TREATMENT
CHANGING THE DYNAMIC
L et me start with a simple question. How many people in your service are getting the most out of their OST? You may not know. You might have a guess. But the fact that a service can’ t easily answer that question is, in itself, a problem.
You can look at doses – what percentage are on methadone above 60mg, say. But that misses the point. The evidence is clear that the best outcomes come from personalised dosing. The right dose for one person is not the right dose for another. It’ s not a magic number. In practice, this means that for many people being in treatment is not the same as doing well in treatment.
Here comes a new approach to finally giving people on OST a genuine voice in their own care, says Professor Adam Winstock
I’ ve been prescribing opioid substitution treatment for more than 25 years. I’ ve seen thousands of people cycle in and out, never quite getting stable, never quite getting the dose right, eventually concluding that treatment doesn’ t work for them. The biggest single modifiable reason – not the only one, but the biggest – is that they were never on enough. People on adequate doses use less heroin, stay in treatment longer, and when they’ re ready to reduce, they do it from a position of stability rather than desperation. NICE says it. The Orange guidelines say it. The evidence has said it for 40 years.
ESCALATING DEATHS And yet here we are in 2026, with average methadone doses in England still sitting well below therapeutic thresholds, over half of people on OST classified as moderately or highly unstable by any structured measure, and no brief tool – until now – that a person could complete themselves in five minutes to make their own instability visible. With escalating deaths related to potent synthetic opioids and the need for services to adapt to the arrival of depot buprenorphine, the importance of learning how to make the most of the tools we have in treating opioid dependence is more important than ever.
That’ s the gap SODA was built to fill. So what does SODA actually do? The Stability of Opioid Dose Assessor( SODA) is a seven-item questionnaire that takes about five minutes to complete. It asks about withdrawal between doses, craving, and on-top use. The score runs from zero to 20 – zero meaning treatment is doing its job, 20 meaning it really isn’ t. Scores fall into four bands from stable to high instability, and the person gets immediate automated feedback in plain English.
It replaces informal, variable clinical assessment with a structured, real-time, patientmediated process – usable by any staff member in any setting, without training, without system integration, and without adding time to existing appointments.
JARGON-FREE SODA starts by asking what the person wants from treatment – whether that’ s to stop using, manage active use, or reduce and eventually detox, SODA follows the patient. That’ s the foundation for trust and shared decision-making.
No jargon. No medical degree needed. It can be selfadministered or completed with a keyworker, nurse, peer
Teen00000 / Dreamstime
6 • DRINK AND DRUGS NEWS • JUNE 2026 WWW. DRINKANDDRUGSNEWS. COM