Methods: To test these hypotheses, an urban, low-income, predominately minority (53% black, 23% Hispanic/latino) sample of patients with OUD and chronic pain receiving community-based MMT (N=30; age=48.8±9.9; 50% female) were randomized to 8 weeks of MORE or treatment as usual (TAU). Intervention fidelity was monitored throughout the trial. Over the 8-week intervention period, participants to were instructed self-initiate event-contingent ecological momentary assessments (EMA) via smartphone whenever they experienced an opioid craving. Participants rated the intensity of the craving and the degree of self-control the experienced over the craving.
Results: Across 8 weeks of treatment, participants in MORE reported 252 cravings, whereas participants in TAU reported 62 cravings. Although participants in MORE reported a greater number of cravings than those in TAU (χ2=14.23, p<.001) their cravings were significantly less intense than those in TAU (F=7.20, p=.008) – on average, cravings were 37% weaker among participants in MORE. Crucially, participants in MORE reported having significantly greater self-control over their cravings than individuals in TAU (F=16.65, p<.001).
Conclusions and Implications: MORE appears to facilitate self-control over craving and decrease craving intensity among individuals with OUD and chronic pain in community-based MMT. The comparatively greater number of craving reports suggests that MORE increases awareness of craving – an explicit therapeutic goal of the intervention. By boosting self-efficacy over cravings through mindfulness skills, MORE may reduce opioid relapse – a hypothesis to be tested in longer-term results of self-reported assessments and urine screen data our ongoing NIH-funded clinical trial.