Motivational Interviewing

Motivational Interviewing for Opioid Use Disorder should ideally be offered in settings that actively offer or monitor medication 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

Motivational Interviewing for Opioid Use Disorder (MI-OUD) has been tested primarily in hospital, primary care, and specialty addiction treatment settings. Because the current data for MI-OUD among patients with an opioid use disorder primarily support its use in combination with other evidence-based treatments, such as buprenorphine and methadone, it should only be offered in settings that actively offer or monitor these medications. One pilot trial suggests that MI-OUD may also work in emergency departments when targeting overdose risk behaviors.