OVAL: Overdoses Among Black pregnant/Postpartum People and Laws Governing Drug Use in Pregnancy: A Mixed-Methods Project to Support Mobilization

翻译后摘要：怀孕和产后妇女谁是黑人和使用毒品的斗争，以生存在国际， 美国21世纪世纪最严重的三大公共卫生危机之一：（1）孕产妇死亡流行病;（2） 不断发展的过量流行病;（3）交叉歧视。在一个莫尔最高的国家- 在所有高收入国家中，美国黑人妇女的死亡率是白色妇女的三倍 妇女尽管这种不公平是可怕的，但最近美国过量用药流行病的流行病学转变正在蓄势待发 虽然在21世纪的大部分时间里，白色人的过量死亡率明显较高， 最近，黑人的过量用药激增，自2018年以来，黑人/白色的不平等已经出现。 州立法机构一直在积极应对这一危机：44个州制定了>1项法律， 怀孕期间使用药物。一些法律是惩罚性的，并试图通过刑事制裁来阻止产前吸毒 (e.g.,将怀孕期间使用毒品归类为虐待/忽视儿童）。其他人寻求扩大物质使用障碍 (SUD)孕妇的治疗（例如，要求治疗方案优先考虑孕妇）。 不幸的是，我们对这些无处不在的法律如何塑造过量或相关健康知之甚少 使用药物的黑人孕妇/产后妇女的服务使用情况。在某种程度上，这种沉默反映了互联网- 医疗/公共卫生方面的种族歧视：产妇保健领域在很大程度上忽视了患有 口腔健康状况和减少危害忽视了孕妇/产后妇女，特别是黑人 妇女然而，现有的证据不足，令人震惊。关于惩罚性法律的少数研究 在很大程度上证实了ACOG，CDC和SAMHSA警告说，这些法律破坏了黑人妇女的健康， 保健用途。关于寻求增加孕妇SUD治疗机会的法律的少数研究 他们发现，他们没有影响，或实际上可能减少SUD治疗使用的黑人孕妇。 在两个社区问责委员会的指导下，拟议的研究采用了混合方法顺序 解释性的“QUAN qual”设计，开创了一系列高影响力的研究和行动，以实现可能的效率， 选择法律的影响，管理药物使用在怀孕过量，SUD治疗的使用，和产前/产后， 黑人孕妇/产后妇女谈话护理使用情况。目标1-3是全国范围的， 行政数据库，以跟踪，第一次，通过这三个法律可能形成的途径 黑人孕妇/产后妇女的过量风险和卫生服务使用。目标4将解释和丰富目标 1-3通过深入的定性案例研究，这些途径在一个大都会区（亚特兰大）的调查结果。目标5 应用循证社区组织方法，支持亚特兰大的社区动员， 选择目标1-4中确定的干预目标。该项目将产生很大的影响：它将帮助布莱克 使用药物的孕妇/产后妇女在黑人孕产妇死亡率和过量用药的冲突中幸存下来 通过优化管理怀孕期间使用药物的法律的好处或减轻其危害，可以防止流行病。

Abstract: Pregnant and postpartum women who are Black and use drugs are fighting to survive at the inter- section of 3 of the gravest public health crises of the 21st century US: (1) the maternal mortality epidemic; (2) an evolving overdose epidemic; and (3) intersectional discrimination. In a nation with the highest maternal mor- tality rate of all high-income countries, US Black women suffer mortality rates threefold higher than White women. Dire as this inequity is, a recent epidemiologic transformation of the US overdose epidemic is poised to widen it. While overdose mortality rates were markedly higher among White people for most of the 2000s, overdoses among Black people have surged recently, and since 2018 Black/White inequities have emerged. State legislatures have been actively responding to this crisis: 44 states have enacted >1 law governing drug use in pregnancy. Some laws are punitive, and seek to deter prenatal drug use through criminal sanctions (e.g., classifying drug use in pregnancy as child abuse/neglect). Others seek to expand substance use disorder (SUD) treatment for pregnant women (e.g., require that treatment programs prioritize pregnant women). Unfortunately, we know remarkably little about how these ubiquitous laws shape overdose or related health service use among Black pregnant/postpartum women who use drugs. In part, this silence reflects intersec- tional discrimination in medicine/public health: the field of maternal health has largely ignored people with be- havioral health conditions, and harm reduction has neglected pregnant/postpartum women, particularly Black women. The scant evidence that does exist is, however, alarming. The handful of studies on punitive laws largely confirm ACOG, CDC, and SAMHSA warnings that these laws undermine Black women’s health and healthcare use. The few studies of laws seeking to increase SUD treatment opportunities for pregnant women find that they have no effects or may actually reduce SUD treatment use among Black pregnant women. Guided by two Community Accountability Boards, the proposed study applies a mixed-methods sequential explanatory “QUAN qual” design to inaugurate a line of high-impact research and action into the possible ef- fects of select laws governing drug use in pregnancy on overdoses, SUD treatment use, and prenatal/ postna- tal care use among Black pregnant/postpartum women. Aims 1-3 are national in scope, and analyze multiple administrative databases to trace, for the first time, the pathways through which these 3 laws might shape Black pregnant/ postpartum women’s overdose risk and health service use. Aim 4 will explain and enrich Aim 1-3 findings through an in-depth qualitative case study of these pathways in one Metro Area (Atlanta). Aim 5 applies evidence-based community organizing methods to support community mobilization in Atlanta around select intervention targets identified in Aims 1-4. The proposed project will have high impact: it will help Black pregnant/ postpartum women who use drugs survive the collision of the Black maternal mortality and overdose epidemics, by either optimizing the benefits of laws governing drug use in pregnancy or mitigating their harms.