Motivational Interviews Reduce Risky Opioid Use

There may be an inexpensive way to reduce the risky use of pain medications by people at high risk of overdosing: using trained therapists in the emergency department (ED) to provide motivational interviews.

In a pilot study, half-hour sessions during a visit to the ED were found to be enough to motivate people who misused prescription opioid painkillers to reduce their use as well as their riskiest behaviors. The sessions with the trained therapist included receiving brochures about how to prevent or respond to overdoses and how to find local resources for treatment and suicide prevention.

The study, from Amy S.B. Bohnert, PhD, and colleagues at the University of Michigan was published in Drug and Alcohol Dependence.

The study found that in the 6 months after the ED visit during which the motivational sessions were held, those who went through the motivational interview session had a 40.5% reduction in behaviors that raised their risk of an overdose, on average, compared with a 14.7% reduction among those who didn’t get the session. They also had a 50% average reduction in nonmedical use of opioids compared with a 39.5% reduction in the control patients who did not have the sessions. Misuse and risky behavior did not drop as much among the patients in the control group that did not receive the motivational sessions and only received usual care and brochures about preventing and responding to overdoses.

The study, of just over 200 people between ages 18 and 60, was set in an ED because about half of ED visits involve pain and nearly one-third of ED patients receive treatment with prescription painkillers. In addition, emergency care reaches people who might not visit other healthcare environments and thus offers a crucial “teachable moment” that may be valuable for changing behavior, said senior author Maureen Walton, MPH, PhD.

Dr Bohnert said that motivational interviewing has been used successfully in helping people reduce use of tobacco, drugs, and alcohol or to lose weight. However, this is the first study in a randomized, controlled trial specifically to reduce risk for overdose.

Motivational interviewing uses techniques to help people increase their desire and commitment to change their behavior and make choices different from before. The method helps people understand the risk that their drug use poses to them, and factors that can increase that risk, such as drinking alcohol or taking certain other drugs while on pain medications. The interviewers focus on what they’ll need to do to reach the goals that they lay out for the individuals at risk.

“This intervention was about reducing risk and harm, not necessarily the amount of use, which may have meant the messages were better received among those who weren’t actively seeking treatment for opioid use,” Dr. Bohnert said in a statement.

The researchers are making their handbook and guide available free at www.injurycenter.umich.edu.