NIDA Funds a Three-Hospital Test of Methadone Intake Before Discharge

A researcher at the University of Colorado Anschutz Medical Campus will lead a three-hospital trial of a simple-sounding idea with a difficult implementation record: enrolling hospitalized patients in an opioid treatment program before they are discharged, rather than handing them a referral and hoping they show up.

Susan Calcaterra, an associate professor of hospital medicine at the CU Anschutz School of Medicine and an investigator with its Adult and Child Center for Outcomes Research and Delivery Science, is running the study with an R01 grant from the National Institute on Drug Abuse. The grant amount was not disclosed in the university's announcement.

The trial will test whether facilitating opioid treatment program intake during hospitalization improves the share of patients who are connected to a program within seven days of leaving the hospital. That single measure — a connection inside a week — is the study's primary outcome.

Why methadone is harder to hand off than a prescription

Buprenorphine can be prescribed by a clinician with a standard DEA registration and filled at a pharmacy. Methadone for opioid use disorder cannot. It is dispensed through federally certified opioid treatment programs, which in most states means a dedicated clinic, an intake appointment, and a daily visit for the first phase of treatment.

Calcaterra described what that structure costs patients at the moment of discharge. "A lot of patients don't have transportation," she said. "Or to be enrolled with a clinic, they have to have ID, and a lot of my patients, especially those who are unhoused, just don't have those resources."

A hospitalization is often the one stretch when a patient is medically stable, reachable and in contact with clinicians. It is also the point where the handoff to a program can fail quietly: the patient leaves with a phone number, and the clinic requires documentation the patient does not have.

What the trial will actually do

The study builds on a program at CU Anschutz that let patients complete the methadone enrollment process while still in a hospital bed, and on the practical work that surrounded it — making sure patients had identification and a way to reach the clinic before discharge.

The new trial adapts that approach to three partner systems: University of New Mexico Health System in Albuquerque, University of Utah Health in Salt Lake City, and New York-Presbyterian Weill Cornell Medical Center in New York. Investigators will use a strategy called implementation facilitation, working with each hospital's addiction consult team to identify local barriers, review data and adjust workflows rather than imposing a single protocol from Colorado.

That design choice is the substance of the study. Getting a hospital to write a discharge order for methadone is not the hard part; getting a clinic's intake staff, a hospital's case management and a patient's transportation to line up before the bed is cleared is. Implementation facilitation is the term for doing that work site by site, and the trial will show whether it can be standardized across systems that do not share an electronic record or a state Medicaid program.

The gap the study is aimed at

Calcaterra's concern is the interval after discharge, when a patient who began treatment in the hospital has no dosing appointment yet. The university's description of the research states that a gap at that stage can lead to withdrawal and a return to opioid use — the outcome that hospital-based addiction care exists to prevent. Medication for opioid use disorder started on a medical floor has limited value if it stops on the way out the door.

Her framing of the problem is occupational. "I focused on addiction research because you could do a lot of good in a short amount of time," she said. The study grew out of caring for hospitalized patients whose health was affected by untreated substance use disorders, and it treats the discharge plan as a clinical intervention rather than an administrative task.

What the results will and will not settle

The trial measures linkage, not outcomes. A patient who reaches an opioid treatment program within seven days has cleared the first gate; whether they stay in treatment, whether they stop using and whether they survive are questions the primary outcome will not answer. That limits how much the results can be used to argue for or against the model, and it makes the seven-day figure the number to watch.

The study also arrives while the rules around methadone delivery are themselves under revision. Congress has weighed bills to let pharmacies dispense methadone for addiction, a fight this blog covered in July, and federal take-home and telehealth rules have loosened considerably since 2020. Calcaterra's work touches that debate without entering it: the study tests a linkage process inside the current system, not a replacement for it.

What she expects the environment to look like is not in doubt. "Fentanyl isn't going away anytime soon," she said. "It's here to stay." The university's announcement notes that the country has recorded more than 100,000 drug overdose deaths annually in recent years, a figure it attributes to federal data.

For hospitals that already run addiction consult services, the trial is a test of whether the opioid treatment program model can be made to bend toward the patient at the one moment patients are easiest to reach. The announcement described the trial in future terms and did not include a timeline for findings.