# Optimizing Patient-Centered Opioid Tapering with Mindfulness-Oriented Recovery Enhancement

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN DIEGO · 2023 · $3,137,034

## Abstract

Patients with chronic pain are commonly treated with long-term opioid therapy (LTOT) despite
risk of opioid-related harms including increased pain sensitivity, opioid misuse, overdose, and
opioid use disorder (OUD). The risks of LTOT may outweigh its benefit for some patients. For
instance, approximately 25% of individuals receiving LTOT for pain engage in opioid misusing
behaviors such as unauthorized dose escalation or using opioids to alleviate negative emotions.
Because opioid misuse confers risks for a range of other opioid-related harms, patients showing
signs of opioid misuse need safe, flexible patient-centered opioid tapering approaches to reduce
these risks. Patient-centered opioid tapering may be facilitated by adjunctive behavioral
interventions. However, due to the complexity of the pathogenic mechanisms fueling the
downward spiral from chronic pain to opioid misuse and OUD, few interventions have been
shown to be efficacious in facilitating opioid tapering and safely reducing opioid-related harms
among people with LTOT. Extant therapies may have limited efficacy because they fail to directly
remediate dysregulation of brain reward systems underpinning this downward spiral of behavioral
escalation. To address this gap, through a NIDA-funded integrative behavioral treatment
development process we translated mechanistic findings from affective neuroscience into an
innovative treatment for opioid misuse and chronic pain, called Mindfulness-Oriented Recovery
Enhancement (MORE), that aims to enhance cognitive regulation of reward processes. In
multiple randomized controlled trials (RCTs) patients treated with MORE reduced opioid dosing
and opioid-related harms while evidencing improvements in chronic pain and quality of life. This
opioid dose reduction was patient-initiated and occurred without explicit guidance from a
physician. MORE has not yet been tested in combination with an explicit patient-centered opioid
tapering approach. Given its demonstrated efficacy as a standalone intervention, we hypothesize
that adding MORE to patient-centered opioid tapering will robustly reduce opioid-related harms
while simultaneously improving chronic pain and quality of life. In primary care clinics in
California, New Jersey and Utah we propose to conduct a hybrid 2 implementation-effectiveness
RCT of MORE as delivered via an economically sustainable, insurance-reimbursable group
medical visit (our key implementation strategy) as an adjunct to a patient-centered opioid tapering
approach that leverages patient agency and therapeutic expectancy. The pragmatic nature of this
study will provide high generalizability of findings. Informed by patients with lived experience, our
trial design will determine whether MORE plus patient-centered opioid tapering can be
implemented with effectiveness and fidelity by community providers, and will evaluate the
implementation elements and intervention cost effectiveness that influence its uptake in the
community.

## Key facts

- **NIH application ID:** 11228324
- **Project number:** 7R01DA058621-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN DIEGO
- **Principal Investigator:** Nina Cooperman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $3,137,034
- **Award type:** 7
- **Project period:** 2023-08-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11228324

## Citation

> US National Institutes of Health, RePORTER application 11228324, Optimizing Patient-Centered Opioid Tapering with Mindfulness-Oriented Recovery Enhancement (7R01DA058621-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/11228324. Licensed CC0.

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