Buprenorphine is an opioid receptor modulator used in recovery programs for opioid misuse. While it effectively reduces the harm associated with opioid misuse, most patients drop out of buprenorphine treatment within six months. This is often due to persistent cravings triggered after exposure to drug-related cues or stressful events. Research is needed to identify which adjunctive interventions can best enhance treatment effectiveness. 

Previous research has shown that mindfulness training can reduce opioid cravings and use in chronic pain patients on methadone maintenance. Schuman-Olivier et al. [JAMA Network Open] compared the efficacy of buprenorphine plus an adjunctive online mindfulness intervention to buprenorphine plus an online support group in reducing opioid cravings and misuse. 

The researchers randomly assigned 196 patients (mean age = 41 years; 61% female; 92% White) receiving buprenorphine for opioid misuse, who reported high anxiety levels or recent substance misuse, to either an online group-based Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) program or an online recovery support group. M-ROCC included four weeks of fostering group engagement followed by four weeks of a low-dose mindfulness program.

Patients who successfully completed the initial mindfulness program were offered the opportunity to continue with a 16-week intensive mindfulness program focusing on mindfulness, self-compassion, emotional regulation, savoring, and urge surfing. Ninety percent of the participants who completed the initial eight-week program elected to continue with the 16-week program. 

The  support group included an eight-week program to foster group cohesion, followed by 16 weeks incorporating elements of cognitive behavioral therapy, motivational interviewing, community reinforcement, and 12-step programs. Both interventions met once weekly, opening with a 30-minute check-in that included weekly surveys and video-monitored oral toxicology screens, followed by a 60-minute group intervention.

The primary outcome was the number of two-week periods of self-reported and toxicology-confirmed abstinence from opioids during weeks 13 to 24. Secondary outcomes included self-reported anxiety and opioid craving levels, as well as the number of two-week periods free from benzodiazepine and cocaine use.

The results showed no significant differences between groups in terms of opioid, benzodiazepine, or cocaine abstinence during weeks 13 to 24 of the study. For example, opioid use in the M-ROCC group occurred during an average 13.4% of the two-week time periods compared to 12.7% in the support group.

Both groups had significantly reductions in anxiety scores from baseline to post-intervention (M-ROCC Cohen’s d = -1.1; Control Cohen’s d = -1.3), with no significant between-group difference. Opioid cravings significantly decreased in both groups from baseline to postintervention (M-ROCC Cohen’s d = -1.3; Control Cohen’s d = -0.7). The reduction in craving scores was significantly greater in the M-ROCC group  compared to the support group (Cohen’s d = -0.5).

The study found that adding adjunctive online mindfulness training to buprenorphine treatment did not improve the criteria for abstinence from substances compared to a support group involving multiple treatment modalities. While the mindfulness intervention led to greater reductions in craving scores ,this did not correlate with improved abstinence.

The study was limited by the absence of a buprenorphine-only or attention placebo control group. Another limitation was the differential attrition rate: 51% of the M-ROCC group and 31% of the support group did not complete the study, meaning  that more support group members received active treatment and this was likely to impact any between-group effect.

Reference:

Schuman-Olivier, Z., Goodman, H., Rosansky, J., Fredericksen, A. K., Barria, J., Parry, G., Sokol, R., Gardiner, P., Lê Cook, B., & Weiss, R. D. (2025). Mindfulness Training vs Recovery Support for Opioid Use, Craving, and Anxiety During Buprenorphine Treatment: A Randomized Clinical Trial. JAMA Network Open, 8(1), e2454950. 

Link to study