Project Summary/Abstract The broad goal of this renewal R15 Academic Research Enhancement Award (AREA) study is to gain a more in-depth understanding of the lived experiences of suburban women who misuse prescription opioids or use illegal opioids while they are pregnant or caring for children 12 years old and younger. The number of opioid- using mothers and pregnant (OMP) women is increasing, along with increased rates of neonatal abstinence syndrome (NAS). Policies addressing this crisis are shifting as women are under more scrutiny by government agencies concerned for the welfare of their children. The specific aims of this study are: (1) To assess availability and access to the health and social service resources needed by OMP women, and (2) To determine the impact of suburban governing agencies on OMP women and their families. This research is conducted in two of the three initial R15 Suburban Opioid Study (SOS) field sites: suburban New Haven, Connecticut and suburban Boston, Massachusetts. The OMP women in the suburban study reported gendered stigmatization that intensified their desire to keep their drug use hidden. Suburban OMP women were further impacted by insufficient services, and they faced barriers to accessing local services, lacking transportation and other resources needed to meet the requirements imposed by governing agencies. This longitudinal study uses mixed methods, including ethnographic research, survey data collection, and three in-depth qualitative interviews with 40 OMP women collected over one year. The first interview will include an in-depth life history with questions on types of treatment accessed, regulations imposed by social or legal services, and experiences at the individual, interpersonal, community, and societal level. The follow-up interviews will update health, drug, and life history data, and experiences with services since the previous interview. Survey data are collected between interviews using a secured Qualtrics APP on a smart phone. Syndemics theory and relational ethnography provide a guiding framework for the data collection and analysis. Syndemics theory focuses research investigation on pathways of disease within socio-environmental conditions and structural domains. Relational ethnography guides research on the relations between OMP women, their families, and the agencies governing them. Findings from this renewal study will give us a greater understanding of the social and environmental context of suburban mothers who use opioids that will inform gender-specific programs and targeted treatment. Our findings will yield recommendations for interventions for pregnant women and mothers at the individual, familial, and community levels that address the health disparities, social inequalities, and gender discrimination exacerbated by the opioid crisis.