Clinical: Motivational interviewing decreases risk for opioid misuse and increases positive behaviour change

Empathetic chats lower risk of painkiller abuse

Marcene Robinson-Buffalo (December 8, 2015). Retrieved from: http://www.futurity.org/opioids-motivational-interviewing-1064232-2/

University at Buffalo - Original Study

Prescription opioid abuse has reached epidemic proportions among baby boomers, with more than half the patients being treated for chronic pain reportedly misusing their medication at some point.

However, new research shows that “motivational interviewing,” a form of behavioral counseling, is an effective tool at curbing the abuse.

Prescription opioids—which include pain medications such as morphine, Lortab, and codeine—are abused by 1.9 million Americans and cause nearly two deaths every hour from overdose or respiratory depression.

Further, nearly 75 percent of opioid addiction patients switch to heroin as a cheaper source of the drug, according to data from the American Society of Addiction Medicine (ASAM).

“Older adults are at high risk for complications resulting from prescription opioid misuse,” says Yu-Ping Chang, associate professor at the School of Nursing at the University at Buffalo. “As the baby boomer generation ages and more patients are prescribed opioids, abuse is likely to become an even greater problem.”

[Drug abusers double up on heroin, painkillers]

Motivational interviewing (MI) is designed to promote a patient’s desire to change problem behaviors by expressing empathy for their experiences, using non-confrontational dialogue, and developing discrepancies between actual and desired behavior.

Although it was developed to treat alcohol abuse, researchers wondered if the intervention also could be effective in treating opioid misuse in older adults.

259 million prescriptions

For the study, published in the journal Perspectives in Psychiatric Care, researchers examined patients 50 years of age and older who experienced chronic pain and were rated at risk for opioid misuse based on screening tools. The participants underwent MI for one month, which consisted of an in-person meeting followed by weekly phone sessions with counselors, and, later, a one month follow-up test.

Before and after the intervention, participants completed screening surveys for risk of opioid misuse, alcohol abuse, levels of motivation, self-efficacy, depression and anxiety, chronic pain intensity, and treatment satisfaction.

[Many ER patients don’t know that painkillers are addictive]

In addition to reducing the risk for opioid misuse, participants reported an increase in confidence, self-efficacy, and motivation to change behavior, and a decline in depression, anxiety, and the intensity of chronic pain.

The success of the low-cost intervention is a positive sign in the battle against prescription opioid abuse in primary care, Chang says.

Opioids are one of the most commonly prescribed medications used to treat individuals with chronic pain, an issue that affects nearly half of Americans at some point in their lives. In 2012 some 259 million opioid pain medication prescriptions were written, enough for every adult in the US to have a bottle of pills.

“Primary care providers who prescribe opioids to their patients with chronic pain are in the unique position to identify and intervene with patients whose use is hazardous or harmful to their health,” Chang says. “With motivational interviewing techniques, a brief and practical behavioral intervention, they can reduce the risk of opioid misuse and abuse.”

Risk factors that could lead to opioid abuse include social isolation, poor health, multiple chronic illnesses, mental illness, and prior or current substance abuse. Health care providers should assess these factors when treating chronic pain patients, Chang says.

Future research will explore the long-term effects of motivational interviewing, and incorporate additional patient testing measures, such as pill counts, refill records, and urine drug tests, says Chang.

Source: University at Buffalo