Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol
Introduction Urine drug tests (UDTs) are commonly used for monitoring opioid agonist treatment (OAT) responses, supporting the clinical decision for take-home doses and monitoring potential diversion. However, there is limited evidence supporting the utility of mandatory UDTs—particularly the impact...
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BMJ Publishing Group
2023-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/5/e068729.full |
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| author | Malcolm Maclure M Eugenia Socías Evan Wood Paul Gustafson Robert W Platt Bohdan Nosyk Jeong Eun Min Micah Piske Julie Bruneau U Siebert P Todd Korthuis Paxton Bach B Carolina Guerra-Alejos Megan Kurz Laura M Dale X Joan Hu Kyle Kampman Tom Loughin |
| author_facet | Malcolm Maclure M Eugenia Socías Evan Wood Paul Gustafson Robert W Platt Bohdan Nosyk Jeong Eun Min Micah Piske Julie Bruneau U Siebert P Todd Korthuis Paxton Bach B Carolina Guerra-Alejos Megan Kurz Laura M Dale X Joan Hu Kyle Kampman Tom Loughin |
| author_sort | Malcolm Maclure |
| collection | DOAJ |
| description | Introduction Urine drug tests (UDTs) are commonly used for monitoring opioid agonist treatment (OAT) responses, supporting the clinical decision for take-home doses and monitoring potential diversion. However, there is limited evidence supporting the utility of mandatory UDTs—particularly the impact of UDT frequency on OAT retention. Real-world evidence can inform patient-centred approaches to OAT and improve current strategies to address the ongoing opioid public health emergency. Our objective is to determine the safety and comparative effectiveness of alternative UDT monitoring strategies as observed in clinical practice among OAT clients in British Columbia, Canada from 2010 to 2020.Methods and analysis We propose a population-level retrospective cohort study of all individuals 18 years of age or older who initiated OAT from 1 January 2010 to 17 March 2020. The study will draw on eight linked health administrative databases from British Columbia. Our primary outcomes include OAT discontinuation and all-cause mortality. To determine the effectiveness of the intervention, we will emulate a ‘per-protocol’ target trial using a clone censoring approach to compare fixed and dynamic UDT monitoring strategies. A range of sensitivity analyses will be executed to determine the robustness of our results.Ethics and dissemination The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. Results will be disseminated to local advocacy groups and decision-makers, national and international clinical guideline developers, presented at international conferences and published in peer-reviewed journals electronically and in print. |
| format | Article |
| id | doaj-art-464aa64fbce64659a6097e3385a7bdb6 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-464aa64fbce64659a6097e3385a7bdb62025-02-01T16:40:15ZengBMJ Publishing GroupBMJ Open2044-60552023-05-0113510.1136/bmjopen-2022-068729Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocolMalcolm Maclure0M Eugenia Socías1Evan Wood2Paul Gustafson3Robert W Platt4Bohdan Nosyk5Jeong Eun Min6Micah Piske7Julie Bruneau8U Siebert9P Todd Korthuis10Paxton Bach11B Carolina Guerra-Alejos12Megan Kurz13Laura M Dale14X Joan Hu15Kyle Kampman16Tom Loughin173 Department of Anaesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, CanadaFaculty of Medicine, The University of British Columbia, Vancouver, British Columbia, CanadaFaculty of Medicine, The University of British Columbia, Vancouver, British Columbia, CanadaDepartment of Statistics, University of British Columbia, Vancouver, British Columbia, CanadaEpidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, CanadaCentre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, CanadaCentre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, CanadaCentre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, CanadaDepartment of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Québec, CanadaCenter for Health Decision Science, Department of Health Policy and Management, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USASchool of Public Health, OHSU-PSU, Portland, Oregon, USAFaculty of Medicine, The University of British Columbia, Vancouver, British Columbia, CanadaCentre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, CanadaCentre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, CanadaCentre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, CanadaDepartment of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, CanadaDepartment of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, CanadaIntroduction Urine drug tests (UDTs) are commonly used for monitoring opioid agonist treatment (OAT) responses, supporting the clinical decision for take-home doses and monitoring potential diversion. However, there is limited evidence supporting the utility of mandatory UDTs—particularly the impact of UDT frequency on OAT retention. Real-world evidence can inform patient-centred approaches to OAT and improve current strategies to address the ongoing opioid public health emergency. Our objective is to determine the safety and comparative effectiveness of alternative UDT monitoring strategies as observed in clinical practice among OAT clients in British Columbia, Canada from 2010 to 2020.Methods and analysis We propose a population-level retrospective cohort study of all individuals 18 years of age or older who initiated OAT from 1 January 2010 to 17 March 2020. The study will draw on eight linked health administrative databases from British Columbia. Our primary outcomes include OAT discontinuation and all-cause mortality. To determine the effectiveness of the intervention, we will emulate a ‘per-protocol’ target trial using a clone censoring approach to compare fixed and dynamic UDT monitoring strategies. A range of sensitivity analyses will be executed to determine the robustness of our results.Ethics and dissemination The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. Results will be disseminated to local advocacy groups and decision-makers, national and international clinical guideline developers, presented at international conferences and published in peer-reviewed journals electronically and in print.https://bmjopen.bmj.com/content/13/5/e068729.full |
| spellingShingle | Malcolm Maclure M Eugenia Socías Evan Wood Paul Gustafson Robert W Platt Bohdan Nosyk Jeong Eun Min Micah Piske Julie Bruneau U Siebert P Todd Korthuis Paxton Bach B Carolina Guerra-Alejos Megan Kurz Laura M Dale X Joan Hu Kyle Kampman Tom Loughin Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol BMJ Open |
| title | Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol |
| title_full | Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol |
| title_fullStr | Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol |
| title_full_unstemmed | Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol |
| title_short | Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol |
| title_sort | comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in british columbia canada a population based observational study protocol |
| url | https://bmjopen.bmj.com/content/13/5/e068729.full |
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