TRIP

A Transitional Opioid Program to Engage Hospitalized Drug Users.

Journal of General Internal Medicine, 2010

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.