Table 2:

Clinical guidance summary^*

Category	Clinical guidance
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	Generally, up to 3 visits per day are recommended. Individuals should self-administer under supervision of a qualified health professional. Patients may inject intravenously, intramuscularly or subcutaneously. Intravenous injection is recommended in upper extremities only. Lower extremity injection should be discussed and risks identified for those who cannot find an appropriate site in their upper extremities or who otherwise prefer intravenous injection in their legs or feet. Intramuscular sites should be identified by a qualified health professional and rotated according to established practice standards.
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: Clinical stabilization, which includes Lack of cravings Improved sleep quality and duration Overall well-being Psychosocial stabilization, which may include Integrating new activities Reconnecting with family Attaining safe housing

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.