A new economic evaluation has found that a mindfulness based opioid misuse treatment could generate $12 in savings for every $1 spent, offering fresh evidence that psychological approaches to addiction can rival, and in some cases outperform, many established interventions.

The treatment, known as Mindfulness Oriented Recovery Enhancement, or MORE, was assessed in a study published in the journal Value in Health by researchers from the University of Utah and the University of California San Diego. Over the course of a patient’s life, the analysis found the savings amounted to more than $324,000 per person, driven largely by reduced healthcare use, fewer interactions with the criminal justice system and improved long term productivity.

The findings land at a time when the opioid crisis continues to weigh heavily on public health systems. It is estimated to cost the United States as much as $4 trillion a year once healthcare, criminal justice and lost productivity costs are added together. Roughly a quarter of people prescribed long term opioid therapy for chronic pain go on to misuse their medication, raising their risk of overdose and opioid use disorder.

How the treatment works

MORE combines three strands of psychological practice. Mindfulness skills help patients manage cravings and pain, cognitive reappraisal techniques support them through stress and difficult emotions, and savouring exercises help people reconnect with everyday sources of pleasure. Delivered across eight weekly two hour group sessions, this treatment for opioid misuse aims to restore the brain’s capacity for healthy reward, easing the pull of opioid cravings over time.

The trial behind the new analysis involved 250 adults with chronic pain who were misusing prescribed opioids, recruited through primary care clinics in Utah. Compared with supportive group psychotherapy, MORE reduced opioid misuse by 45 per cent and produced measurable improvements in pain symptoms and opioid dosing. At the nine month mark, 54 per cent of MORE participants had a positive drug misuse rating, against 78 per cent in the comparison group, a gap of 24 percentage points that the researchers describe as clinically meaningful.

A treatment that stacks up on cost as well as outcomes

What sets this opioid misuse treatment apart, according to the researchers, is how little it costs to deliver relative to the benefits it produces. The incremental cost effectiveness ratio worked out at $116 per averted case of opioid misuse. Even under more cautious assumptions about staffing costs, the figure only rose to somewhere between $473 and $743, still a modest sum set against the scale of harm opioid misuse can cause.

The benefit to cost ratio of 12 to 1 compares favourably with other options for treating addiction that have previously been evaluated. Comprehensive case management has been estimated at 1.8 to 1, residential treatment somewhere between 2 to 1 and 4.8 to 1, and intensive outpatient care at 5.1 to 1. Put simply, this opioid misuse treatment appears to be between two and six times more cost effective than several of the approaches currently in wider use.

“At a relatively low cost, MORE has strong potential to reduce opioid misuse and generate substantial economic benefits for patients, health systems and society,” said Fernando Wilson, professor of economics and population health sciences at the University of Utah and first author on the study. “The cost of implementing MORE is small, and its potential payoff in averting misuse and risk of opioid use disorder is very large.”

Wider implications for tackling addiction

The study builds on more than 16 randomised clinical trials involving over 2,500 participants, adding economic weight to a growing body of clinical evidence behind MORE. The researchers point out that opioid misuse is closely tied to overdose deaths, hospital admissions, homelessness and lost economic output, meaning that even modest gains in access to treatment for opioid misuse could translate into significant benefits for whole communities, not just individual patients.

“Opioid misuse is a major driver of overdose deaths, hospitalisations, homelessness and economic loss, so substantially reducing opioid misuse could have huge positive consequences for society,” said Eric Garland, professor of psychiatry at UC San Diego School of Medicine and endowed professor at the Sanford Institute for Empathy and Compassion, who developed MORE and is senior author on the study. “Our study suggests that MORE could be part of a scalable solution that improves outcomes for patients while also reducing burdens on the healthcare system and society at large.”

Garland, who developed the therapy, said he hopes it could eventually become a standard part of care, not only within specialist addiction services but earlier on too, in primary care settings, where clinicians have a chance to step in before opioid misuse develops into more severe dependency.

With opioid litigation settlement funds now reaching many US states, the researchers suggest there is a genuine window of opportunity to expand access to this opioid misuse treatment on a much wider scale, potentially easing pressure on health systems already stretched thin by the ongoing crisis.

Source: dbrecoveryresources