Motivational Interviewing for Drug Overdose

(MI-CHANCE Trial)

Overseen By Alicia Harvey-Vera, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Diego

Disqualifiers: Other trial, CheckSD, MI-CHANCE, others

Compensation: Varies

Number of Visits: Unknown

Duration: 30 months

588 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on drug checking services and safer drug use behaviors, so it's best to ask the trial coordinators for more details.

What data supports the effectiveness of the treatment MI-CHANCE for drug overdose?

The RIMO pilot study showed that interventions linking individuals to treatment after an overdose can significantly increase the likelihood of receiving treatment, suggesting that motivational approaches like MI-CHANCE could be effective. Additionally, speaking with someone about treatment after an overdose was associated with seeking treatment, highlighting the potential impact of motivational interviewing. ^{1 2 3 4 5}

How is the treatment MI-CHANCE different from other treatments for drug overdose?

MI-CHANCE uses motivational interviewing, a unique counseling approach that helps people explore and resolve their mixed feelings about changing their behavior, which is different from traditional treatments that may not focus on personal motivation and ambivalence. ^{6 7 8 9 10}

What is the purpose of this trial?

A hybrid type 1 study will be conducted to evaluate efficacy and preliminary implementation considerations for a novel intervention to promote uptake of drug checking services (DCS) and safer drug use behaviors among people who use drugs (PWUD) to reduce incidence of overdose (OD) and HIV and Hepatitis C virus (HCV) infections in San Diego County. Along with \~50 other syringe services programs (SSPs) in the US, the Harm Reduction Coalition San Diego (HRCSD), a local SSP, recently launched CheckSD (San Diego), a DCS using test strips (TS) and Fourier Transform Infrared Spectrometry (FTIR) that allows people to submit drug samples with non-nominal identifiers and obtain personalized results. While most existing DCS using FTIR offer some counseling, no theory-based interventions to increase DCS uptake and promote post-DCS adoption of safer drug use behaviors have been rigorously evaluated

Eligibility Criteria

This trial is for adults over 18 in San Diego who've used opiates or methamphetamine within the last week and haven't used CheckSD drug checking service. They must be willing to follow study procedures, not planning to move from San Diego soon, and consent to participate. Most participants will likely be opiate users due to higher overdose risk.

Inclusion Criteria

I have signed a consent form for the trial.

I am willing and able to follow all study rules and attend all appointments.

I have used drugs like heroin or meth within the last week.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the MI-CHANCE intervention or standard of care, including drug checking services and educational sessions

30 months

Semi-annual visits

Follow-up

Participants are monitored for safety and effectiveness after treatment, including overdose rates and infection rates

30 months

Semi-annual follow-up

Treatment Details

Interventions

• MI-CHANCE

Trial Overview The study tests a new intervention called MI-CHANCE aimed at increasing the use of drug checking services (TS + FTIR) and promoting safer drug habits among people using drugs. It combines education on Flu/Hepatitis A with motivational interviewing techniques.

Participant Groups

Group I: MI-CHANCE Intervention (Group 2) - TS+FTIR+MI. Experimental Treatment 1 Intervention

Participants will receive naloxone, overdose prevention pamphlets and MI in a 30-minute counseling session. Trained peer-support specialists will engage participants in discussion on the drug supply, ask to rate how certain they are about their drugs' content, how they perceive their OD risk, and shown a brief video about FTIR. Using "decisional balance", participants will identify pros and cons of regularly using DCS prior to drug use and modifying drug use behaviors based on their own potential safer alternatives. Once the balance shifts towards positive change, they will be offered to get their own drug tested by CheckSD's technician and provided with results highlighting drug potency and purity. If they decline, a dummy sample containing fentanyl will be used. Participants will develop an action plan with harm reduction principles to problem-solve specific challenges, identify their goals to use DCS and prevent OD.

Group II: Standard of Care Control (SOC; Group 1) -TS + FTIR + Flu and Hepatitis A education. Placebo Group 1 Intervention

Participants will receive naloxone, overdose prevention pamphlets and be shown videos (English or Spanish) on how naloxone works. Participants will be offered the services of drug sample testing by CheckSD's technician after their study session. The training videos will be on Flu and Hepatitis A education. Overall, the session for Group 1 as the attention control participants will last 30 minutes.

Who Is Running the Clinical Trial?

University of California, San Diego

Lead Sponsor

Trials

1,215

Recruited

1,593,000+

Harm Reduction Coalition of San Diego (HRCSD)

Collaborator

Trials

1

Recruited

590+

Findings from Research

Staff in Swedish prisons who received ongoing training in motivational interviewing (MI) showed significantly greater competency in MI skills compared to those conducting usual prison planning interviews, indicating that continuous training is beneficial.

However, overall competency levels among staff were low, suggesting that even with training, more extensive and ongoing support is necessary to achieve proficiency in MI techniques for effectively helping substance-misusing prisoners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Learning motivational interviewing in a real-life setting: a randomised controlled trial in the Swedish Prison Service. Forsberg, L., Ernst, D., Farbring, CÅ.[2022]

Training in motivational interviewing (MI) for substance use disorder (SUD) treatment did not consistently lead to sustained practice change, with only 2 out of 20 studies achieving the target of 75% of clinicians reaching proficiency after training.

The review highlighted that ongoing competency monitoring and training are necessary for clinicians to effectively implement MI, and the impact of this training on client outcomes remains unclear, indicating a need for further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing? Hall, K., Staiger, PK., Simpson, A., et al.[2022]

A survey of 36 motivational interviewing (MI) trainers identified key preferences for the format, duration, and content of beginner-level MI training aimed at addiction treatment, highlighting the need for effective training methods.

The survey also revealed common challenges faced by novice trainers in delivering MI training and provided recommended strategies to overcome these barriers, which is crucial for improving the implementation of evidence-based practices in community treatment settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers. Schumacher, JA., Coffey, SF., Walitzer, KS., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Experience of non-fatal overdose among heroin users in Adelaide, Australia: circumstances and risk perceptions. [2022]

3. England pubmed.ncbi.nlm.nih.gov

'I saved a life': a heroin addict's reflections on managing an overdose using 'take home naloxone'. [2021]

4. Australia pubmed.ncbi.nlm.nih.gov

Opioid overdose risk during and after drug treatment for heroin dependence: An incidence density case-control study nested in the VEdeTTE cohort. [2021]

5. Ireland pubmed.ncbi.nlm.nih.gov

Non-fatal overdose and subsequent drug treatment among injection drug users. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Learning motivational interviewing in a real-life setting: a randomised controlled trial in the Swedish Prison Service. [2022]

7. England pubmed.ncbi.nlm.nih.gov

After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing? [2022]

8. England pubmed.ncbi.nlm.nih.gov

Impact of motivational interviewing training on emergency department nurses' skills: A one-group pretest-posttest pilot study. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Correlates of Motivational Interviewing Use Among Substance Use Treatment Programs Serving American Indians/Alaska Natives. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers. [2021]