Motivational Interviewing

Motivational Interviewing for Opioid Use Disorder should be offered to patients actively initiating or receiving other evidence-based treatments for opioid use disorder, such as methadone and buprenorphine. For patients with non-medical opioid misuse, the provision of MI-OUD shortly after hospitalization may help to reduce risk behaviors.

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) should ideally be offered to patients actively initiating or receiving other evidence-based treatments for opioid use disorder, such as methadone and buprenorphine. Prior studies have not systematically assessed when MI-OUD is most effective in a patient’s treatment journey, though the theory underlying MI-OUD suggests it is ideally suited for patients during periods of high ambivalence. One randomized pilot trial suggests that MI-OUD might be beneficial for patients waiting for care in the emergency department. In this trial, patients were approached while waiting in private rooms and offered MI-OUD targeting overdose risk behaviors associated with non-medical opioid misuse.