Question 3: How is patient progress in opioid agonist treatment monitored?

Answer: Patient progress should be monitored via clinical evaluation (e.g., patient self-report) and objective measures (e.g., urine toxicology testing).

The Addiction Severity Index (ASI) (McLellan, Kushner, Metzger, et al., 1992) is an instrument designed to assess the impact of a patient's addiction on his or her function. Although this instrument is typically used in research, it has been adapted for clinical use and illustrates the various aspects of a patient's life that should be assessed at each patient visit to determine the impact of active addiction or the benefits of abstinence. The ASI evaluates patient function in the areas of

• Drug use
• Alcohol use
• Psychiatric function
• Medical function
• Employment
• Social/family functioning
• Legal problems

In addition to patient self-report, urine testing can be a useful practice in monitoring patient progress in treatment. In some countries, urine testing is mandated as part of the treatment plan. A variety of substances can be detected in urine testing. Testing can occur for naturally occurring opioids (e.g., codeine, morphine) or synthetic or semi-synthetic opioids (e.g., oxycodone, methadone). Testing also can occur for benzodiazepines, cocaine, marijuana, or other drugs that are used and/or abused by the patient population. The period of detection of each of these substances varies with the laboratory technique that is used and the extent of drug use and can range from days to weeks.

References

McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, et al. The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse Treatment 1992;9(3):199-213