Motivational Interviewing

Motivational Interviewing for Opioid Use Disorder can be delivered by a range of health professionals, including psychologists and psychiatrists, pharmacists, psychology students, social workers, general medical practitioners, case managers, criminal justice staff, physician assistants, and nurses. It appears to work best when delivered as part of multidisciplinary team-based care.

Motivational Interviewing — Evidence Rating: Low to Moderate Quality

There is a paucity of studies testing Motivational Interviewing for Opioid Use Disorder (MI-OUD), particularly compared to the knowledge base for Motivational Interviewing for Substance Use Disorder (MI-SUD). MI-OUD has been studied in both randomized trials and observational studies, but typically only as an adjunctive intervention, and rarely with a comparison condition that enables isolation of its effect. We were only able to identify one pilot randomized trial that found that MI-OUD offered to patients admitted to the emergency department with a recent history of non-medical opioid misuse was more effective than enhanced usual care in reducing overdose risk behaviors and symptoms related to non-medical opioid misuse. We were not able to identify any studies providing convincing data that MI-OUD delivered in combination with medication decreases patient opioid use or promotes opioid abstinence more effectively than medication alone. However, some studies suggest that MI-OUD may have beneficial effects on patient well-being or mental health, or may reduce the risk of other opioid-related consequences. Because we could only find one pilot randomized trial among patients with risky opioid use, indicating that MI-OUD is more effective than enhanced usual care on opioid-related outcomes, and we could not find any trials among patients with opioid use disorder supporting the effectiveness of MI-OUD, we assigned this intervention a rating of yellow.

Evidence-based Scale

Health professionals from various disciplines have delivered Motivational Interviewing for Opioid Use Disorder (MI-OUD), including (but not limited to) doctoral-level psychologists and psychiatrists, pharmacists, master’s-level psychology students, social workers, general medical practitioners, case managers, criminal justice staff, physician assistants, and nurses. Studies of MI-OUD in hospital settings suggest that it works best when targeting overdose risk behaviors and delivered in combination with medication for opioid use disorder as part of multidisciplinary team-based care. As such, MI-OUD should ideally be delivered by multidisciplinary teams that have the capacity to deliver MI-OUD while initiating and/or maintaining the patient’s medication for opioid use disorder.