title: The opiate dosage adequacy scale for identification of the right methadone dose--a prospective cohort study.
abstract: BACKGROUND
  Opioid maintenance treatment with methadone is regarded as gold standard in the therapy of opioid dependence. Identification of the 'right' methadone dose, however, remains challenging. We wanted to explore if the Opiate Dosage Adequacy Scale (ODAS) is a helpful instrument in methadone titration.
  
  
  METHODS
  Within this 12-months prospective naturalistic cohort study patients in stable maintenance treatment with methadone (Eptadone®) were included. Sociodemographic and clinical data were gathered at baseline, and months 3, 6, and 12. At the same points in time, the instruments ODAS, European Addiction Severity Index (EuropASI), and Derogatis Interview for Sexual Functioning-Self Report (DISF-SR) were applied.
  
  
  RESULTS
  Five hundred fifteen patients were enrolled, 129 patients prematurely terminated substitution treatment (treatment failure), in 108 patients substitution medication was changed, likely due to bitter taste of Eptadone®. Complete longitudinal ODAS and EuropASI data sets were available for 229 patients. The frequency of adequate methadone doses (ODAS) increased (60.9 % at baseline, 85.3 % at month 12) as well as the average daily methadone dose (63.8 (±30.8) mg/day at baseline to 69.6 (±36.0) mg/day at month 12). Inadequacy of methadone dose was not associated with treatment failure (RR 1.019; CI 95 % 0.756-1.374). Addiction severity decreased statistically significantly. Compared to adequately dosed patients, inadequately dosed patients benefited more, in that they showed greater improvements in ODAS scores, had higher increases in methadone dose, and partially experienced more advanced sexual functioning.
  
  
  CONCLUSIONS
  Application of ODAS was associated with improved methadone dose adequacy and addiction severity parameters as well as increased methadone doses. Its usefulness should be corroborated in a controlled trial.
authors.affiliation: Concept, Addiction Medicine, Kaiserstr. 1, D-80801, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Walcher
authors.affiliation: Psychiatry and Addiction Medicine, Stockholmer Str. 51, D-28719, Bremen, Germany.
authors.forename: John
authors.initials: J
authors.lastname: Koc
authors.affiliation: General Medicine, Kaiserplatz 17, D-53113, Bonn, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Reichel
authors.affiliation: Turmstrasse, Turmstrasse 76, D-10551, Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Schlote
authors.affiliation: Centre for Interdisciplinary Addiction Medicine, Hamburg University, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Verthein
authors.affiliation: Centre for Interdisciplinary Addiction Medicine, Hamburg University, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany. reimer@uke.de.|Health North Bremen, Kurfürstenallee 130, D-28211, Bremen, Germany. reimer@uke.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Reimer
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D016903:Drug Monitoring; D005260:Female; D005858:Germany; D006556:Heroin Dependence / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D060046:Maintenance Chemotherapy; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D010349:Patient Compliance; D010352:Patient Dropouts; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000517:prevention & control
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Dosing; Opioid dependence; Outcomes; Substitution treatment