Inclusion Criteria:  Age > 18 years Opioid misuse or OUD Chronic pain Currently taking opioids Fluency in English or Spanish Planned hospitalization for ≥ 48 hours  Exclusion Criteria:  Current OUD treatment (BUP, methadone, naltrexone) Severe alcohol or benzodiazepine use disorder Hypersensitivity to BUP or naloxone Pain due to malignancy Severe untreated mental illness (suicidality, psychosis) Pregnancy Unable to consent due to pain or cognitive impairment