title: A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose.
abstract: Prescription opioid overdose is a significant public health problem. Interventions to prevent overdose risk behaviors among high-risk patients are lacking. This study examined the impact of a motivational intervention to reduce opioid misuse and overdose risk behaviors.
  
  
  
  This study was a pilot randomized controlled trial set in a single emergency department (ED) in which, 204 adult, English-speaking patients seeking care who reported prescription opioid misuse during the prior 3 months were recruited. Patients were randomized to either the intervention, a 30-minute motivational interviewing-based session delivered by a therapist plus educational enhanced usual care (EUC), or EUC alone. Participants completed self-reported surveys at baseline and 6 months post-baseline (87% retention rate) to measure the primary outcomes of overdose risk behaviors and the secondary outcome of non-medical opioid use.
  
  
  
  Participants in the intervention condition reported significantly lower levels of overdose risk behaviors (incidence rate ratio [IRR]=0.72, 95% CI: 0.59-0.87; 40.5% reduction in mean vs. 14.7%) and lower levels of non-medical opioid use (IRR=0.81, 95% CI: 0.70-0.92; 50.0% reduction in mean vs. 39.5%) at follow-up compared to the EUC condition.
  
  
  
  This study represents the first clinical trial of a behavioral intervention to reduce overdose risk. Results indicate that this single motivational enhancement session reduced prescription opioid overdose risk behaviors, including opioid misuse, among adult patients in the ED.
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA; University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA. Electronic address: amybohne@med.umich.edu.
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Bonar
authors.affiliation: University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cunningham
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, and Department of Pharmacy Practice, 3901Chrysler Service Drive, Suite 2A, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Greenwald
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Chermack
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA.
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Walton
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D062787:Drug Overdose / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D061345:Early Medical Intervention / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010865:Pilot Projects; D063487:Prescription Drug Misuse / Q000517:prevention & control* / Q000523:psychology; D012307:Risk Factors; D012309:Risk-Taking; D057566:Self Report
chemical_list: D000701:Analgesics, Opioid
keywords: Behavioral intervention; Overdose; Pain; Prescription opioids