Harris Miriam T H, Hall Megan, Ellison Sylvia, Holloway JaNae, Bridden Carly, Bagley Sarah M, Bullard Mackenzie, Chassler Deborah, Chatterjee Avik, Dasgupta Anindita, Drainoni Mari-Lynn, Gruss Dawn E, Jadovich Elizabeth, Katz Rachel, Mayotte Christine, Neufeld Jessica L, Oga Emmanuel, Glasgow LaShawn
Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States; Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States; Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States.
RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, United States.
J Subst Use Addict Treat. 2025 Oct;177:209766. doi: 10.1016/j.josat.2025.209766. Epub 2025 Jul 31.
Pregnant and postpartum women (PPW) face substantial barriers to opioid use disorder (OUD) care despite overdose being a leading cause of maternal mortality in the United States. In this study, we leveraged data from the Helping End Addictions Long Term (HEALing) Communities Study (HCS), a community-engaged implementation trial aimed at reducing opioid overdose deaths, to 1) describe evidence-based practice (EBP) strategies designed to reach PPW and 2) review implementation determinants.
We analyzed data from 50 communities across Massachusetts, New York, and Ohio that implemented the Communities That HEAL intervention from January 2020 through December 2023. HCS community coalitions used the HCS Opioid-overdose Reduction Continuum of Care Approach (ORCCA) menu to inform the selection of overdose education naloxone distribution (OEND) and medication for OUD (MOUD) EBP strategies. We used the ORCCA tracker, an HCS tool documenting strategy selection and implementation details, to identify and summarize strategies designed for PPW. We reviewed written community action and implementation plans to analyze and summarize implementation determinants.
The 50 communities included in this analysis selected 29 EBP strategies designed to reach PPW, and 21 (72.4 %) of the selected strategies were implemented, accounting for 3.5 % of all implemented strategies. Most (85.7 %) focused on MOUD, 31.0 % were based in rural communities, and 66.7 %, 23.8 %, and 9.5 % were delivered in healthcare sectors, behavioral health sectors, and criminal legal sectors, respectively. Barriers to implementing OUD strategies intended for PPW included a lack of staff or services with adequate experience, and stigma preventing delivery and engagement. Facilitators included leveraging existing services and community expertise to expand OUD care.
Our findings indicate a need for greater awareness of OUD among PPW and research on implementation approaches for EBPs that effectively reach this group. Leveraging existing community programs that serve PPW with substance use disorders could help expand tailored services.
尽管药物过量是美国孕产妇死亡的主要原因，但孕妇和产后妇女在获得阿片类药物使用障碍（OUD）护理方面面临重大障碍。在本研究中，我们利用了“帮助终结长期成瘾（HEALing）社区研究”（HCS）的数据，这是一项旨在减少阿片类药物过量死亡的社区参与实施试验，以1）描述旨在覆盖孕妇和产后妇女的循证实践（EBP）策略，以及2）审查实施决定因素。
我们分析了马萨诸塞州、纽约州和俄亥俄州50个社区的数据，这些社区在2020年1月至2023年12月期间实施了“治愈社区”干预措施。HCS社区联盟使用HCS阿片类药物过量减少连续护理方法（ORCCA）菜单来指导选择过量教育纳洛酮分发（OEND）和OUD药物治疗（MOUD）的EBP策略。我们使用ORCCA追踪器（一种记录策略选择和实施细节的HCS工具）来识别和总结为孕妇和产后妇女设计的策略。我们审查了书面社区行动和实施计划，以分析和总结实施决定因素。
本分析纳入的50个社区选择了29项旨在覆盖孕妇和产后妇女的EBP策略，其中21项（72.4%）选定策略得到实施，占所有实施策略的3.5%。大多数（85.7%）聚焦于MOUD，31.0%基于农村社区，分别有66.7%、23.8%和9.5%在医疗保健部门、行为健康部门和刑事法律部门实施。针对孕妇和产后妇女实施OUD策略的障碍包括缺乏经验丰富的工作人员或服务，以及阻碍提供服务和参与的污名化现象。促进因素包括利用现有服务和社区专业知识来扩大OUD护理。
我们的研究结果表明，需要提高孕妇和产后妇女对OUD的认识，并开展关于有效覆盖该群体的EBP实施方法的研究。利用现有的为患有物质使用障碍的孕妇和产后妇女服务的社区项目，可能有助于扩大量身定制的服务。
