and opioid use for individuals in methadone maintenance treatment in a preliminary pilot study.

MORE is an 8-week group therapy that incorporates mindfulness, reappraisal skills, and savoring of natural rewards designed to target hedonic dysregulation associated with chronic pain and OUD. Ultimately, MORE aims to alter neurophysiological responses and reward circuitry to weaken relations between pain and opioid use behavior. MORE has been shown to decrease craving, stress, and pain unpleasantness while increasing positive affect at the momentary level (Garland et al., 2019). The present work expands on these findings by comparing MORE to treatment as usual (TAU) on drug use, health, and well-being at 16-week follow-up for individuals in methadone maintenance treatment.

At follow-up, those in the MORE group reported fewer days of illicit drug use and less craving compared the TAU group. In addition, the MORE group reported significantly less pain and physical and emotional limitations. The MORE group also reported higher levels of social functioning, well-being, and vitality compared to the TAU group. Both groups showed increases in depression over time, however these increases were more pronounced for the TAU group with the MORE group reporting lower levels of depression and anxiety at follow-up than the TAU group.

This pilot study demonstrates early feasibility and utility of MORE for OUD and chronic pain among individuals in methadone maintenance treatment. Those receiving MORE showed treatment gains across multiple domains including substance use, mood and anxiety symptomology, pain, and well-being. This work provides further support for MORE and sets the stage for a larger clinical trial.

Dr. Nina Cooperman is a clinical psychologist and associate professor in the Division of Addiction Psychiatry at the Rutgers Robert Wood Johnson Medical School. Her research aims to develop and evaluate interventions for substance use and health behaviors with a current focus on mindfulness for opioid use disorder and chronic pain. In addition to her research, Dr. Cooperman oversees the Opioid Overdose Prevention Network, which serves to education the public about the opioid epidemic and distribute Naloxone to stakeholders.

Dr. Cooperman will be giving a virtual presentation as part of the Emerging Addiction Science Seminar Series “Data Blitz” on April. Please see https://alcoholstudies.rutgers.edu/events/ for additional details and to register to attend.