Table 1.
Harm Reduction Checklist for Outpatient OUD Treatment Programs
| √ Prevent overdose | |
| - Prescribe intranasal naloxone | |
| - Distribute naloxone in clinic | |
| - Counsel on naloxone, test shots, using with others | |
| - Provide virtual overdose prevention resources if using alone | |
| - Develop a clinic overdose response plan | |
| - Install reverse motion detectors in high-risk areas | |
| √ Provide treatment on demand | |
| - Provide same-day intakes with MOUD Rx | |
| - Accommodate patients who arrive late or walk-in unscheduled | |
| - Leverage multidisciplinary team to reduce downtime | |
| - Offer telemedicine for new and follow-up visits | |
| √ Take a patient-centered approach to MOUD | |
| - Offer in-office and community-based buprenorphine inductions | |
| - Consider microdosing in patients at risk of precipitated withdrawal | |
| - Incorporate patient preference in medication and dose | |
| - Do not require abstinence from other drugs to continue MOUD | |
| - Incorporate UDT only when results will change management | |
| - Ask patients prior to UDT about expected results | |
| √ Reduce stigma during medical visits | |
| - Normalize a positive response to questions about stigmatized behavior | |
| - Use inclusive language during sexual history | |
| - Screen for incarceration using language that does not presume guilt | |
| √ Prevent and treat infection | |
| - Offer comprehensive HIV, viral hepatitis, and bacterial STI testing | |
| - Offer rapid HIV tests | |
| - Offer on-site treatment for bacterial STIs | |
| - Co-locate HCV treatment and MOUD care | |
| - Vaccinate against hepatitis A and B | |
| - Provide condoms and safer injection equipment | |
| - Prescribe HIV PrEP and PEP | |
| √ Provide harm reduction supplies | |
| - Distribute condoms | |
| - Distribute sterile syringes and injection equipment | |
| - Distribute fentanyl test strips | |
| - Talk to patients about community syringe access | |
| - Consider prescribing syringes, alcohol swabs | |
| √ Discuss safer injection technique | |
| - Ask patients how they inject | |
| - Discuss sterile technique, drug preparation, and safer venous sites | |
| - Teach patients how to inject themselves if others do this for them |