Web-Based Treatment for Perinatal Opioid Use Disorder

1.摘要 围产期处方阿片类药物(PO)的孕产妇、产科和新生儿发病率和死亡率 滥用和阿片类药物使用障碍(OUD)是公认的，包括母亲的风险增加4.6倍 分娩时死亡、胎儿发育不良、早产和新生儿阿片类药物戒断综合征。2012年，在 在美国，平均每25分钟就有一个婴儿出生时出现阿片类药物戒断的迹象 15亿美元，其中医疗补助覆盖了这些费用的80%。尽管众所周知， 孕产妇、胎儿和新生儿健康与围产期阿片类药物滥用的治疗，仍然缺乏 为患有药物使用障碍的孕妇提供综合治疗方案。我们队有 采用循证认知行为疗法(CBT)治疗疼痛并结合共享 孕妇滥用POS或OUD的药物管理决策(包括 海洛因)。初步数据显示，阿片类药物滥用和滥用显著减少，该计划是 现在由心理健康提供者亲自提供并通过远程医疗在产科实践中进行整合和提供 在整个南卡罗来纳州。然而，由于缺乏卫生保健服务，妇女仍然难以获得医疗服务。 交通、照看孩子或请假。此外，该方案的扩展受到依赖于 精神卫生服务提供者提供护理。然而，大多数产科提供者认为没有能力管理PO 滥用，或OUD，限制了这一计划在产科人口中的扩展。基于网络的干预措施已经 有可能克服照顾孕妇的障碍，并为一线提供者提供证据- 基于处理PO滥用和OUD的工具，但到目前为止，还没有这样的程序。这项提议将填补这一关键的 通过追求以下研究活动，差距和解决这一未得到满足的临床需求。该计划的目标 目前的应用是：1)将我们当前的面对面CBT计划转变为基于Web的患者友好型计划 减少孕妇滥用和滥用阿片类药物的行为干预；2)将我们的 共享阿片类药物滥用决策，并将其纳入基于网络的计划中，以便第一线产科 提供者可以有效和安全地管理怀孕期间滥用或滥用PO；以及3)评估 患者-提供者网络计划在社区产科实践中的可行性。拟议的研究 将在怀孕期间管理阿片类药物的使用和滥用方面取得重大进展。这一贡献 意义重大，因为它有可能通过以下方式改善妇女及其子女的生活：1)减少 孕妇、胎儿和新生儿与滥用PO和OUD相关的风险；2)减少阿片类药物 孕期暴露和相关不良后果，包括新生儿阿片类药物戒断综合征；以及 3)防止与滥用PO和OUD相关的长期风险，包括服药过量和死亡。

1. ABSTRACT The maternal, obstetric and newborn morbidity and mortality associated with perinatal prescription opioid (PO) misuse and Opioid Use Disorder (OUD) are well established including a 4.6 fold increased risk for maternal death at delivery, poor fetal growth, preterm birth and neonatal opioid withdrawal syndrome. In 2012, on average, one infant was born every 25 minutes in the United States with signs of opioid withdrawal costing $1.5 billion dollars, with Medicaid covering 80% of these costs. Despite the well-known improvement in maternal, fetal and newborn health with treatment of perinatal opioid misuse and OUD, there remains a dearth of comprehensive treatment programs for pregnant women with substance use disorders. Our team has adapted an evidence-based Cognitive Behavioral Therapy (CBT) program for pain combined with shared decision making for medication management for pregnant women misusing POs or with OUD (including heroin). Preliminary data demonstrate significant reductions in opioid misuse and abuse and the program is now integrated and delivered by mental health providers in-person and via telemedicine in obstetric practices throughout the state of South Carolina. However, women still have difficulties accessing care due to lack of transportation, childcare, or time off from work. Further, expansion of the program is limited by relying on mental health providers to deliver care. However, most obstetric providers feel ill-equipped to manage PO misuse, or OUD, limiting the expansion of this program in obstetric populations. Web-based interventions have the potential to over-come barriers to care for pregnant women and equip front-line providers with evidence- based tools to treat PO misuse and OUD, but to date, no such program exists. This proposal will fill this critical gap and address this unmet clinical need by pursing the following research activities. The objectives of the current application are to: 1) convert our current in-person CBT program into a web-based patient-friendly behavioral intervention to reduce opioid misuse and abuse in pregnant women; 2) convert our in-person shared decision making for opioid misuse and OUD into a web-based program so that front-line obstetric providers can effectively and safely manage PO misuse or OUD during pregnancy; and 3) evaluate the feasibility of the patient-provider web-based program in community obstetric practices. The proposed research will result in a critical advance in the management of opioid use and abuse during pregnancy. This contribution is significant because it has the potential to improve the lives of women and their children by: 1) decreasing the maternal, fetal, and newborn risks associated with maternal PO misuse and OUD; 2) decreasing opioid exposure in pregnancy and associated adverse outcomes including newborn opioid withdrawal syndrome; and 3) preventing long-term risks associated with PO misuse and OUD including overdose and death.