Your voice matters!
WHAT SODA IS
» A structured reflection tool for people in opioid treatment
» Captures patient-reported experience – withdrawal, craving, use, adherence
» Generates a simple stability score » A consistent, repeatable signal of treatment experience » Supports conversations with clinicians » Helps people understand and discuss their treatment
» Works across settings – community, GP shared care, pharmacy, prisons
» Fits into routine care » No integration required – can be used between appointments
WHAT SODA IS NOT
» NOT a clinical decision tool » Does NOT provide dosing advice » Does NOT diagnose or monitor patients » Does NOT replace clinical assessment » Does NOT trigger automated clinical actions » Does NOT provide emergency or acute care guidance
SODA provides a structured summary of patient-reported treatment experience to support reflection and conversation. It does not guide prescribing decisions. Clinical judgement remains with the treating clinician.
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.
or prescriber. No retrospective outcome monitoring. Just a structured, plain-English way for someone to articulate something they already know – that their dose isn’ t covering them – in a format that makes it easier to do something about it. People can also create an anonymous account and track themselves over time, seeing how their decisions influence their treatment outcomes.
We piloted it across three community OST services in England and Wales with just over a thousand people. The results were sobering but unsurprising – 67 per cent fell into moderate or high instability bands despite being actively engaged in treatment. Being in treatment, it turns out, does not mean treatment is working.
Acceptability was high – 87 per cent rated SODA as accurate, 88 per cent found it helpful, and 72 per cent said they would definitely discuss their treatment with their prescriber after completing it. In the highest instability band, that rose to 92.6 per cent. So SODA doesn’ t just measure the problem, it activates the conversation.
WHY THIS MATTERS The majority of people in OST have far more contact with their keyworker than with their prescriber. The keyworker is the relationship. But without a structured tool, their knowledge stays informal – a hunch, a concern raised in supervision, a note in the file that might not reach the prescriber before the next review. With high staff turnover and variation in confidence around medication conversations, we’ re left with informal descriptors:‘ it’ s not holding her’,‘ still using on top’.
SODA changes that dynamic. It gives non-prescribing staff a shared language and a concrete number to work with. The patient’ s own score speaks for them. It turns the conversation about dose from a negotiation into a clinical discussion, and it shifts the locus of agency back towards the person in treatment where it belongs.
WHAT’ S NEXT? SODA v2 has been adapted to take into account medication adherence and will include adjustments to better accommodate long-acting injectable buprenorphine, an audio option to bypass health literacy barriers, and improved data architecture to enable population-level benchmarking for services and commissioners. Prison integration pathways are also in development – because the weeks after release from custody represent one of the highest-risk periods for opioidrelated death, and continuity of care assessment matters enormously at that transition.
It’ s worth being clear about what SODA is not. It’ s not a medical device, it doesn’ t tell people they are underdosed. It does not direct a prescription. All clinical decisions remain the responsibility of the prescriber – what SODA does is enable
Your voice matters!
people to understand their treatment, their options, and how their own choices can influence their outcomes.
SODA isn’ t about parking people on OST, it’ s about allowing OST to fulfil its dual role as both harm reduction and a recovery tool. For people who want to come off, we’ ve developed a‘ readiness to reduce’ companion – a structured assessment that starts from the position that reducing from a place of instability usually leads to escalating use and abandoned attempts. Getting stable before reducing isn’ t about keeping people on treatment longer than they want to be. It’ s about giving them the best possible chance when they do decide to come off.
THE BOTTOM LINE People on OST are not passive recipients of a prescription. They know how they feel. They know when their dose is covering them, and when it isn’ t. What they haven’ t always had is a simple, dignified, structured way of making that knowledge count in the room where decisions get made.
SODA is that tool. It won’ t replace clinical judgement, and it won’ t tell a prescriber what to do. But it will make sure that what the person already knows isn’ t lost in the gap between how they feel walking in and what gets discussed before they walk out. That gap has cost lives. It’ s time to close it.
SODA v1 is available at mydose. digital. The pilot evaluation has been submitted to Drug and Alcohol Review. For service partnership enquiries: adam @ stayingsafer. com
Professor Adam Winstock is a consultant addiction psychiatrist, founder of the Global Drug Survey, and clinical lead for SODA
DDN is currently running a series on Clearer Conversations in OST – see part one in DDN, May 2026, page 12-14. We would love to have your involvement – please get in touch if you can offer your thoughts or experiences.
The series is made possible by an educational grant from Camurus, who have no involvement in the content of articles.
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