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People who use substances often mistrust the primary care system, impeding access. To build on research clarifying how to improve patients' feelings of safety, through co-creating best practice guidelines with physicians and patient representatives. After obtaining Research Ethics Board approval, this qualitative study engaged 22 participants including patients, physicians, and health system partners. We held a series of workshops, co-facilitated by patients and researchers, corresponding to 3 phases of the research (1) establishment of