Table 2.

Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic.

Statement number	Statements
	Assessment
1	All people seeking opioid agonist treatment (OAT) for opioid dependence should be offered an initial short health assessment with little to no waiting time
2	To make sure the initial short health assessment is done quickly, particularly if an in-person assessment would result in delayed access to OAT, people should be offered the choice between a remote assessment (for example by phone or video-consultation), and a face-to-face assessment
3	If a person selects a remote initial health assessment, a follow-up face-to-face consultation should be scheduled within 2 to 4 weeks of the initial remote assessment
4	The initial short health assessment should include the following: •Current and past medical history •Current drug use (establish opioid dependence according to ICD10/11 or DSMV criteria) •History of accidental and deliberate overdose •Current prescribed and non-prescribed medications •Any drug-related complications such as abscesses, venous thrombosis, septicaemia, endocarditis, and constipation •Pregnancy •Presence of past infection with blood-borne viruses (Hepatitis, HIV), including assessment of risk such as previous injecting or sharing or having tattoos) •Psychiatric history and current symptoms •At least one urine drug test to confirm recent opioid use
5	The treating doctor should start a person on OAT once the initial short health assessment is completed, and the person meets the diagnostic criteria for opioid dependence with a positive urine test to confirm recent opioid use, in the knowledge that the full health assessment will be completed within one month
6	The full health assessment as described in the 2016 Clinical Guidelines for OAT, including vaccinations for Hepatitis A and B, and Tetanus, should be completed within one month of the person starting on OAT
7	Waiting lists for people seeking OAT should be avoided. However, when a service is full, people should be placed on a waiting list for the shortest time possible (less than 1 month).
8	All people placed on the OAT waiting list should be told when they can expect to start their treatment
9	The cap on Level 2 GPs (specialist GPs qualified to initiate OAT and stabilise OAT drug doses) should be increased to reduce waiting times for people seeking OAT
	OAT drug choice and optimal dosing
10	People starting on OAT should be supported to make a fully informed choice between Methadone and Buprenorphine (Suboxone/Subutex), if both drugs are considered clinically suitable for that person
11	The starting dose for Buprenorphine (Suboxone/Subutex) is between 4 mg and 8 mg daily. Following review, this dose can be increased by 2-8 mg daily until the person is stabilised
12	People on OAT should be seen (face to face or remotely) by their prescribing doctor at least once a month
	Take-Away Doses
13	Once a person has stabilised on their OAT medication, their doctor should discuss the possibility of take-away doses (takeaways), with reduced supervised consumption, in line with the person's treatment goals
	Overdose Prevention
14	All people on OAT should be prescribed and encouraged to take a supply of Naloxone, particularly during high-risk periods (on waiting list; treatment initiation)
15	All people on OAT should be offered information and training on how to use Naloxone
	E-Prescriptions
16	Doctors prescribing OAT should continue with electronic-prescriptions directly to the person's pharmacy using the national electronic prescription transfer system (Health-mail)