Mindfulness-based interventions for opioid misuse: A systematic review of randomized controlled trials

Opioid misuse and opioid use disorder (OUD) remain critical public health concerns. Pharmacological and psychosocial treatment methods do not always fully address craving, emotional dysregulation, pain-related distress, and other recovery processes associated with opioid misuse/OUD. Mindfulness-based interventions (MBIs), including yoga- and meditation-based approaches, may help address these gaps. This systematic review evaluated randomized controlled trials (RCTs) examining the effectiveness of mindfulness-based interventions for opioid misuse and OUD.

Following PRISMA 2020 guidelines, we searched five databases (PubMed, Scopus, PsycINFO, CINAHL, and Ovid) for peer-reviewed RCTs published in English between 2010 and 2025 that evaluated MBIs in adults with opioid misuse or OUD. Seventeen articles representing 14 distinct RCTs met inclusion criteria from a pool of 293 records. We applied the Cochrane Risk of Bias 2 tool and conducted a descriptive synthesis of outcomes (PROSPERO: CRD420261382140).

Ten studies evaluated Mindfulness-Oriented Recovery Enhancement (MORE), while seven examined other mindfulness-based approaches. Most studies included treatment-as-usual or active comparison conditions. Across studies, MBIs were associated with reductions in opioid craving and opioid misuse/use outcomes, alongside improvements in pain-related functioning, emotional regulation, psychological distress, and quality of life. MORE demonstrated the strongest and most consistently developed evidence base, while findings from other MBIs were promising but more variable in methodological quality and outcome consistency.

MBIs appear to be promising adjunctive approaches for opioid misuse/OUD treatment and recovery, particularly for craving, pain-related functioning, emotional regulation, and psychological distress. However, study heterogeneity and variability in methodological quality warrant cautious interpretation. Future research should explore scalability, durability of effects, and implementation across diverse treatment settings.