Relevance of urinalysis monitoring of methadone maintenance patients: a clinical-biological agreement on 41 patients

FRANÇAIS :
L'évolution de la consommation de drogues de 41 patients en traitement de maintenance à la méthadone sur 12 mois a été évaluée par des mesures cliniques subjectives (établies par entretien avec un médecin à l'entrée en traitement, à 6 mois et 12 mois) et par des contrôles biologiques urinaires réguliers (test EMIT). La cohérence entre les deux mesures a été déterminée par le calcul du coefficient kappa pour les opiacés, la cocaïne et les benzodiazépines. Ces coefficients ne montrent pas une concordance marquée entre les mesures biologiques et cliniques, mais suggèrent une complémentarité.
ENGLISH :
This study evaluated the concordance of concomitant urinalysis and clinical assessments of drug abusers included in a methadone maintenance programme. The agreement between a clinical subjective score and an objective biological score, both measuring the evolution of illicit substance consumption over 12 months, was analysed. The clinical score, established by physicians and applied during patient interviews, was determined at entry into the programme and re-evaluated after 6 and 12 months. Forty-one patients were evaluated. The urinalysis score was based on regular screening of urine samples with the EMIT method. Agreement between the two scores was determined by using the kappa coefficient for each substance (opiates, benzodiazepines and cocaine) for each time-point. The calculated kappa coefficients showed poor agreement between the two scores, but could indicate the complementarity of these clinical and biological appraisals. Indeed, the urinalysis objectively detected change in drug use before the clinician. Thus, urinalysis monitoring should be considered as an additional and complementary biological procedure for patient follow-up by physicians. (Author' s abstract)