Improving Access to Treatment for Women with Opioid Use Disorder

改善患有阿片类药物使用障碍的女性获得治疗的机会

• 批准号: 10088429
• 负责人: Stephen W Patrick
• 金额: $ 26.68万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-15 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088429
• 关键词: Address; Affect; Age; Appointment; Biometry; Birth Weight; Buprenorphine; Caring; Characteristics; Clinic; Data; Data Set; Diagnosis; Discipline of obstetrics; Drug usage; Economics; Eligibility Determination; Employment; Ensure; Evidence based treatment; Family Practice; Female; Fetal Development; First Pregnancy Trimester; Growth; HIV risk; Health; Health Policy; Health Services Accessibility; Health Services Research; Healthcare; Improve Access; Individual; Infant; Insurance; Insurance Coverage; Laws; Measures; Medicaid; Medicaid eligibility; Medical; Medicine; Methadone; Methodology; Methods; Mothers; Neonatal; Opioid Antagonist; Opioid agonist; Outcome; Outpatients; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Policies; Pregnancy; Pregnant Women; Privatization; Provider; Qualitative Research; Reporting; Reproducibility; Research; Resources; Source; Surveys; Time; Treatment Cost; Uninsured; United States Dept. of Health and Human Services; Visit; Vulnerable Populations; Wait Time; Woman; Work; addiction; adverse outcome; combat; criminal behavior; drug mechanism; effective therapy; experience; experimental study; flexibility; health care availability; illicit drug use; improved; improved outcome; in utero; kappa opioid receptors; mu opioid receptors; opioid agonist therapy; opioid epidemic; opioid exposure; opioid treatment program; opioid use; opioid use disorder; overdose death; overdose risk; programs; relapse risk; reproductive; treatment strategy; waiver; Address; Affect; Age; Appointment; Biometry; Birth Weight; Buprenorphine; Caring; Characteristics; Clinic; Data; Data Set; Diagnosis; Discipline of obstetrics; Drug usage; Economics; Eligibility Determination; Employment; Ensure; Evidence based treatment; Family Practice; Female; Fetal Development; First Pregnancy Trimester; Growth; HIV risk; Health; Health Policy; Health Services Accessibility; Health Services Research; Healthcare; Improve Access; Individual; Infant; Insurance; Insurance Coverage; Laws; Measures; Medicaid; Medicaid eligibility; Medical; Medicine; Methadone; Methodology; Methods; Mothers; Neonatal; Opioid Antagonist; Opioid agonist; Outcome; Outpatients; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Policies; Pregnancy; Pregnant Women; Privatization; Provider; Qualitative Research; Reporting; Reproducibility; Research; Resources; Source; Surveys; Time; Treatment Cost; Uninsured; United States Dept. of Health and Human Services; Visit; Vulnerable Populations; Wait Time; Woman; Work; addiction; adverse outcome; combat; criminal behavior; drug mechanism; effective therapy; experience; experimental study; flexibility; health care availability; illicit drug use; improved; improved outcome; in utero; kappa opioid receptors; mu opioid receptors; opioid agonist therapy; opioid epidemic; opioid exposure; opioid treatment program; opioid use; opioid use disorder; overdose death; overdose risk; programs; relapse risk; reproductive; treatment strategy; waiver

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.

项目摘要 在过去的二十年中，怀孕期间阿片类药物的消费量已大大增长， 孕妇中阿片类药物使用障碍的诊断，以及阿片类药物的新生儿并发症 接触。孕妇未经治疗的阿片类药物使用障碍导致母亲的结果不佳 婴儿;但是，阿片类药物使用障碍的阿片类药物激动剂治疗（OAT）非常有效。燕麦改善 保留治疗，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，确保在怀孕前进入燕麦会减少 在孕期胎儿发育的关键时期，非法吸毒的可能性。尽管有证据表明 治疗可有效缓解阿片类药物使用障碍的不良后果，证据表明庞大 大多数需要治疗的患者没有接受。我们将进行严格且可重复的领域 在10个中随机选择的门诊门诊提供者和阿片类药物治疗计划的实验10 具有一系列国家政策的国家。该研究将包括模拟的女性患者，具有 随机选择的特征，包括怀孕状况。我们旨在确定是否：1A）怀孕 与患有阿片类药物使用障碍的女性相比 未怀孕的妇女，1B）保险类型修改了使用燕麦的能力，2）国家政策促进或 阻碍治疗的机会。拟议的研究使用了丰富的方法和利用 经验丰富的研究团队具有定性研究，卫生法，成瘾医学，生物统计学的专业知识， 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 要使用有限资源来对抗阿片类药物流行并改善预后的国家决策者 对于这个脆弱的人群。