Using Big Data to Optimize Treatment of Opioid Use Disorder in Pregnancy - PROJECT SUMMARY
I am an early career investigator in the fields of pharmacoepidemiology, health equity, and addiction
psychiatry. My overarching career goal is to become an independently funded researcher dedicated to
investigating the real-world effectiveness of addiction medications with a focus on treatment gaps in
populations underrepresented in RCTs, such as pregnant people. In this K08 award, I am interested in
studying disparities in the prescription of medications to treat opioid use disorder (OUD), specifically
buprenorphine and methadone, and assessing how the segregated landscape of buprenorphine and
methadone availability may be associated with their effectiveness against overdose. The K08 award will
support my early career training in the use of health equity theoretical models, target trial emulation, and
causal inference methods; address my mentorship and career development needs; and enable me to obtain
the data required for my continued transition toward independence. In the proposed K08 research study, I will
address the ongoing yet preventable epidemic of OUD-related overdose during pregnancy, particularly in
segregated Black communities that suffer the highest rates of perinatal overdose death. The specific aims of
the study are (1) to evaluate associations of race and Black–White segregation indexes with buprenorphine
and methadone use and opioid-related overdose during pregnancy; (2) to elucidate differences in
buprenorphine’s and methadone’s effectiveness against overdose by racial subgroup during pregnancy while
adjusting for segregation; and (3) to examine structural racism as a mechanism of the associations between
race and overdose during pregnancy. I will use a target trial emulation-based approach to achieve these aims,
enriching existing Medicaid claims data with data on area-based characteristics to assess how segregation and
structural racism might mediate racial disparities in OUD treatment. The training and research experience I
gain during the proposed K08 award period will be instrumental to my career trajectory, and the data generated
in the proposed K08 study will be foundational to my planned applications for independent R01 funding, along
with supporting NIDA’s goal of developing new and improved strategies to prevent drug use and its
consequences.
