Effect of Mindfulness Training on Opioid Use and Anxiety During Primary Care Buprenorphine Treatment

阿片类药物使用障碍(OUD)是一个国家健康危机。办公室阿片类药物治疗(OBOT) 丁丙诺啡/纳洛酮(B/N)可防止过量死亡。心理社会压力与精神病学 问题(如焦虑)是OBOT辍学和复发的主要原因。许多患者求助于 苯二氮卓类药物(BZD)，用于治疗焦虑和情绪困扰，具有危险后果，非 在小学阶段需要药物治疗焦虑、压力和情绪失调。 CARE OBOT，这是美国大多数县OUD治疗的主要接入点。正念- 基于干预(MBI)安全可靠地减少压力、焦虑、抑郁和 慢性疼痛，可增加OBOT滞留，同时降低复发率和过量用药 死亡。然而，目前的8周标准mbi似乎并没有对 物质使用结果，表明在OUD治疗环境中需要更长的或增强的MBIS。 该项目建议调整、改进和比较为期6个月的正念康复的效果。 在基于组的阿片类药物治疗(GBOT)内提供的连续护理(M-ROCC)与 只有标准的GBOT。M-ROCC是从循证医学的基础上发展而来的三阶段规划。 建立初级护理的正念训练(MTPC)计划，该计划已被调整为 阿片类药物使用障碍。M-ROCC包括灵活、以患者为中心、激励响应的设计， 包括为期4周的低剂量正念入门小组，正念维持签到支持 组和为期8周的初级护理强化正念训练(MTPC-OUD)组。M-ROCC 建立在之前展示的提升正念练习剂量阶梯方法的基础上，它 帮助有意识的人培养动机，解决正念练习的矛盾心理。 MTPC已显示出较低的焦虑、压力和抑郁，同时增加自我效能感和 通过使用自我调节机制来改变行为的能力。在R21阶段，我们将 通过1)改编M-ROCC手册；2)在5个MA小学提供培训机构，为多站点RCT做好准备 护理站点领导M-ROCC；3)试行M-ROCC，评估迭代改进的质量反馈； 4)制作GBOT手册并向MA OBOT站点提供培训；以及5)通过以下方式为R33阶段做准备 获得必要的批准和现场合同。在R33阶段，我们将进行五个站点的RCT M-ROCC加GBOT与单纯GBOT对200例B/N处方的初级保健患者的比较 OUD，主要评估其对阿片类药物使用和焦虑的影响，以及对可卡因和BZD使用的影响，如 以及持续戒除成瘾所需的自我调节方面。

Opioid Use Disorder (OUD) is a national health crisis. Office-Based Opioid Treatment (OBOT) with buprenorphine/naloxone (B/N) prevents overdose deaths. Psychosocial stress and psychiatric problems (e.g., Anxiety) are major reasons for OBOT drop out and relapse. Many patients turn to benzodiazepines (BZD) to address anxiety and emotional distress with dangerous consequences, non- pharmacologic approaches to anxiety, stress, and emotion dysregulation are needed during primary care OBOT, which is the primary access point for OUD treatment in most US counties. Mindfulness- Based Interventions (MBI) safely and reliably reduce the impact of stress, anxiety, depression, and chronic pain, which could increase OBOT retention, while reducing rates of relapse and overdose deaths. However, current 8-week standard MBIs do not appear to have strong, sustained impact on substance use outcomes, suggesting longer or enhanced MBIs are needed in the OUD treatment setting. This project proposes to adapt, refine and compare the effectiveness of the 6-month Mindful Recovery OUD Care Continuum (M-ROCC) delivered within Group-Based Opioid Treatment (GBOT) versus standard GBOT alone. M-ROCC is derived a three phase program derived from the evidence-based, established Mindfulness Training for Primary Care (MTPC) program, which has been adapted for Opioid Use Disorder. M-ROCC includes a flexible, patient-centered, motivationally responsive design, including a 4-week Low Dose Mindfulness Entry Group, Mindfulness Maintenance Check-in Support Group, and an 8-week intensive Mindfulness Training for Primary Care (MTPC-OUD) Group. M-ROCC builds on the previously demonstrated ascending mindfulness practice dose ladder approach, which helps individuals with OUD nurture motivation and resolve ambivalence for mindfulness practice. MTPC has been shown of lower anxiety, stress, and depression, while increasing self-efficacy and capacity for behavioral change by engaging self-regulation mechanisms. During the R21 phase, we will prepare for a multi-site RCT by 1) adapting the M-ROCC manual; 2) training providers at 5 MA primary care sites to lead M-ROCC; 3) piloting M-ROCC assessing qualitative feedback for iterative refinement; 4) manualizing GBOT and offering training to MA OBOT sites; and 5) preparing for the R33 phase by obtaining necessary approvals and site contracts. In the R33 phase, we will conduct a five-site RCT comparing M-ROCC plus GBOT with GBOT alone for 200 primary care patients prescribed B/N for OUD, primarily evaluating its impact on opioid use and anxiety, but also on cocaine and BZD use, as well as aspects of self-regulation needed for sustained addiction recovery.