Expansion of Clinical Trials Network Research Capacity to Address Overdose Mortality in Pregnant and Post-Partum Women with OUD ABSTRACT/PROJECT SUMMARY From 2010 to 2017, opioid-related maternal deaths increased by 220%. Drug overdose deaths, par�cularly deaths involving synthe�c opioids like fentanyl, reached record highs in 2020 and 2021; drug overdose is now a leading cause of pregnancy-associated mortality in the United States, especially among women of color and those living in rural areas. During pregnancy, u�liza�on of medica�ons for the treatment of opioid use disorder (MOUD) (buprenorphine or methadone) have been associated with improvements in prenatal care adherence and pregnancy outcomes, including lower rates of preterm birth and low birth weight and reduc�ons in maternal relapse and overdose. Prior research has iden�fied health dispari�es in MOUD ini�a�on, consistent u�liza�on, and treatment adherence among underserved pregnant and postpartum people with OUD. However, recent na�onal trends in pregnancy- associated overdose mortality are under-characterized, and there is a need to beter understand key facilitators and barriers to treatment engagement for these under-served women with OUD. This proposal seeks supplemental funds to u�lize the inves�gators and resources of the CTN0080 study to conduct research to address overdose preven�on and learn about persistent barriers to treatment among Hispanic, Black, and Na�ve American pregnant and post-partum (PP) women, as well as PP women living in rural areas of the US. The CTN is currently suppor�ng CTN0080, a large mul�-site clinical trial (13 sites) led by Dr. T. John Winhusen of the CTN Ohio Valley Node that evaluates the compara�ve effec�veness of buprenorphine formula�ons in PP women. This proposal requests supplemental funding to conduct four projects that will target opioid overdose preven�on, as well as learn about barriers and facilitators regarding treatment engagement in PP women, especially PP of color and living in rural areas. Most projects will involve pa�ent and/or community advisors to assist with study procedures and approaches.