WiP Seminar: Dr. Bohdan Nosyk

Bohdan Nosyk, PhD
Scientist, CHÉOS
Associate Professor, Faculty of Health Sciences, Simon Fraser University

Emulating target trials to strengthen the evidence base for the clinical management of opioid use disorder

In 2016, following a dramatic increase in opioid-related overdose deaths, the province of British Columbia (B.C.), Canada declared a public health emergency. Opioid agonist treatment (OAT) is among the most effective tools available to combat the epidemic. However, OAT uptake and retention is sub-optimal in B.C. and internationally, compromised largely by social and structural factors, but also deviations from evidence-based standards of care and fragmented care, particularly for those with concurrent disorders. Furthermore, a number of aspects of Canadian and U.S. clinical guidelines for the management of opioid use disorder are based on limited and low-quality evidence. This proposal aims to apply cutting-edge methods for causal inference in emulating a series of ‘target trials’ using B.C.’s extensive population-based linked administrative databases. The target trial framework channels counterfactual theory in providing a flexible basis for comparing the effects of treatment and clinical management strategies on either an intent-to-treat or per-protocol basis.

Learning Objectives:

• Overview of treatment options and clinical management of opioid use disorder in B.C.
• Application and use of B.C.’s linked administrative databases for research
• Description of current statistical methods for causal inference with observational data

Relevant References:

• Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada
• Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

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