Motivational Interviewing

Motivational Interviewing for Opioid Use Disorder is a form of patient-centered counseling that can help patients understand and resolve their reasons for change, encouraging the patient to reduce their opioid use and/or change their opioid-related behaviors to reduce opioid-related consequences.

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 a form of patient-centered counseling that can help patients understand and resolve their reasons for change, encouraging the patient to reduce their opioid use and/or change their opioid-related behaviors to reduce opioid-related consequences. Although originally designed to address risky alcohol consumption, MI has demonstrated effectiveness for a range of substances, including tobacco, stimulants, and marijuana. This guide focuses on the data for MI-OUD among patients with active non-medical misuse of opioids and does not focus on the data for motivational interviewing as a preventive strategy among those prescribed opioids for pain.

MI-OUD includes open and often evocative questions that help patients reflect on their past experiences, how opioid use affects their life, and what changes need to be made to reduce opioid-related consequences. This conversation also affirms the patient’s past efforts and instills confidence in their ability to reduce their opioid use by acknowledging that the patient has expertise and autonomy. Throughout, the counselor analyzes the patient’s language to identify what is being said against change (sustain talk) and in favor of change (change talk). Within this conversation, the counselor strives to strike a balance between actively listening, often summarizing and repeating what is said to ensure a shared understanding, and guiding the conversation without judgment. The counselor does not try to convince the patient of changing, but rather discusses the possible consequences of change. When ready, the counselor and patient explore the “how” of change and develop a tailored plan to promote opioid-related change, which recognizes that ambivalence is normal and can be resolved.