Author/Authors :
Paul A. Lagace James W. Mar and John F. Mandell. نويسنده , Dennis Brittany B. نويسنده St. George’s University of London, London, United
Kingdom , Bawor Monica نويسنده St. George’s University of London, London, United
Kingdom , Plater Carolyn نويسنده Canadian Addiction Treatment Centres, Richmond Hill,
Canada , Pare Guillaume نويسنده Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Canada , Worster Andrew نويسنده Canadian Addiction Treatment Centres, Richmond Hill,
Canada , Varenbut Michael نويسنده Canadian Addiction Treatment Centres, Richmond Hill,
Canada , Daiter Jeff نويسنده Canadian Addiction Treatment Centres, Richmond Hill,
Canada , Marsh David C. نويسنده Canadian Addiction Treatment Centres, Richmond Hill,
Canada , Desai Dipika نويسنده Population Genomics Program, Chanchlani Research Center,
McMaster University, Hamilton, Canada , Thabane Lehana نويسنده Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Canada , Samaan Zainab نويسنده Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Canada
Abstract :
Background Current tools such as the Maudsley Addiction Profile
(MAP) exist to evaluate different facets of addiction severity, however
these instruments have neither been designed for nor validated within
patients on methadone maintenance treatment (MMT). Objectives We aimed
to provide a reliable tool to evaluate multiple domains of treatment
response for patients on MMT. This tool can be applied easily with
minimal time to patients, researchers and clinicians. Patients and
Methods We modified the MAP to address health and social outcomes
specific to the MMT patient population. Construction of the new tool was
accomplished using expert opinion and MAP scores from participants
recruited for the Genetics of Opioid Addiction (GENOA) study. This
modified scale known as the GENOA Risk Evaluation Tool (GREAT) was then
applied to 21 MMT patients in a generalizability study (G-Study) to
assess reliability and consistency. We performed a criterion validation
of the GREAT to assess the predictive validity of GREAT substance use
domain scores against urine toxicology screening for illicit opioids
using multi-variable logistic regression analysis (n = 117). Results
Results showed excellent test-retest reliability for the GREAT (0.95)
and its subscales (all ≥ 0.94). Results from the regression model showed
the GREAT substance use score was a significant predictor for 3-month
history of illicit opioid use (Odds Ratio [OR]: 1.16, 95% Confidence
Interval 1.05, 1.29; P = 0.003). Conclusions A modified tool to assess
methadone treatment response serves to identify patients at high-risk
for relapse at a minimal cost, as well as evaluate the relevant physical
and psycho-social domains affecting opioid-dependent patients. The GREAT
will serve as a useful adjunct to regular clinical assessments, allowing
clinicians and researchers to properly assess opioid addiction patient’s
response to MMT.
