A transitional opioid program to engage hospitalized drug users

J Gen Intern Med. 2010 Aug;25(8):803-8. doi: 10.1007/s11606-010-1311-3. Epub 2010 Mar 17.


Background: Many opioid-dependent patients do not receive care for addiction issues when hospitalized for other medical problems. Based on 3 years of clinical practice, we report the Transitional Opioid Program (TOP) experience using hospitalization as a "reachable moment" to identify and link opioid-dependent persons to addiction treatment from medical care.

Methods: A program nurse identified, assessed, and enrolled hospitalized, out-of-treatment opioid-dependent drug users based on their receipt of methadone during hospitalization. At discharge, patients transitioned to an outpatient interim opioid agonist program providing 30-day stabilization followed by 60-day taper. The nurse provided case management emphasizing HIV risk reduction, health education, counseling, and medical follow-up. Treatment outcomes included opioid agonist stabilization then taper or transfer to long-term opioid agonist treatment.

Results: From January 2002 to January 2005, 362 unique hospitalized, opioid-dependent drug users were screened; 56% (n = 203) met eligibility criteria and enrolled into the program. Subsequently, 82% (167/203) presented to the program clinic post-hospital discharge; for 59% (119/203) treatment was provided, for 26% (52/203) treatment was not provided, and for 16% (32/203) treatment was not possible (pursuit of TOP objectives precluded by medical problems, psychiatric issues, or incarceration). Program patients adhered to a spectrum of medical recommendations (e.g., obtaining prescription medications, medical follow-up).

Conclusions: The Transitional Opioid Program (TOP) identified at-risk hospitalized, out-of-treatment opioid-dependent drug users and, by offering a range of treatment intensity options, engaged a majority into addiction treatment. Hospitalization can be a "reachable moment" to engage and link drug users into addiction treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid*
  • Case Management
  • Female
  • Harm Reduction
  • Heroin Dependence / epidemiology*
  • Heroin Dependence / prevention & control
  • Heroin Dependence / rehabilitation
  • Hospitalization / statistics & numerical data*
  • Humans
  • Illicit Drugs
  • Interview, Psychological
  • Male
  • Massachusetts / epidemiology
  • Methadone*
  • Motivation
  • Opiate Substitution Treatment*
  • Outpatients / statistics & numerical data
  • Program Development
  • Program Evaluation*
  • Risk Reduction Behavior
  • Substance Abuse Treatment Centers / statistics & numerical data
  • Time Factors


  • Analgesics, Opioid
  • Illicit Drugs
  • Methadone