Evaluation of the Stability of Opioid Dose Assessor (SODA), helping patient work out right dose for them

Background: For people with opioid dependence, being on the correct (optimal) dose of methadone and buprenorphine for opioid substitute treatment (OST) is an important factor in treatment efficacy. Although people vary in their optimal dose, recommended therapeutic doses are methadone 60-100mg and buprenorphine 12-16mg per day. Studies from the UK and US suggest optimal dosing is rare. Underdosing leaves people at risk of on top use, overdose, and disengagement from treatment. Negative attitudes to methadone (among other factors such as a poor understanding of treatment also contribute to poorer retention in treatment. While there are a number of scales that can be used to assess opioid withdrawal and guide induction few if any scales have been designed for the person in treatment and consider what they want from treatment. In order to help individuals identify their optimal dose the SODA was developed in conjunction with service users and a range of treatment providers. Anonymous and confidential and freely available at www.mydose.digital, this tool aims to help individuals self-identify their optimal dose of methadone or buprenorphine. SODA is 7-item self-assessment tool that takes 3 minutes to complete. Comprised of 4 items exploring withdrawal relief between doses and 3 items exploring use and craving, scores on the SODA (range zero = optimal dose and 20 = highest/worst stability score) provides individuals with an indication of how well optimised their dose is. It also provides information of side effects and risk of treatment. 
Methods: Piloted at 3 UK treatment organisations, 500 people on OST were recruited to explore the acceptability and perceived utility of the SODA. Data on dose, stability and actions to be taken in terms of seeking changes in medication dose after completion were conducted. Analyses to determine the impact on increasing stability in dose over time are on-going.  
Results: Initial results showed at least 65% of patients could be considered as being on sub-optimal doses. Based on what they learned from the SODA 83% said they intended to discuss their treatment with their prescriber. 90% thought the SODA’s assessment of their assessment in treatment was totally or mostly accurate, 100% 53% of participants found the SODA tool very useful/bit useful in helping them understand how to get the most out of treatment. Further data analysis on sensitivity and impact on dose and stability over time is underway.
Conclusions: The SODA appears to be a useful tool to help people work out what the right dose of OST is for them, supporting shared decision making, streamlining service delivery and increasing the number the number of people on optimal doses. In light of novel potent synthetic opioids, optimal dosing and titration regimes to achieve rapid stability are even more important. As SODA builds up its database, it will allow users to compare their stability score with others on the same / higher doses.