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.
Shanahan
Christopher W
CW
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
Beers
Donna
D
Alford
Daniel P
DP
Brigandi
Eileen
E
Samet
Jeffrey H
JH
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