Behavioral Interventions in the ED Can Reduce Risk of Opioid Overdose

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The combination of a single session of motivational interviewing from a trained therapist and enhanced brochures was successful in reducing behaviors associated with opioid overdose.
The combination of a single session of motivational interviewing from a trained therapist and enhanced brochures was successful in reducing behaviors associated with opioid overdose.

The rate of deaths associated with overdose from nonmedical use of prescription opioids (NMUPO) is a prevailing threat to public health in the United States. As the first of its kind, a recent pilot randomized controlled trial proposes a promising new approach to decreasing behaviors associated with increased risk of prescription opioid overdose.1

Because 31% of all visits to an emergency department (ED) lead to an opioid prescription, behavioral interventions in this setting may prove to be an effective strategy for reducing risky behaviors that lead to opioid misuse and overdose. The study, led by research staff at the University of Michigan, showed that a single session of motivational interviewing in the ED setting significantly reduced behaviors that increased participants' risk of an overdose.

The study was set in the ED at the University of Michigan Medical Center and included 204 adults, aged 18 to 60 years, with a history of NMUPO. Patients were randomly assigned to receive educational enhanced brochures (control group) or a single session of motivational interviewing from a trained therapist in addition to the enhanced brochures (intervention group). A measure of overdose risk behaviors was assessed at baseline and at the trial's 6-month follow-up.

The researchers found that 6 months after their ED visit, participants in the intervention group were 40.5% less likely to partake in the risk behaviors associated with NMUPO overdose and had a 50% average reduction in NMUPO. In comparison, the control group only had a 14.7% reduction in risk behaviors associated with NMUPO overdose and a 39.5% reduction in NMUPO.

“It's very promising that we see a reduction in risky behaviors with this brief, one-time intervention among people who weren't seeking treatment for their opioid use but had a history of nonmedical use of these drugs,” explained lead researcher Amy Bohnert, PhD, an assistant professor of psychiatry in the University of Michigan Medical School and a member of the VA Center for Clinical Management Research, in Ann Arbor, Michigan, in a University of Michigan Health System press release.2 “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,” she noted.

The trial results indicate that a motivational intervention for individuals at increased risk for overdose can be beneficial to implement in the ED setting, particularly if there is already staff available trained in motivational interviewing. Dr Bohnert and colleagues are currently conducting a larger-scale study of the intervention in primary care clinics at the VA Ann Arbor Healthcare System to determine whether this approach can be successful in other settings.

Healthcare providers interested in the handbook and therapist's guide used by Dr Bohnert and colleagues can obtain them for free by visiting the University of Michigan Injury Center website

References

  1. Bohnert AS, Bonar EE, Cunningham R, et al. A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose. Drug Alcohol Depend. 2016; Mar 26 [in press] pii:S0376-8716(16)30005-9.doi:10:1016/j.drugalcdep.2016.03.018.
  2. Taking the fight against risky pain pill use to the ER: study shows promise [news release]. Ann Arbor, MI: University of Michigan Health System; April 20, 2016. http://www.newswire.com/articles/view/652011/?sc=dwhr&xy=10015899. Accessed April 20, 2016.
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