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In-Hospital Methadone Enrollment: a Novel Program to Facilitate Linkage from the Hospital to the Opioid Treatment Program for Vulnerable Patients with Opioid Use Disorder

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Abstract

Introduction

Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP.

Aim

Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage.

Setting

Seven hundred-bed university hospital in Aurora, CO.

Program Description

A physician dually affiliated with a hospital’s addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins.

Program Evaluation Metrics

IN-MEET enrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments.

Results

Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients (n = 1687), a higher percentage of IN-MEET patients were older (39.7 years, standard deviation [SD] 11.2 years vs. 36.1 years, SD 10.6 years) and were unhoused (n = 43, 58.9% vs. n = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance (n = 53, 72.6% vs. n = 677, 40.1%), reported methamphetamine as their secondary substance (n = 27, 37.0% vs. n = 380, 22.5%), and reported they injected their primary substance (n = 46, 63.0% vs. n = 478, 28.3%).

Conclusion

IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.

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Data Availability

Data are available upon request.

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Funding

Dr. Calcaterra is supported by the National Institute on Drug Abuse (NIDA), National Institutions of Health, grant award number K08DA049905. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health. IN-MEET is funded by Colorado State Bill 16-202, “Increasing Access Effective Substance Use Services”.

National Institute on Drug Abuse,K08DA049905,Susan Calcaterra

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Authors and Affiliations

  1. Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA

    Susan L. Calcaterra MD, MPH, MS, Scott Saunders MD, Eric Grimm MS & Angela Keniston PhD

  2. Division of General Internal Medicine, University of Colorado, Aurora, CO, USA

    Susan L. Calcaterra MD, MPH, MS

  3. Department of Psychiatry, University of Colorado, Aurora, CO, USA

    Emma Maki-Gianani MSS, RN, MAC, CAS, Angi Wold MS & Angela Bonaguidi MSW

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  1. Susan L. Calcaterra MD, MPH, MS
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Correspondence to Susan L. Calcaterra MD, MPH, MS.

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Calcaterra, S.L., Saunders, S., Grimm, E. et al. In-Hospital Methadone Enrollment: a Novel Program to Facilitate Linkage from the Hospital to the Opioid Treatment Program for Vulnerable Patients with Opioid Use Disorder. J GEN INTERN MED 39, 385–392 (2024). https://doi.org/10.1007/s11606-023-08411-0

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