Motivational Interviewing

Studies have examined the cost-effectiveness of Motivational Interviewing for risky drinking and other substances, but have not examined the cost-effectiveness of Motivational Interviewing for Opioid Use Disorder.

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

There is limited data on the cost-effectiveness of Motivational Interviewing for Opioid Use Disorder (MI-OUD), which is not surprising given the limited data supporting its effectiveness as a stand-alone or adjunctive intervention. The primary costs associated with MI-OUD implementation are for provider training, while ongoing costs to deliver MI-OUD sessions after the initial training are substantially lower due to the ease of integration with existing services. Training strategies that yield the greatest uptake and effectiveness of behavioral interventions such as MI-OUD are often the most time-intensive and costliest, for instance, ongoing supervision and external facilitation by an MI expert. The cost-effectiveness of investing in ongoing technical assistance relative to potential reimbursements for brief MI-OUD services is a key question for further exploration.