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Mindful : April 2018
E Addressing the Opioid Epidemic ver y day, some 90 Americans die from overdoses of prescription opi- oid painkillers—more than the number of people who died during the peak of the AIDS epidemic. The toll, especially among young adults, is so high that life expectancy has declined in the US over the past two years. No single strategy will end this complex and far-reaching epidemic. But a growing number of researchers think mindfulness-based inter ven- tions could play a key role. At the University of Utah’s Center on Mindfulness and Integrative Health, psycho- therapist Eric Garland has pioneered an approach called Mindfulness-Oriented Recovery Enhancement, or MORE, that’s already helping patients addicted to opioids. The approach shares many of the features of mindful- ness meditation, but with an emphasis on “savor- ing”—using mindfulness to encourage participants to find pleasure and meaning in nature, loved ones, and other life-affirming activities. “ What we’re learning is that as individuals become addicted to opioids, they become hypersensitive to pain,” Garland explains. “At the same time, they become less sensitive to the things that used to give them pleasure, things like walking in nature, listening to music, talking to friends.” The goal of MORE is to reverse that shift, using mindfulness to encourage people to savor positive, everyday experi- ences. “The more patients can savor the pleasures of these life-affirming activities, the less they seek pleasure from opioids.” Garland recently tested an eight-session MORE program in 55 chronic pain patients who were taking opioid painkillers. Compared to volunteers in a standard support group, patients learn- ing mindfulness meditation reported less pain and were less likely to misuse opioids. Many patients in his program have been able to reduce the amount of painkillers they take. Some have stopped taking them completely. The preliminary results are so promising that Garland has received more than $23 million in research funds to expand and test the approach. Other researchers are looking into whether mind- fulness interventions could also help pain sufferers from becoming hooked in the first place. “Mindfulness can’t do away with pain,” says Muham- mad Hassan Majeed, MD, a psychiatrist at Natchaug Hospital in Connecticut who specializes in addiction. But it has been shown to reduce symptoms of pain associated with fibromyalgia, migraines, irritable bowel syndrome, and lower-back problems— some of the leading reasons patients get prescribed opioids. Mindfulness can help patients accept that they may have to live with a certain amount of discomfort or pain. And it can help chronic pain sufferers in other ways, says Majeed. “Many patients with chronic pain are also suffering from depression. The two con- ditions often occur together. And there’s good evidence that Mindfulness-Based Stress Reduction can help ease depression and the per- ception of pain.” In an analysis of 13 randomized controlled studies, for example, British researchers reported in 2017 that mindfulness meditation significantly reduced depres- sion among chronic-pain sufferers and improved their quality of life and overall sense of physical health. “Mindfulness meditation is a powerful tool,” says Majeed, “ that deser ves a place in every chronic pain clinic.” 54 mindful April 2018 health care