Examining the Association Between Buprenorphine Dose Trajectories and Opioid Use Disorder-Related Outcomes Among Pregnant and Postpartum Women - The goal of the proposed fellowship is to prepare the applicant, Valerie Ganetsky, for an independent research career focused on improving access to medication for opioid use disorder (MOUD) treatment for individuals with opioid use disorder (OUD), particularly for pregnant and parenting women. This fellowship will help Valerie prepare for a career as an independent investigator by providing opportunities for individualized training aimed at achieving four key goals: (1) to attain proficiency in analyzing large administrative claims datasets to investigate OUD health services, (2) to apply advanced quantitative statistical methods to examine critical issues within OUD health services, (3) to lead qualitative research to explore the perceptions of relevant stakeholders within the OUD treatment paradigm, and (4) to integrate her prior clinical expertise with advanced research training to disseminate scientific findings and inform evidence-based policy and practice interventions. To achieve these goals, Valerie will engage in activities such as mentored research, didactic and informal training through coursework and seminars, experiential learning through participation in national organizations and action groups, and dissemination of research findings through manuscript development, grant writing, and presenting at academic conferences. Throughout the training period, Valerie will benefit from a wealth of resources at the Johns Hopkins Bloomberg School of Public Health and a strong mentorship team with complementary expertise in substance use health services research, the use of administrative claims datasets, advanced causal inference methods, qualitative methods, and perinatal substance use policy issues. The mentored research will employ a multi-method approach to examine the association between buprenorphine dose trajectories and OUD-related outcomes among pregnant and postpartum women, particularly during an era when high-potency synthetic opioids dominate the illicit drug supply. This research aims to fill several gaps in the literature. First, the role of buprenorphine dosing as a potential strategy for improving OUD outcomes in pregnant and postpartum women has been notably understudied, highlighting the timeliness and significance of this research. Second, this proposal represents the first use of group-based trajectory modeling (GBTM) to examine buprenorphine dose changes during pregnancy and their impact on postpartum OUD-related outcomes. GBTMs will allow the applicant to identify distinct buprenorphine dose trajectories, identify subgroups more likely to follow certain trajectories, and examine how different trajectories influence outcomes. Third, this research will incorporate qualitative methods to explore previously unexamined attitudes, beliefs, and prescribing practices among buprenorphine treatment providers in Maryland. The proposed research is well-aligned with NIDA’s Strategic Plan Goal 4.2 to support research on developing and testing strategies for overcoming barriers to access and continuity of care.
