Adding yoga to standard care for opioid use disorder (OUD) may speed up recovery from opioid withdrawal and improve nervous system regulation, results from a new randomized clinical trial suggested.

Among male patients with OUD, those who received buprenorphine and completed 10 supervised yoga classes recovered from opioid withdrawal 4 days faster than those who received buprenorphine alone. Yoga was also associated with improved measures of anxiety, sleep, and pain.

“These findings support integrating yoga into withdrawal protocols as a neurobiologically informed intervention addressing core regulatory processes beyond symptom management,” wrote lead investigator Pratima Murthy, MD, director of the National Institute of Mental Health and Neuro Sciences, Bengaluru, India, and colleagues.

The study was published online on January 7 in JAMA Psychiatry.

Regulating the Nervous System

The opioid epidemic is currently considered a public health crisis, with 76% of US drug overdose deaths in 2023 involving opioids.

While drug treatments for OUD such as buprenorphine help manage opioid withdrawal symptoms, they don’t fully address the disruption of nervous system activity that has been linked to a greater risk for relapse, the investigators noted. 

They wanted to know if adding yoga to standard treatment might aid autonomic regulation and speed up withdrawal recovery.

For the randomized, blinded clinical trial, a total of 59 male participants (mean age, 26 years) with OUD who had mild-to-moderate withdrawal symptoms received treatment with buprenorphine plus yoga (n = 30) or buprenorphine alone (n = 29).

Patients who had severe withdrawal symptoms, neurologic disorders affecting autonomic function, and severe psychiatric conditions were excluded from the analysis. Those who had undertaken yoga classes for OUD in the past 6 months were also excluded.

Buprenorphine dosage was determined by each participant’s psychiatrist based on the patient’s withdrawal symptoms.

The yoga group completed up to 10 supervised sessions of yoga (45 minutes each) for 2 weeks. The yoga classes were designed to address withdrawal symptoms and consisted of various breathing techniques and mindful poses.

Accelerated Withdrawal Recovery

One of the primary outcomes was the time to recover from opioid withdrawal, measured using the daily Clinical Opiate Withdrawal Scale (COWS). Recovery was defined as the first day a patient’s COWS score fell below 4 (indicating minimal or no withdrawal symptoms) and remained at that level.

Autonomic nervous system regulation was assessed by heart rate variability (HRV) and analyzed using linear mixed-effects models.

Secondary outcomes assessed were anxiety, measured by the Hamilton Anxiety Rating Scale; sleep latency based on participants’ self-reported time to fall asleep; and pain, assessed using the Brief Pain Inventory questionnaire.

Investigators found that withdrawal symptoms stabilized significantly faster in the yoga group, with a median time to stabilization of 5 days vs 9 days for the control group (hazard ratio [HR], 4.40; P < .001). There was no significant difference in total doses of buprenorphine between the groups.

The yoga group also showed improved autonomic regulation compared to the control group, with statistically significant effects on measures of HRV.

Researchers reported that parasympathetic activity was associated with yoga’s effect on withdrawal, accounting for an estimated 23% of the treatment effect (indirect HR, 1.38; 95% CI, 1.10-2.03).

Those in the yoga group showed a significant decrease in anxiety scores (P < .001) and moderate improvements in pain and sleep latency.

Limitations included the male-only sample, single-center design, and short intervention period.

“By targeting parasympathetic restoration, yoga may fill a critical therapeutic gap in standard OUD care, supporting integration into withdrawal protocols as a neurobiologically informed intervention with potential economic benefits,” the investigators wrote.

Kevin Hill, MD, reported receiving other fees from Hazelden Publishing and Wolters Kluwer outside of this study. This research was supported by the DBT/Wellcome Trust India Alliance Fellowship.