For the millions of Americans managing chronic pain on long-term opioid prescriptions, the line between therapeutic use and misuse is dangerously thin — and conventional addiction support tools remain expensive, scarce, or stigmatizing. A rigorous cost-effectiveness analysis now puts hard numbers behind a behavioral intervention that may change how payers and clinicians approach this problem.
The trial enrolled 250 adults with chronic pain who were already prescribed opioids long-term and actively misusing them. Participants averaged 51.8 years of age and were predominantly taking oxycodone or hydrocodone at a mean morphine-equivalent dose of 101 mg daily — a clinically significant load. Half were randomized to Mindfulness-Oriented Recovery Enhancement (MORE), an eight-session group program integrating mindfulness training, cognitive reappraisal, and positive-experience savoring. At nine-month follow-up, 54% of MORE participants still met criteria for opioid misuse via a composite Drug Misuse Index, compared to 78% of those receiving supportive group psychotherapy — a 24-percentage-point absolute risk reduction. The incremental cost-effectiveness ratio came to just $116.30 per averted misuse case, with an estimated benefit-to-cost ratio of 12:1.
This finding is notable for several reasons beyond the headline numbers. The comparison arm — supportive group psychotherapy — is itself an active, credible treatment, meaning MORE's advantage isn't simply beating usual care or a waitlist. That distinction strengthens the internal validity considerably. The composite misuse outcome, drawing on self-report, clinical interview, and urine toxicology, also reduces the social-desirability bias that plagues self-report-only opioid studies. However, with 250 participants at a single trial stage, the evidence base remains narrow; generalizability to populations with severe opioid use disorder, comorbid psychiatric illness, or illicit opioid use is untested. Cost-effectiveness figures are also highly sensitive to healthcare system context and implementation fidelity. Still, at an ICER orders of magnitude below standard willingness-to-pay thresholds, MORE presents as an unusually economical behavioral option — incremental in sample size, but potentially paradigm-shifting for payer coverage decisions.