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.
Prescription opioid (PO) misuse and Opioid Use Disorder (OUD) during pregnancy has increased by 2-5-fold over the past decade and is now a major public health problem due to its impact on maternal and fetal health and overutilization of healthcare resources. Integrated behavioral and pharmacological interventions delivered in obstetric practices are greatly needed to effectively address this important public health problem. Directly in line with the research priorities set forth by the National Institute on Drug Abuse, this proposal will transform an in-person program for perinatal opioid misuse and OUD into a web-based patient-provider friendly program to reduce perinatal opioid misuse and abuse and ultimately improve the lives of women, their children and families.
