Category | Clinical guidance |
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Eligibility | Guideline recommendations for eligibility should be considered in concert with clinical judgment and precautions. |
Titration process | The titration protocol should be followed. |
Pre-intake assessment | This must be performed by a qualified health professional or other trained staff member supervised by a health professional to ensure the patient is not intoxicated or in any other contraindicated acute clinical condition. |
Administration of injectable medications |
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Postintake assessment | This must be performed by a qualified health professional or other trained staff member supervised by a health professional to ensure safety and attend to dose intolerance or other adverse event. |
Co-prescription of oral opioid agonist treatment | Co-prescription of slow-release oral morphine or methadone should be considered, to prevent withdrawal and cravings between injectable opioid agonist treatment doses, particularly overnight. |
Missed doses | The missed-doses protocol should be consulted. |
Ongoing substance use | Ongoing substance use while on injectable opioid agonist treatment may be an indication to intensify treatment, which may include increasing dosage, transferring to a more intensive model of care, or increasing psychosocial and other supports. The substance-specific guidance should be consulted. |
Stabilization | Stabilization will be patient specific, depending on each patient’s circumstances and needs and how these change over time. Patients’ DSM-5 diagnoses, physical and mental health comorbidities, and social determinants of health (e.g., poverty, homelessness) should be identified at baseline and tracked over time. Stabilization includes:
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Note: DSM-5 = Diagnostic and Statistical Manual of Mental Disorders.
↵* Protocols and other clinical guidance can be found in the full guideline in Appendix 1.