Prevention of Methamphetamine Use among Postpartum Women (PROMPT)

项目摘要 在阿片类药物流行期间，甲基苯丙胺流行摧毁了美国西部， 这两种流行病对孕妇和产后妇女产生了深刻的影响。事实上，大多数女性 在犹他州的物质使用和怀孕的大学接受护理-恢复，成瘾，依赖 诊所有甲基苯丙胺使用障碍（MUD）。甲基苯丙胺的使用（MU）经常减少， 怀孕怀孕的荷尔蒙变化，特别是孕酮水平的增加及其 代谢物别孕烯醇酮可能会减少孕妇的渴望和药物使用。反之， 产后激素急剧下降可能会增加重新使用的风险。孕酮的研究 在产后期间补充可卡因在减少可卡因的返回方面显示出有希望的结果， 产后妇女吸烟情况。我们的长期目标是促进对怀孕的理解 产后妇女独特的生理影响MUD的轨迹，并将这些知识应用于 开发新的干预措施，旨在减少这一人群的MU。此R21应用程序的目标是 测试孕酮补充剂减少MU复发的可行性、安全性和初步疗效 在产后妇女中，并探讨别孕烯醇酮水平与 对冰毒的渴望。该项目的基本原理是，孕酮将减少对MU的回报， 产后妇女这项研究将追求两个具体目标：（1）评估可行性，安全性， 微粒化孕酮降低产后MUD妇女MU恢复的初步疗效; (2)为了评估唾液别孕烯醇酮水平和甲基苯丙胺渴求之间的关联， 对照组和治疗组。对于目标1，我们将随机选择患有MUD的产后妇女， 在分娩前禁欲至少一个月，以微粒化孕酮，其代谢为 别孕烯醇酮或安慰剂，并将在12周内评估MU。我们将跟踪注册和保留 MUD妇女，这种干预措施的安全性，并建立孕酮减少复发的初步疗效 到MU。对于目标2，我们将检验增加的别孕烯醇酮水平与减少的 产后妇女对冰毒的渴望这个项目是创新的，因为它解决了一个重大的 这一脆弱群体面临的健康问题，并采取新的干预措施。所提出的研究是有意义的 因为它有可能通过减少产后妇女的MU来改善公共卫生， 通过调查别孕烯醇酮和甲基苯丙胺的渴望之间的关联科学知识。

PROJECT SUMMARY In the midst of the opioid epidemic, the methamphetamine epidemic has devastated the Western United States, These twin epidemics have profoundly affected pregnant and postpartum women. Indeed, the majority of women receiving care at the University of Utah's Substance Use and Pregnancy – Recovery, Addiction, Dependence clinic have methamphetamine use disorder (MUD). Methamphetamine use (MU) frequently decreases during pregnancy. The hormonal changes of pregnancy, specifically the increased levels of progesterone and its metabolite allopregnanolone, may decrease craving and drug use among pregnant women. Conversely, the precipitous postpartum hormonal drop may increase the risk of return to use. Studies of progesterone supplementation in the postpartum period have shown promising results in reducing return to cocaine and tobacco use among postpartum women. Our long-term goal is to advance the understanding of how pregnant and postpartum women's unique physiology impacts the trajectory of MUD and to apply this knowledge to developing novel interventions aimed at reducing MU in this population. The objective of this R21 application is to test the feasibility, safety and preliminary efficacy of progesterone supplementation to reduce return to MU among postpartum women and to explore the association between allopregnanolone levels and methamphetamine craving. The rationale for this project is that progesterone will reduce return to MU among postpartum women. This research study will pursue two specific aims: (1) To assess feasibility, safety, and preliminary efficacy of micronized progesterone to decrease return to MU among postpartum women with MUD; (2) To evaluate the association between salivary allopregnanolone levels and methamphetamine craving in control and treatment groups. For Aim 1, we will randomize postpartum women with MUD who have achieved abstinence for at least one month prior to delivery to micronized progesterone, which metabolizes into allopregnanolone, or placebo and will assess MU over 12 weeks. We will track enrollment and retention of women with MUD, safety of this intervention and establish preliminary efficacy of progesterone to reduce return to MU. For Aim 2, we will test the hypothesis that increased allopregnanolone levels are correlated with reduced methamphetamine cravings among postpartum women. This project is innovative as it addresses a significant health issue facing this vulnerable population with a novel intervention. The proposed research is significant because of its potential to improve public health by decreasing MU among postpartum women and to advance scientific knowledge by investigating the association between allopregnanolone and methamphetamine cravings.