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Project SMART

Support Models for Addiction Related Treatment (SMART)Trial of Opioid Use Disorder in Pregnant Women

Promoting evidence-based Perinatal Opioid Use Disorder treatments by examining optimal models to support reproductive health clinicians

Between 1999 and 2014 the point prevalence of an Opioid Use Disorder (OUD) in pregnant women increased from 1.5 to 6.5 per 1000 deliveries (1). Although the prevalence of OUD increased considerably over the past decades, research indicates that providers of outpatient medication assisted treatment (MAT) are less likely to treat pregnant women compared to non-pregnant women (75% vs 91%) (2). The provision of MAT in reproductive health settings may augment the capacity to treat pregnant women with an OUD and increase treatment rates, but the optimal models for care need to be determined.

Project SMART was funded in 2019 by the Patient-Centered Outcomes Research Institute (PCORI) to examine optimal models to support reproductive health clinicians in treating peripartum women with OUD. This is a multi-site cluster randomized clinical trial comparing the effectiveness of two support models 1) a collaborative care (CC) approach based upon the Massachusetts Office-Based-Opioid Treatment (OBOT) Model and 2) a telesupport approach modeled on the Project Extension for Community Healthcare Outcomes (ECHO), a remote education model that provides mentorship and guided practice and participation in a learning community, via video conferencing.


1. Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014. Morbidity and Mortality Weekly Report. 2018;67(31):845-9. doi: 10.15585/mmwr.mm6731a1. PubMed PMID: PMC6089335.

2. Patrick SW, Buntin MB, Martin PR, Scott TA, Dupont W, Richards M, Cooper WO. Barriers to Accessing Treatment for Pregnant Women with Opioid Use Disorder in Appalachian States. Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. 2018:1-18. Epub 2018/06/28. doi: 10.1080/08897077.2018.1488336. PubMed PMID: 29949454.