A transitional opioid program to engage hospitalized drug users.
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.
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA. cshanaha@bu.edu
Christopher W
CW
Shanahan
Donna
D
Beers
Daniel P
DP
Alford
Eileen
E
Brigandi
Jeffrey H
JH
Samet
D000328:Adult; D000701:Analgesics, Opioid; D019090:Case Management; D005260:Female; D040261:Harm Reduction; D006556:Heroin Dependence / Q000453:epidemiology* / Q000517:prevention & control / Q000534:rehabilitation; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs; D007406:Interview, Psychological; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008691:Methadone; D009042:Motivation; D058850:Opiate Substitution Treatment; D010045:Outpatients / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D013997:Time Factors
D000701:Analgesics, Opioid; D013287:Illicit Drugs; D008691:Methadone