Researchers at the Geisel School of Medicine have been awarded a four-year, $5.3 million Patient-Centered Outcomes Research Institute grant to study the effectiveness of various medication-assisted treatment models for opioid use disorder in pregnant women. PCORI is a non-profit organization authorized by Congress whose purpose is to fund health care-related research.
Through MAT, patients suffering from opioid use disorder receive medications that stimulate opioid receptors, thus replacing the need for opiates. According to Geisel clinical assistant professor Daisy Goodman, who is one of the study’s principal investigators, there are two options for medications: methadone and buprenorphine. According to the project announcement on the PCORI website, women have traditionally received this care from an addiction treatment center, but as demand has increased, some maternity care clinics have begun to provide MAT services.
“[DHMC has] been involved in this work for quite a while in terms of actually providing services,” Goodman said.
Goodman noted that the researchers will examine which combinations of medication, treatment administration and mental health care produce better results. She added that different methods may work better for women with different life circumstances.
“It’s likely that for some groups of people, it’s better to do it one way, and for other groups of people, it will be better to do it another way,” Goodman said.
For that reason, Goodman said, the study will examine differences in results across demographic groups such as race, ethnicity, income and age. Ultimately, Goodman said she and her co-principal investigator Sarah Lord, an assistant professor of psychiatry and pediatrics at Geisel, aim to gather the data needed to develop more effective treatment programs for specific populations throughout northern New England, the area with the highest per-capita rates of opioid dependence and opioid-related deaths in the country.
In the study’s target region, five to eight percent of infants are born to mothers with opioid use disorder, and rates are rising, according to the project announcement. However, both Goodman and Lord stressed that opioid use disorder is a national problem affecting a broad swath of the population and is not limited to pregnant women in Maine, Vermont and New Hampshire.
Lord said that while she brings a background in clinical psychology and implementation science to the project, Goodman is an expert in obstetrics. As a result, she added, they can examine the issue together from an interdisciplinary perspective.
The project announcement states that “patients and stakeholder partners will be active collaborators in all phases of the study,” including planning and conducting the study and analyzing, interpreting and disseminating the results.
According to Lord, these stakeholders include clinicians, researchers, state policymakers, state Medicaid directors and women who have suffered from opioid use disorder while pregnant.
“It’s a project that’s very focused on community engagement,” Lord said.
Goodman and Lord said they will be working with 21 maternity care practices in New Hampshire, Vermont and Maine. They will follow the women under study, beginning with pregnancy until up to six months after delivery. This extended time frame is important, as many women discontinue treatment after giving birth, the announcement said. The study will track metrics such as patient experience of care, abstinence, maintenance of child custody, infant treatment, quality of life and rates of depression and anxiety.
The grant was approved by the PCORI board in April and is set to conclude in September 2022. Geisel now holds six awards from PCORI, according to the press release.
