Treatment for Incarcerated Pregnant Women with Opioid Use Disorder: Implementaton Research on Medication Assisted Treatment in Jails

项目概要/摘要 为患有阿片类药物使用障碍 (OUD) 的孕妇提供循证治疗对于对抗阿片类药物使用障碍至关重要 阿片类药物流行病。许多患有 OUD 的人在监狱里度过了一段时间，他们最终被释放回监狱 社区。因此，监狱也是解决阿片类药物泛滥问题战略的重要组成部分， 通过 OUD 为被监禁者提供治疗，并为释放后建立社区联系 治疗。对于患有 OUD 的孕妇尤其如此，因为应避免阿片类药物戒断，因为 母婴风险，应接受药物辅助治疗（MAT）。然而，治疗 监狱中患有 OUD 的孕妇情况各不相同，许多妇女被迫戒毒。造成这一差距的原因 对监狱中孕妇的照顾是多因素的，与独特的组织、后勤和文化有关 在惩教环境中提供护理的环境。实施基于证据的 MAT 的策略 监狱里迫切需要孕妇。 为了推进传播和实施 OUD 孕妇治疗的目标 从而推进个人和公共卫生目标，将实现三个目标：(1) 审查感知到的 来自主要监狱行政和临床的 OUD 孕妇在监狱中对 MAT 的障碍和态度 利益相关者和社区治疗提供者使用混合方法进行调查和 定性访谈； 2) 从监狱中患有 OUD 的孕妇收集定性数据，了解她们的看法 在监狱中和释放后接受 MAT 的障碍和态度； 3）设计和试点针对监狱的患者- 以监狱利益相关者和患者观点为中心的实施战略，为 监狱里携带 OUD 的孕妇。 我的职业目标是成为以患者为中心的研究领域的领导者，专注于提高护理质量和 刑事司法系统中患有 OUD 的孕妇的结果。支持我实现我的职业生涯 为了实现目标，我组建了一个由不同研究学科的高级研究人员组成的导师团队，他们拥有 成功的研究合作和指导活动的记录。我还设计了一个 补充性的教学和体验式培训计划，以获取实施中的知识和技能 科学、妊娠期 OUD 治疗以及成瘾政策研究。拟议的职业发展 计划包含成为一名成功的独立调查员所需的培训、指导和资源。

PROJECT SUMMARY/ABSTRACT Providing evidence-based treatment to pregnant women with opioid use disorder (OUD) is essential to fighting the opioid epidemic. Many people with OUD spend time in jails, and they are eventually released back into the community. Jails thus also represent an important part of the strategy to address the opioid epidemic, by providing treatment to incarcerated people with OUD and creating community linkages for post-release treatment. This is especially true for pregnant women with OUD, as opioid withdrawal should be avoided due to maternal and fetal risks, and they should receive medication assisted treatment (MAT). However, treatment of pregnant people with OUD in jails is variable and many women are forced to detox. The reasons for this gap in care for pregnant women in jail are multifactorial, and relate to the unique organizational, logistical, and cultural environment of providing care in a correctional setting. Strategies to implement evidence based MAT for pregnant women in jails are urgently needed. In order to advance the goal of disseminating and implementing treatment for pregnant women with OUD and thereby advancing individual and public health goals, three aims will be undertaken: (1) to examine perceived barriers and attitudes about MAT for pregnant women with OUD in jail from key jail administrative and clinical stakeholders and from community treatment providers using a mixed methods approach with surveys and qualitative interviews; 2) to collect qualitative data from pregnant women with OUD in jail on their perceived barriers and attitudes about receiving MAT in jail and upon release; 3)to design and pilot a jail-specific, patient- centered implementation strategy that incorporates jail stakeholder and patient perspectives to provide MAT to pregnant women with OUD in jail. My career goal is to be a leader in patient-oriented research focused on improving quality of care and outcomes for pregnant women with OUD in the criminal justice system. To support me in meeting my career goals, I have assembled a mentorship team of senior investigators in different research disciplines, who have a track record of successful research collaborations and mentoring activities. I have also designed a complementary didactic and experiential training plan to acquire knowledge and skills in implementation science, treatment of OUD in pregnancy, and addiction policy research. The proposed career development plan contains the training, mentoring, and resources to become a successful independent investigator.