Motivational Interviewing

The theory underlying Motivational Interviewing for Opioid Use Disorder (MI-OUD) suggests that it is most suitable for patients who are highly ambivalent about changing their opioid use. Prior studies suggest MI-OUD should ideally be offered to patients who are receiving another evidence-based treatment for opioid use disorder, such as buprenorphine and methadone, and not as a stand-alone treatment.

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 theorized to be particularly well-suited for patients who are ambivalent about reducing their opioid use to build motivation for change. MI-OUD delivered as a stand-alone treatment has not been found to reduce the frequency of opioid use or opioid abstinence among patients with an opioid use disorder. However, one pilot randomized trial of patients admitted to the emergency department with non-medical opioid misuse found that MI-OUD was more effective than enhanced usual care in helping patients to reduce overdose risk behaviors and frequency of problems related to their non-medical opioid use. Combined, this prior research suggests MI-OUD may be better suited for those with risky opioid misuse than those with an opioid use disorder diagnosis. Additionally, research has indicated that motivational interviewing is more effective for those using only one substance than for patients using multiple substances. As a result, MI-OUD may be most effective for those using only opioids.