BACKGROUND: Individuals with opioid use disorder (OUD) are frequently hospitalized for injection-related medical complications, yet they often receive inadequate treatment for the OUD itself. We previously conducted a qualitative study to adapt an existing remotely delivered intensive outpatient program (IOP) specifically for hospitalized patients with OUD. We then conducted a pilot feasibility and acceptability study to assess the program. METHODS: The 4-week IOP consisted of asynchronous video content and in-person peer support. The primary outcomes were the feasibility of recruitment, acceptability of the treatment as assessed by the completion of videos, and engagement with the peer recovery coach. Secondary outcomes included OUD treatment retention. RESULTS: Of the 12 participants, the mean age was 40.9 years, 58.3% were female, and 58.3% had an injection-related serious infection. Results demonstrated potentially acceptable recruitment feasibility (70.6%, 95% CI [48.9-92.3]), but the median percentage of video completion was only 2% (range: 0-16%) and the median percentage of engagement with recovery coach was 31.8% (range: 16.7-66.7%). All participants received medications for OUD (MOUD) during the hospital stay (methadone 83%, buprenorphine 17%), and 33.3% remained retained in MOUD treatment at 28 days. CONCLUSIONS: Hospitalized patients with OUD desired additional support through an IOP along with MOUD. While recruitment feasibility was acceptable, the overall program was not. Future research should explore IOP content that is more personalized and engaging while also including peer support.