Improving Treatment Engagement and Adherence to Optimize Outcomes for Opioid-Exposed Mother-Infant Dyads

项目概要： 处方阿片类药物，海洛因和芬太尼的非医疗使用激增是一个关键的公共卫生问题。 影响到育龄妇女及其家庭的紧急情况。怀孕可能是一个激励的时间， 妇女与阿片类药物使用障碍（OUD）从事治疗，与药物治疗（美沙酮或 丁丙诺啡）和心理治疗推荐的第一线治疗。药物治疗依从性 与分娩时改善产科、婴儿和产妇物质使用结果有关。然而 在产后期间停药的发生率很高，增加了复发的风险， 服药过量然而，迄今为止，支持孕妇坚持药物治疗的干预措施 OUD的结果喜忧参半，很少有针对产后妇女的干预措施， 家庭因此，这项混合方法研究的中心目标是量化OUD药物治疗 利用率影响产后母婴结局，并定性探讨影响治疗的因素 坚持，以制定药物治疗促进干预措施，以改善阿片类药物的健康- 暴露的母婴二分体本研究的主要目的有三：（1）分析一个相互关联的、纵向的、 来自马萨诸塞州公共卫生部的行政数据集，以检查 药物治疗参与和药物治疗类型影响母婴结局; (2)与不同的利益相关者群体接触，包括患有阿片类药物使用障碍的产后妇女， 他们的家庭定性确定信仰和态度，并划定人际和结构性障碍 以及促进治疗参与和坚持，以制定药物治疗促进干预措施; 和（3）对药物治疗干预进行试点测试，以提高孕妇和 评估干预措施的可行性和可接受性。的结果 这一系列项目将填补NIDA内部一个高优先级研究领域的现有空白， 妊娠和产后OUD妇女的护理。主要研究者希夫博士是一名早期职业临床研究者， 儿科医生和成瘾医学医生谁将使用这个职业发展奖，以提高她 定量研究技能，包括复杂公共卫生数据集的纵向分析，定性 弱势群体研究、干预措施开发和临床试验设计。在整个 获奖期间，希夫博士将与一个多学科的指导和咨询团队密切合作， 在母婴健康、成瘾精神病学、围产期流行病学、生物统计学、定性分析 干预发展和临床试验设计，以实现她的职业目标和具体目标。

PROJECT SUMMARY: The surge in the non-medical use of prescription opioids, heroin, and fentanyl is a critical public health emergency affecting women of child bearing age and their families. Pregnancy can be a motivating time for women with opioid use disorder (OUD) to engage in treatment, with pharmacotherapy (with methadone or buprenorphine) and psychotherapy the recommended first line treatment. Pharmacotherapy adherence has been associated with improved obstetric, infant, and maternal substance use outcomes at delivery. Yet medication discontinuation in the postpartum period occurs at high rates, increasing the risk of relapse and overdose. To date, however, interventions to support pharmacotherapy adherence among pregnant women with OUD have shown mixed results, and few interventions have been aimed at postpartum women and families. Therefore, the central objective of this mixed-methods study is to quantify how OUD pharmacotherapy utilization impacts postpartum maternal-infant outcomes and qualitatively explore factors impacting treatment adherence in order to develop a pharmacotherapy promotion intervention to improve the health of the opioid- exposed mother-infant dyad. This project includes three main aims: (1) To analyze a linked, longitudinal, administrative dataset from Massachusetts Department of Public Health to examine how duration of pharmacotherapy engagement and type of pharmacotherapy received impact maternal and infant outcomes; (2) To engage with a diverse group of stakeholders including postpartum women with opioid use disorder and their families to qualitatively identify beliefs and attitudes and delineate interpersonal and structural barriers and facilitators to treatment engagement and adherence to develop a pharmacotherapy promotion intervention; and (3) Pilot test the pharmacotherapy intervention to improve treatment adherence among pregnant and postpartum women with OUD assessing the feasibility and acceptability of the intervention. The findings from this series of projects will fill an existing gap in a high priority research area within NIDA that will inform the care of pregnant and postpartum women with OUD. The PI, Dr. Schiff, is an early-career clinician investigator, pediatrician, and addiction medicine physician who will use this career development award to enhance her skills in quantitative research including longitudinal analyses of complex public health datasets, qualitative research with vulnerable populations, intervention development, and clinical trials design. Throughout the award period, Dr. Schiff will work closely with a multidisciplinary mentorship and advisory team with expertise in maternal-child health, addiction psychiatry, perinatal epidemiology, biostatistics, qualitative analysis, intervention development, and clinical trials design to carry out her stated career objectives and specific aims.