# Yoga for Opioid Withdrawal and Autonomic Regulation: A Randomized Clinical Trial

## TL;DR

This study found that adding yoga to standard treatment for opioid withdrawal significantly speeds up recovery and improves heart rate, anxiety, sleep, and pain in patients.

## Contribution

This is the first randomized clinical trial to show yoga accelerates opioid withdrawal recovery and improves autonomic regulation.

## Key findings

- Yoga group achieved withdrawal stabilization 4.4 times faster than controls (median 5 vs 9 days).
- Yoga improved heart rate variability, anxiety, sleep latency, and pain scores significantly.
- Parasympathetic activity increases mediated 23% of the treatment effect.

## Abstract

Can yoga as adjuvant therapy accelerate opioid withdrawal recovery and improve autonomic regulation in patients with opioid use disorder?

In this randomized clinical trial of 59 male participants with opioid use disorder, those receiving yoga alongside standard buprenorphine treatment achieved withdrawal stabilization 4.4 times faster than controls (median, 5 vs 9 days) and showed significant improvements in heart rate variability, anxiety, sleep, and pain measures.

In this trial, yoga significantly enhanced opioid withdrawal recovery through measurable autonomic and clinical improvements, supporting its integration into withdrawal protocols as a neurobiologically informed intervention.

This randomized clinical trial examines the efficacy of yoga as adjunct therapy to standard treatment for opioid withdrawal among patients with opioid use disorder.

Opioid withdrawal involves sympathetic hyperactivity and reduced parasympathetic tone, which standard pharmacological treatments may not adequately address, contributing to relapse vulnerability.

To evaluate yoga as adjuvant therapy to accelerate opioid withdrawal recovery and assess its impact on heart rate variability, anxiety, sleep, and pain.

This 2-arm, early-stage randomized clinical trial was conducted at an addiction medicine inpatient ward in India from April 30, 2023 to March 31, 2024. The outcome assessors and data analyst were blinded to group allocation. Participants included adults aged 18 to 50 years with opioid use disorder experiencing mild to moderate withdrawal symptoms (Clinical Opiate Withdrawal Scale [COWS] scores 4-24). Exclusion criteria included severe withdrawal, neurological conditions affecting autonomic function, severe psychiatric conditions, and recent yoga training. Of 68 individuals screened, 59 were randomized (30 yoga and 29 control participants).

Participants in the yoga group received 10 supervised 45-minute sessions during 14 days alongside standard buprenorphine treatment, including relaxation practices, postures, breathing techniques, and guided relaxation. Participants in the control group received standard buprenorphine treatment only.

Co–primary outcomes included time to withdrawal stabilization (COWS score <4) and heart rate variability parameters. Secondary outcomes included anxiety (Hamilton Anxiety Rating Scale), sleep latency, and pain scores. Assessments were conducted at baseline (day 1) and day 15.

Fifty-nine participants (59 male [100%]; mean [SD] age, 25.6 [3.9] years) completed intent-to-treat analysis. Participants in the yoga group recovered faster than those in the control group (hazard ratio [HR], 4.40; 95% CI, 2.40-8.07; P < .001), with a median stabilization time of 5 days (95% CI, 4-6 days) for those in the yoga group vs 9 days (95% CI, 7-13 days) for the control group. Participants in the yoga group showed superior heart rate variability improvements with large effects on low frequency (LF) power (ω2 = 0.16), high frequency (HF) power (ω2 = 0.14), and LF/HF ratio (ω2 = 0.12); all effects were statistically significant (P < .001). Mediation analysis showed that increases in parasympathetic activity accounted for 23% of the treatment effect (indirect HR, 1.38; 95% CI, 1.10-2.03). Anxiety reduction was significantly greater among those in the yoga group (ω2 = 0.28; P < .001), with moderate improvements in sleep latency (a 61-minute reduction; P = .008) and pain (P = .004).

In this randomized clinical trial, yoga significantly accelerated opioid withdrawal recovery and improved autonomic regulation, anxiety, sleep, and pain. These findings support integrating yoga into withdrawal protocols as a neurobiologically informed intervention addressing core regulatory processes beyond symptom management.

Clinical Trials Registry of India Identifier: CTRI/2023/04/051302