Improving Access to Treatment for Women with Opioid Use Disorder

项目摘要 在过去的二十年里，怀孕期间阿片类药物的消费量大幅增长， 孕妇阿片类药物使用障碍的诊断，以及宫内阿片类药物引起的新生儿并发症 exposure.孕妇中未经治疗的阿片类药物使用障碍导致母亲的不良结局， 婴儿;然而，阿片样物质激动剂治疗（OAT）对阿片样物质使用障碍非常有效。OAT改善 治疗保留，降低复发风险，降低艾滋病毒风险，减少犯罪行为，降低 过量死亡，并改善出生体重。此外，确保在怀孕前获得OAT， 在前三个月胎儿发育的关键时期使用非法药物的可能性。尽管有证据表明 治疗在减轻阿片类药物使用障碍的不良后果方面是有效的，证据表明， 大多数需要治疗的患者没有得到治疗。我们将进行严格的和可重复的领域 随机选择的门诊丁丙诺啡提供者和阿片类药物治疗计划的实验，10 一系列国家政策。该研究将包括模拟的育龄女性患者， 随机选择的特征，包括妊娠状态。我们的目标是确定是否：1a）怀孕 阿片类药物使用障碍的女性更有可能在获得OAT方面遇到困难， 非孕妇，1b）保险类型改变获得OAT的能力，以及2）国家政策促进或 阻碍获得治疗。拟议的研究使用了丰富的方法，并利用了 经验丰富的研究团队，在定性研究，卫生法，成瘾医学，生物统计学， 卫生政策、卫生服务研究和经济学。这项工作的结果将立即适用 国家政策制定者的任务是利用有限的资源来打击阿片类药物的流行并改善结果 为这些弱势群体。

PROJECT SUMMARY Over the past two decades, there has been substantial growth in opioid consumption during pregnancy, diagnoses of opioid use disorder among pregnant women, and neonatal complications from in utero opioid exposure. Untreated opioid use disorder among pregnant women leads to poor outcomes for the mother and infant; however, opioid agonist treatment (OAT) for opioid use disorder is highly effective. OAT improves treatment retention, reduces relapse risk, reduces HIV-risk, reduces criminal behavior, reduces risk of overdose death, and improves birth weights. Further, ensuring access to OAT before pregnancy decreases the likelihood of illicit drug use during critical times of fetal development in the first trimester. Despite evidence that treatment is effective in mitigating adverse outcomes from opioid use disorder, evidence suggests that the vast majority of patients in need of treatment do not receive it. We will conduct a rigorous and reproducible field experiment of randomly-selected outpatient buprenorphine providers and opioid treatment programs in 10 states with a range of state policies. The study will include simulated female patients of reproductive age with randomly-selected characteristics, including pregnancy status. We aim to determine whether: 1a) pregnant women with opioid use disorder are more likely to experience difficulty accessing OAT when compared with non-pregnant women, 1b) insurance type modifies ability to access OAT, and 2) state policies promote or hinder access to treatment. The proposed study uses a rich array of methodologies and leverages an experienced research team with expertise in qualitative research, health law, addiction medicine, biostatistics, health policy, health services research, and economics. Results from this work will have immediate applicability to state policymakers tasked with using finite resources to combat the opioid epidemic and improve outcomes for this vulnerable population.