Reposted from U of U Health.
An epidemic of opioid addiction costs the United States as much as $4 trillion per year in health care, criminal justice and lost productivity costs. But an evidence-based, neuroscience-informed therapy for opioid misuse and chronic pain saves $12 for every dollar spent, according to a new economic evaluation conducted by a University of Utah health economist.
That's between two and six times more cost-effective than other addiction treatments. 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, the therapy, called Mindfulness-Oriented Recovery Enhancement (MORE), which was developed at the U, could be a potent, cost-effective solution for the opioid crisis, according to economics professor Fernando Wilson, who holds a joint appointment in the Department of Population Health Science at the University of Utah School of Medicine.
"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 Wilson, who directs 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 findings appear in the journal Value in Health.
A proven effective treatment
The MORE program was developed by Wilson's co-author, former U professor Eric Garland, now a professor of psychiatry at UC San Diego School of Medicine and endowed professor at the Sanford Institute for Empathy and Compassion.
It combines techniques designed to address addiction, emotional distress and chronic pain at the same time. It 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. By restoring the brain's ability to experience healthy pleasure, the therapy reduces cravings and prevents opioid misuse.
Previous research led by the University of Utah, 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%, led to improvements in pain symptoms and opioid dosing and strengthened the brain's responses to positive experiences to reduce cravings. The new study asked 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-to-1 and 4.8-to-1) and intensive outpatient treatment (5.1-to-1).
- The lifetime cost savings per patient were $324,489.
Improving outcomes for patients and communities
"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," Garland said. "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."
Until his departure from Utah in 2024, Garland was a distinguished professor and associate dean for research at the U's College of Social Work, where he founded and directed the Center on Mindfulness and Integrative Health Intervention Development.
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.
The new study builds on a broader body of evidence supporting the therapy. MORE has now been tested in more than 16 randomized clinical trials involving more than 2,500 participants. The researchers say that MORE could have an even larger impact if embedded widely into health systems.
"My hope is that MORE can become a central part of the standard of care, 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," Garland said.
The research was published July 23 in Value in Health as "Economic Evaluation of Mindfulness-Oriented Recovery Enhancement for the Treatment of Opioid Misuse." The study was funded, in part, by grants from the National Institute on Drug Abuse (R01DA058621, R01DA056537 and R01DA057631). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Garland is Founder of the MORE Science Institute. The authors declare no other competing interests.
See related stories:
Mindfulness therapy reduces opioid misuse and chronic pain
Banner photo shows a research subject in Eric Garland's lab, which develops mindfulness-oriented treatments at the College of Social Work. Photo credit: University of Utah.
