Opioids are natural, semi-synthetic or synthetic chemicals that interact with receptors in our body and reduce the perception of pain. (Opioids are natural or lab-derived, while opiates are derived from poppy plants.)

Opioid use disorder (OUD) is a severe substance use disorder. Dependence may be on prescription opioids (drugs such as codeine, tramadol, tapentadol, morphine) often given to ameliorate pain or street opioids (such as heroin, brown sugar). When the body becomes used to opioids, it can lead to severe withdrawal symptoms such as watering through eyes and nose, severe body aches, flu-like symptoms, sleeplessness, anxiety and irritability. Chronic use can cause impairment in cognition, sexual dysfunction, severe impairment of social and occupational functions and adds to the financial burden.

In order to find an alternative to opioids for pain control, a study to develop a yoga module to reduce opioid use was carried out by Dr Hemant Bhargav from Integrated Centre for Yoga, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru.

Alternative pain control

It was found that yoga increases gamma-aminobutyric acid (GABA) levels in the brain, as well as oxytocin which contributes in the management of opioid withdrawal symptoms and the attenuation of relapse. It has also been found to be useful in enhancing prefrontal activation, reducing impulsivity and promoting positive behavioural changes with better self-regulation.

“In the initial clinical case study with 9-month follow-up, the module was found suitable for bringing relief to patients suffering from opioid dependence,” says a press release from the Department of Science and Technology, Government of India.

Subsequently, a randomised controlled trail was performed with 60 subjects divided into two groups. One group performed yoga in addition to standard therapy while another group took up exercise in addition to standard therapy. After the 12 weeks of intervention, it was observed that subjects in the yoga group were 2.68 times more likely to show negative urine screening for opioids than the exercise group.

The study suggested that yoga can be a useful add-on tool to enhance abstinence and reduce substance use severity in the people with opioid dependence. Besides, the yoga group had significantly better reduction in pain, craving, anxiety and depression and better improvement in quality of life and quality of sleep as compared to the exercise group.

Also, the results showed that OUD patients, when viewing opioid-related cues, manifested significantly activated bilateral brain regions. These regions are involved in Salience Attribution (Anterior Cingulate, and Insula) as well as Brain arousal/stress systems in the extended amygdala-hippocampal areas. This suggested a potential mechanism through which yoga reduced craving and improved abstinence. Additionally, the study implied that yoga may reduce ruminations and help people relax better and thereby improve disease patho-physiology.

“Thirty-four per cent of the Indian population who suffered from chronic pain, particularly females, opted for yoga and meditation,” says a paper authored by Bhargav and his team. “Yoga may enhance pain thresholds and bring a state of natural ‘high’ by providing deep relaxation and calmness to the mind,” the paper says.