Neuroscience-informed therapy provides massive cost-savings for opioid addiction treatment

A new economic evaluation from the University of California San Diego School of Medicine has revealed that Mindfulness-Oriented Recovery Enhancement (MORE) - an innovative, evidence-based, neuroscience-informed therapy for opioid misuse and chronic pain - provides $12 in cost savings for every dollar spent, between two and six times more cost effective than other addiction treatments such as residential or intensive outpatient treatment. Over the course of a patient's life, the analysis found that these savings came out to more than $324,000 per patient. 

The results suggest that, if widely implemented, MORE could provide a potent, cost-effective solution for the opioid crisis, which currently costs the U.S. as much as $4 trillion per year in health care, criminal justice and lost productivity costs. The findings are published online in the journal Value in Health.

Opioid misuse is a major driver of overdose deaths, hospitalizations, homelessness and economic loss, so substantially reducing opioid misuse could have huge positive consequences for society. Our study suggests that MORE could be part of a scalable solution that improves outcomes for patients while also reducing burdens on the health care system and society at large."

Eric Garland, PhD, lead author, professor of psychiatry, UC San Diego School of Medicine and endowed professor at the Sanford Institute for Empathy and Compassion

MORE, developed by Garland, combines a unique sequence of mind-body techniques designed to address addiction, emotional distress and chronic pain at the same time. The intervention teaches mindfulness skills to regulate craving and pain, cognitive reappraisal skills to manage stress and negative emotions, and savoring techniques to help patients reconnect with naturally rewarding experiences. 

"Opioid addiction decreases the brain's ability to experience natural healthy pleasure, driving increased cravings for the drug," said Garland. "Our research shows that MORE helps restore this capacity in the brain, reducing cravings and preventing opioid misuse."

Previous publications from the MORE research team, based on a randomized clinical trial of 250 adults with chronic pain who were misusing prescribed opioids, found that the treatment reduced opioid misuse by 45% (tripling the effect of standard therapy), led to improvements in pain symptoms and opioid dosing, and strengthened the brain's responses to positive experiences to reduce cravings. The new study, based on the trial data, sought to put this clinical success into an economic context, asking whether the treatment is cost-effective in addition to being clinically effective. 

The economic analysis found:

• MORE had a benefit-to-cost ratio of 12-to-1, meaning the intervention was estimated to generate $12 in economic benefit for every $1 spent.
• This is significantly greater than prior estimates for several other addiction treatment approaches, including comprehensive case management (1.8 to 1), residential treatment (between 2.0 to 1 and 4.8-to-1) and intensive outpatient treatment (5.1-to-1).
• The lifetime cost savings per patient were $324,489.

The researchers say the economic benefits of MORE likely stem from reductions across several major categories of harm associated with opioid misuse, including healthcare utilization, criminal justice involvement, lost productivity and overdose mortality.

"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, PhD, co-author on the study, professor of economics and population health sciences at the University of Utah, and director and endowed chair of the Matheson Center for Health Care Studies. "The cost of implementing MORE is small, and its potential payoff in averting misuse and risk of opioid use disorder is very large."

The new study builds on a broader body of evidence supporting the therapy. MORE has now been tested successfully in more than 16 randomized clinical trials involving over 2,500 participants, and has been taught to more than 1,200 clinicians in the United States and internationally. However, the researchers suggest that MORE could have an even larger impact if embedded more widely into health systems, which will require support and investment from healthcare organizations, insurers and policymakers.

"My hope is that MORE can become a central part of the standard of care," said Garland, "not only in addiction treatment settings, but also upstream in primary care, where we have a chance to intervene before opioid misuse progresses to more severe addiction."