| Recommendation 1: A homeless or vulnerably housed person | Moderate certainty
⊕⊕⊕○ |
Identify homelessness or housing vulnerability and willingness to consider housing interventions. Ensure access for homeless or vulnerably housed individuals to local housing coordinator or case manager (i.e., call 211 or via a social worker) for immediate link to permanent supportive housing and coordinated access system.
Clinical considerations: Many jurisdictions will provide alternative housing services for specific marginalized populations, for example, Indigenous people, women and families, youth, those who identify as LGBTQ2+, those with disabilities, refugees and migrants. | Strong recommendation |
| Recommendation 2: A homeless or vulnerably housed person with experience of poverty, income instability or living in a low-income household | Low certainty
⊕⊕○○ |
|
Clinical considerations: Consult poverty screening tools when needed (e.g., https://cep.health/clinical-products/poverty-a-clinical-tool-for-primary-care-providers). | Conditional recommendation |
| Recommendation 3: A homeless or vulnerably housed person with multiple comorbid or complex health needs (including mental illness and/or substance use) | Low certainty
⊕⊕○○ |
Identify history of severe mental illness, such as psychotic or mood and anxiety disorders, associated with substantial disability, substance use, or multiple/complex health needs. Ensure access to local community mental health programs, psychiatric services for assessment, and linkage to intensive case management, assertive community treatment or critical time intervention where available.
Clinical considerations: Call 211 or consult primary care providers, social workers or case managers familiar with local access points and less intensive community mental health programs. | Conditional recommendation |
| Recommendation 4: A homeless or vulnerably housed person currently using opioids | Very low certainty
⊕○○○ |
Identify opioid use disorder. Ensure access within primary care or via an addiction specialist to opioid agonist therapy (OAT), potentially in collaboration with a public health or community health centre for linkage to pharmacologic interventions.
Clinical considerations: Encourage all patients taking opioid medication to have a naloxone kit. Though barriers to prescribing methadone and buprenorphine remain, be aware of new regulations that aim to facilitate OAT access and options in your jurisdiction, in particular for buprenorphine. | Conditional recommendation |
| Recommendation 5: A homeless or vulnerably housed person with substance use disorder | Very low certainty
⊕○○○ |
Identify, during history or physical examination, problematic substance use, including alcohol or other drugs. Identify the most appropriate approach, or refer to local addiction and harm-reduction/prevention services (e.g., supervised consumption facilities, managed alcohol programs) via appropriate local resources such as public health or community health centre or local community services centre.
Clinical considerations: In case of active opioid use disorder, facilitate patient access to OAT. Patients should be made aware of supervised consumption facility locations (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.190777/-/DC1). | Conditional recommendation |