Risk of opioid overdose reduced by motivational interview in the ED

By John Murphy, MDLinx
Published April 21, 2016

Key Takeaways

A single, half-hour motivational session in the emergency department (ED) reduced misuse of prescription opioids and risky overdose behaviors in at-risk patients, according to a study published online March 26, 2016 in the journal Drug and Alcohol Dependence.

At 6 months after the ED visit, patients were less likely to take prescription opioids for non-medical use or in ways that could lead to an overdose, as compared to similar patients who didn’t receive motivational treatment.

“It’s very promising that we see a reduction in risky behavior with this brief, one-time intervention among people who weren’t seeking treatment for their opioid use but had a history of non-medical use of these drugs,” said lead researcher Amy Bohnert, PhD, Assistant Professor of Psychiatry at University of Michigan Medical School and member of the VA Center for Clinical Management Research, both in Ann Arbor, MI.

This study is the first randomized clinical trial to use a behavioral intervention (in this case, motivational interviewing) to reduce the risk of overdose. Motivational interviewing is defined as a collaborative, person-centered way of guiding a person to elicit and strengthen motivation for change. It uses standard techniques to help individuals increase their desire and commitment to change their behavior and make different choices from before.

Previous research has shown that motivational interviewing can help people reduce their use of tobacco, drugs, alcohol, and lose weight.

For this study, researchers recruited 204 adults who were seeking care in a single emergency department; these were individuals who reported prescription opioid misuse in the prior 3 months. The researchers randomized patients either to usual care (along with educational information) or to a 30-minute motivational interviewing session delivered by a therapist plus usual care with educational information.

Upon follow-up 6 months later (87% retention rate), patients in the intervention group reported an average 40.5% reduction in behaviors that put them at risk for overdose, compared with a 14.7% reduction in the usual care group.

Those in the motivational interviewing group also averaged a 50% reduction in non-medical opioid use compared with a 39.5% reduction in the control group.

“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 noted.

Some larger emergency departments already have social workers and others trained in motivational interviewing to help people who report heavy alcohol use. That same training could be applied to people who report opioid misuse, she said.

The researchers chose this setting for their study because about half of ED visits involve pain, and nearly one-third of emergency patients in the U.S. receive treatment with prescription painkiller medication. Emergency visits related to prescription opioid use have more than quadrupled since the 1990s.

The researchers are now studying whether this intervention works in primary care clinics with patients who have prescriptions for opioids.

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