Motivational Interviewing

Motivational Interviewing for Opioid Use Disorder has been studied in combination with medications for opioid use disorder, including buprenorphine and methadone, and in combination with other behavioral treatments, such as Cognitive Behavioral Therapy, contingency management, and collaborative 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

Motivational Interviewing for Opioid Use Disorder (MI-OUD) is typically recommended as one component of a patient’s overall recovery plan and is not recommended as a stand-alone treatment. Because of the limited research supporting MI-OUD for persons with opioid use disorder when delivered alone, it should ideally be delivered in combination with other evidence-based interventions for opioid use disorder, including methadone and buprenorphine or with overdose prevention like naloxone. One pilot trial of MI-OUD found that the model worked to reduce overdose risk behaviors when delivered in combination with content on peer outreach, which emphasized ways to discuss overdose risk reduction with others at risk for overdose, and content on response to a witnessed overdose, including information on how to respond and find naloxone distribution locations.