Journal of General Internal Medicine

, Volume 25, Issue 8, pp 803–808 | Cite as

A Transitional Opioid Program to Engage Hospitalized Drug Users

  • Christopher W. ShanahanEmail author
  • Donna Beers
  • Daniel P. Alford
  • Eileen Brigandi
  • Jeffrey H. Samet
Original Article



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.


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.


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).


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.


harm reduction opioid dependence methadone addiction treatment 



Preliminary study results were presented by CW Shanahan at the American Association for the Treatment of Opioid Dependence Conference, Washington DC (October 2003), and by JH Samet, in a symposium at the 2007 Addiction Health Services Research conference, Athens, Georgia (October 2007). We appreciate the support of the Massachusetts Department of Public Health—HIV/AIDS Bureau and the Bureau of Substance Abuse Services for funding this pilot project, with particular appreciation to Jean F. McGuire, PhD, former Director of the HIV/AIDS Bureau. We also appreciate the leadership of Mr. Tom Scott, former Director of the Boston Public Health Commission, Division of Substance Abuse Prevention and Treatment Services, and Barbara Dworetzky, MD, for her reviews of the manuscript.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Christopher W. Shanahan
    • 1
    • 2
    Email author
  • Donna Beers
    • 2
    • 4
  • Daniel P. Alford
    • 1
    • 2
  • Eileen Brigandi
    • 4
  • Jeffrey H. Samet
    • 1
    • 2
    • 3
    • 4
  1. 1.Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of MedicineBoston University School of MedicineBostonUSA
  2. 2.Boston Medical CenterBostonUSA
  3. 3.Department of Social and Behavioral SciencesBoston University School of Public HealthBostonUSA
  4. 4.Division of Substance Abuse Prevention and Treatment ServicesBoston Public Health CommissionBostonUSA

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