Mindfulness Therapy Returns $12 Per Dollar in Opioid Misuse Treatment

An evidence-based therapy that teaches people with chronic pain to regulate craving through mindfulness saves $12 for every dollar spent on it, according to an economic evaluation published in the journal Value in Health — a return two to six times greater than other addiction treatments. Over the course of a patient's life, the analysis found, those savings add up to more than $324,000 per person.

The therapy, Mindfulness-Oriented Recovery Enhancement, or MORE, was developed by Eric Garland, professor of psychiatry at the UC San Diego School of Medicine and endowed professor at the Sanford Institute for Empathy and Compassion. The new study asks a question payers and health systems rarely see answered for behavioral treatments: not whether the therapy works, but whether it pays for itself.

A treatment built for three problems at once

MORE was designed to address addiction, emotional distress, and chronic pain simultaneously — a recognition that the three conditions travel together in most people who misuse prescription opioids. The eight-week program trains participants in mindfulness techniques for regulating craving and pain, cognitive reappraisal skills for managing stress and negative emotions, and "savoring" exercises meant to restore the brain's capacity to find pleasure in everyday experience.

That last component reflects the therapy's underlying theory: prolonged opioid use blunts the brain's response to natural rewards, and rebuilding that response reduces the drive to seek chemical relief.

The clinical case for MORE rests on a randomized trial of 250 adults with chronic pain who were misusing prescribed opioids. In that study, the therapy reduced opioid misuse by 45 percent while improving pain symptoms and lowering opioid doses. The approach has now been tested in more than 16 randomized clinical trials involving over 2,500 participants — an unusually deep evidence base for a behavioral intervention.

Where the savings come from

The economic analysis attributes MORE's returns to reductions across the major categories of harm associated with opioid misuse: health care utilization, criminal justice involvement, lost productivity, and overdose mortality. The context is a crisis that costs the United States as much as $4 trillion per year across those same categories, according to estimates cited by the research team.

"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 in a statement released through University of Utah Health. "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."

The researchers argue the impact would grow if the therapy were embedded widely in health systems rather than confined to academic trials. Garland said he hopes MORE becomes "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."

What cost-effectiveness means for access

Cost-effectiveness findings matter most to the people who decide what gets covered. Insurers and Medicaid programs have historically been quicker to reimburse medications for opioid use disorder than structured psychotherapies, partly because drug treatments arrive with cleaner pharmacoeconomic dossiers. A 12-to-1 return gives advocates for behavioral treatment an unusually strong number to bring to those negotiations.

The therapy's flexibility has been part of its appeal to researchers. Earlier this year, a separate trial led by Garland's team paired MORE with ketamine-assisted sessions for people on buprenorphine maintenance, finding that the combination deepened engagement with mindfulness practice and reduced craving — a sign the program can serve as a platform rather than a fixed protocol. MORE has also been delivered by telehealth, which the research team has pointed to as a way of reaching rural patients who live far from specialty addiction clinics.

The limits of the number

Economic evaluations rest on modeling assumptions, and lifetime savings figures in particular depend on how durable treatment effects prove to be. The 45 percent reduction in opioid misuse that anchors the analysis comes from a trial population of chronic pain patients misusing prescribed opioids — not from people using illicit fentanyl, who now account for most overdose deaths. Whether the same returns hold for that population remains an open question, as does reimbursement: no major insurer has yet announced coverage of MORE as a standard benefit.

The study was funded in part by the National Institute on Drug Abuse. Garland is the founder of the MORE Science Institute; the authors declared no other competing interests.

For now, the findings land in a treatment landscape where cost arguments increasingly shape which programs survive. A therapy that cuts opioid misuse nearly in half while returning twelve dollars on the dollar is, at minimum, a difficult one for payers to keep ignoring.