Yoga halves opioid withdrawal time, finds NIMHANS study

A randomised clinical trial by researchers from NIMHANS has found that adding a short yoga module to standard medical management for opioid dependence can reduce the time patients take to stabilise from withdrawal symptoms by nearly half.

The study, published in JAMA Psychiatry on Wednesday, is among the first controlled trials to evaluate a yoga-based intervention for opioid use disorder.

Participants, who received yoga alongside buprenorphine-based treatment, achieved withdrawal resolution in a median of five days, compared with nine days among those on medication alone. Patients in the yoga group also reported better sleep and lower anxiety and pain during the withdrawal period.

The researchers additionally monitored heart rate variability (HRV) as an objective marker of autonomic stress. The yoga group showed stronger improvement in HRV indices reflective of parasympathetic activation, which accounted for a quarter of the faster recovery in mediation analysis.

Hemant Bhargav from the Department of Integrative Medicine at NIMHANS, who led the study, told reporters on Thursday that the module was designed to be practical even during acute withdrawal and can be administered at the bedside without special equipment. “In the trial, we observed faster clinical stabilisation and better autonomic recovery among those receiving yoga in addition to standard treatment,” Mr. Bhargav said.

“This is a population that is difficult to engage and treat, and standard pharmacotherapy does not address all symptom domains. The objective and subjective markers we assessed showed improvement with the yoga add-on,” said Jayant Mahadevan, co-principal investigator.

Trial design

The early-stage randomised trial was conducted at the Centre for Addiction Medicine in collaboration with the Department of Integrative Medicine. Recruitment of patients was carried out between April 30, 2023, and March 31, 2024. Fifty-nine adult in-patients with opioid use disorder were randomly assigned to standard withdrawal management or standard management with an added 45-minute yoga module for two weeks.

Both arms received buprenorphine-based treatment, counselling and psychosocial support. The yoga module included supine relaxation postures, slow breathing with prolonged exhalation, left-nostril breathing, humming breath, and brief guided relaxation. Sessions were delivered bedside or in small groups by trained therapists.

Another author Bharath Holla, associate professor of Psychiatry in the Department of Integrative Medicine, said anxiety, disturbed sleep and pain often persist beyond physical withdrawal and contribute to early relapse risk. In the trial, sleep latency reduced by about an hour on average in the yoga arm, while anxiety scores decreased more sharply compared with the control group, he said.

Shifting opioid patterns

Doctors at the Centre for Addiction Medicine pointed to changing opioid use patterns in Karnataka, with misuse of synthetic pharmaceutical opioids such as tapentadol becoming more common among young adults. “Nearly 80% of participants were tapentadol users, many of them in their twenties,” said Prabhat Chand, head of the centre. Around 90% of participants were from Karnataka, with a small number from West Bengal and Manipur.

The study was carried out under the supervision of NIMHANS Director Pratima Murthy and Dr. Chand, with collaboration from researchers at Harvard Medical School. Funding was provided by the DBT–Wellcome Trust India Alliance.

The researchers said shortening the withdrawal period could improve treatment retention during a vulnerable phase of recovery, but follow-up studies are ongoing. A six-month relapse prevention phase is under way, and the group is exploring the feasibility of community and digital delivery models.

“There is potential public health value in low-cost, low-risk interventions that can be layered onto existing care,” Dr. Chand added.