Status Report on Protecting Our Infants Act Implementation Plan. Recommendations Addressing Research and Evaluation Changes

02/07/2019

Recommendations addressed by the following agencies:

29. Determine the safety and effectiveness of naltrexone and naloxone when combined with buprenorphine use during pregnancy and breastfeeding.(Research & Evaluation, Maternal)

  1. NICHD, NIDA, SAMHSA

30. Research consequences of unrelieved pain on women and their pregnancies.(Research & Evaluation, Maternal)

  1. NICHD

31. Conduct research to support effective and safe non-opioid pharmacotherapy and non-pharmacologic pain relief strategies during pregnancy and breastfeeding.(Research & Evaluation, Child)

  1. NICHD, NIDA

32. Develop easy to implement and valid screening instruments for SUD in pregnancy.(Data & Surveillance, Maternal)

  1. CDC, HRSA, IHS, NIDA, OASH/OWH, SAMHSA

33. Research the modifiable maternal risk and protective factors and most effective interventions to minimize the impact of prenatal substance exposure on the fetus and child.(Research & Evaluation, Maternal)

  1. CDC, NICHD, NIDA, SAMHSA

34. Study prenatal opioid treatment for pain and develop an objective risk-benefit analysis for providers and patients to use in making pain management decisions.(Research & Evaluation, Maternal)

  1. CDC, FDA, IHS, NICHD

35. Research effective non-pharmacologic and non-opioid pharmacotherapies for pain management during pregnancy, labor and delivery, the postpartum care, and breastfeeding for women with chronic pain or OUD.(Research & Evaluation, Maternal)

  1. NICHD, NIDA

36. Establish evidence-based protocols for identifying and managing NAS and NOWS.(Research & Evaluation, Child)

  1. CDC, FDA, IHS, NICHD, NIDA, OASH/OWH, SAMHSA

37. Determine optimal toxicology screening of the opioid-exposed infant to support effective management with or without NAS/NOWS. (Research & Evaluation, Child)

  1. IHS, NICHD, NIDA

38. Assess and determine optimal family and development support services for the child who experienced prenatal substance exposure or NAS/NOWS.(Research & Evaluation, Child)

  1. ACF/Children's Bureau, CMS, HRSA, NICHD, NIDA, SAMHSA

39. Research the long-term developmental effects of prenatal substance exposure so that services can be developed to mitigate any effects. (Research & Evaluation, Child)

  1. CDC, NICHD, NIDA, SAMHSA

Examples of Agency activities to address recommendations:

Recommendation Agency Action Funding Milestones/Status
29. Determine the safety and effectiveness of naltrexone and naloxone when combined with buprenorphine use during pregnancy and breastfeeding. (Research & Evaluation, Maternal) NICHD (move to next NICHD)
  • Serves as a lead on the Opioid Use Disorder in Pregnancy (R01) RFA issued on September 25, 2017, which solicits grant applications on various topics including MAT.
  • Funded
  • Ongoing
  • Along with NIDA, jointly issued NOT-DA-17-067, which covers MAT including naltrexone.
  • Funded
  • Ongoing
  • Supports research to optimize buprenorphine dosing for pregnant women and reduce the risk of maternal relapse and neonatal opioid withdrawal syndrome. While this study does not specifically include naltrexone or naloxone, its dosing information is expected to inform future research on combination therapies.
  • Funding TBD
  • Ongoing
  • Serves as lead on the proposed Prevention and Treatment of Opioid Use Disorders in Women of Reproductive Age initiative using 2019 funds.
  • Funding TBD
  • Proposed new activity 2019
NIDA (move to next NIDA)
  • Funded research related to longitudinal neurobehavioral effects of buprenorphine and naloxone exposure on the developing fetus and newborn.
  • Funded
  • Ongoing
  • Continues funding for this research.
  • Funded
  • TBD
SAMHSA (move to next SAMHSA)
  • Held an expert panel meeting titled 'The Developmental Impacts on Children of Opioid Use During Pregnancy: Pragmatic Approaches to Support Children and Families' to discuss the state of the evidence on the impact of in utero opioid exposure on child development and identify protective/mitigating factors that can reduce or eliminate negative long-term impacts. As an outcome of the meeting, SAMHSA will develop a product that summarizes the literature and strategies from the meeting.
  • Contract funding
  • April 2018
Recommendation Agency Action Funding Milestones/Status
30. Research consequences of unrelieved pain on women and their pregnancies. (Research & Evaluation, Maternal) NICHD (move to next NICHD)
  • Serves as a lead on the Opioid Use Disorder in Pregnancy (R01) RFA issued on September 25, 2017, which solicits grant applications on various topics including the effects of opioid agonist treatment on maternal, fetal, and neonatal outcomes.
  • Funded
  • Ongoing
  • Along with NIDA, jointly issued NOT-DA-17-067, Notice of Interest in Advancing Research about the Effects of Opioids and Opioid Antagonists on the Fetal and Neonatal Brain Development, which studies antepartum and postpartum care and support for women with OUD.
  • Funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
31. Conduct research to support effective and safe non-opioid pharmacotherapy and non-pharmacologic pain relief strategies during pregnancy and breastfeeding. (Research & Evaluation, Child) NICHD (move to next NICHD)
NIDA (move to next NIDA)
  • Leads the proposal of an initiative "Prevention and Treatment of Opioid Use Disorders in Women of Reproductive Age" initiative using FY 2019 funds which would address research on non-pharmacologic/non-opioid therapies during pregnancy.
  • Funding TBD
  • If funded, initiative will be implemented 2019-2023; RFA funding starts 2018 and ends 2022
  • Opioid Use Disorder in Pregnancy (RFA-HD-18-036) co-funded by NIDA. Topics for applications:
    • Clinical studies of maternal medically-supervised opioid withdrawal examining maternal, fetal, and neonatal outcomes
    • Observational or cohort studies evaluating the effects of opioid agonist treatment on maternal, fetal, and neonatal outcomes. This may include evaluation of fetal status and placental function.
    • Pharmacokinetic and pharmacodynamic studies of medications used to treat opioid use disorder in pregnant and/or post-partum women
    • Pharmacogenomic and other studies of genetic or epigenetic factors associated with the effects of opioid use during pregnancy on fetal and neonatal outcomes
  • Funding starts July 2018
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
32. Develop easy to implement and valid screening instruments for SUD in pregnancy. (Data & Surveillance, Maternal) CDC (move to next CDC)
  • Provided grant funds for a research project to compare and validate screening tools for substance use among women.
  • Grant funded
  • FY18
HRSA (move to next HRSA)
  • Through the AIM initiative, dozens of partners and experts developed a maternal safety bundle (best practices) for hospitals, on the obstetric management of women with opioid dependence. Now 14 state-based teams and hospital systems are engaged in launching these best practices in hospitals and improving access to care for women and babies.
  • Funded
  • 8/2018
IHS (move to next IHS)
  • IHS involvement with AAP, CONACH, and ACOG review of guidelines for managing addiction and pain in pregnant women.
  • Funded
  • To be implemented in 10-12 months
  • Revisions to IHS Electronic Medical Record to capture 4Ps, DAST scores and CRAFFT scores.
  • Funding TBD
  • 12 months
  • CRS GPRA measure in discussion.
  • Funding TBD
  • TBD
  • Development of training plan.
  • Funding TBD
  • TBD
NIDA (move to next NIDA)
  • Funded research in providing treatment entry and family planning in substance-using NICU mothers.
  • Funded
  • Ongoing
  • Evaluates current data of risk and protecting factors.
  • Funded
  • Ongoing
OASH (move to next OASH)
OWH (move to next OWH)
  • A potential element of the OASH/OWH and HRSA Office of Women's Health initiative to produce a care coordination model for women impacted by opioids who receive healthcare services via HRSA-administered programs.
  • Funded via IAA in FY18, FY19 funding TBD
  • FY18-FY20
SAMHSA (move to next SAMHSA)
  • Advertise the SAMHSA "Substance Exposed Infants: State Responses to the Problem" document that includes a discussion of screening.
  • Funded
  • Completed February 2018
Recommendation Agency Action Funding Milestones/Status
33. Research the modifiable maternal risk and protective factors and most effective interventions to minimize the impact of prenatal substance exposure on the fetus and child. (Research & Evaluation, Maternal) CDC (move to next CDC)
  • Provided funds for a PRAMS supplement that will allow selected states to collect data on maternal substance use. PRAMS data provides information on additional maternal behaviors and experiences before, during and after pregnancy.
  • Funded
  • PRAMS supplement to be completed 2018
  • Provided funds in collaboration with the March of Dimes to conduct pilot projects on NAS to better understand the incidence, severity, and long-term developmental and educational outcomes associated with NAS.
  • Funded co-agreement
  • NAS pilot projects to be completed June 2018
  • Leading the Treating for Two initiative to improve the availability and quality of data to help inform clinical management decisions for pregnant women and their healthcare providers.
  • Unfunded
  • Ongoing
  • Proposes leveraging the public health surveillance infrastructure of the US Zika Pregnancy and Infant Registry and existing birth defects surveillance systems to monitor maternal, neonatal, and pediatric outcomes of infants following sustained prenatal exposure to opioids. A population with sustained prenatal opioid use that could be monitored is pregnant women on MAT (e.g. buprenorphine and methadone). Surveillance will increase understanding of co-factors that impact maternal and infant outcomes (e.g., nutrition status, other substance use, timing of treatment initiation in pregnancy) and also increase understanding of the longer-term outcomes of infants who experienced sustained prenatal exposure to opioids, including adverse outcomes among infants who both did and did not have NAS at birth.
  • TBD
  • Proposed, contingent on funding
  • Has been monitoring alcohol use among women of reproductive age and related risk factors since the 1990s using the BRFSS and also have analyzed data from the National Survey of Family Growth which has questions on family planning, contraception, and related issues including alcohol use.
  • Funded
  • Ongoing
NICHD (move to next NICHD)
  • Serves as a lead on the Opioid Use Disorder in Pregnancy (R01) RFA issued on September 25, 2017, which solicits grant applications on various topics including observational or cohort studies evaluating the effects of opioid agonist treatment on child outcomes including maternal risk and protective factors and evaluation of fetal status and placental function.
  • Funded
  • Ongoing
  • Jointly with NIDA, issued NOT-DA-17-067, Notice of Interest in Advancing Research about the Effects of Opioids and Opioid Antagonists on the Fetal and Neonatal Brain Development, in which studies on this topic are requested.
  • Funded
  • Ongoing
  • NICHD is also funding other research on neonatal opioid withdrawal syndrome. For example:
    • NICHD is supporting the "Prevention of Neonatal Abstinence Syndrome" study, a clinical trial of administering ondansetron treatment (a broadly utilized drug with good safety record) to pregnant, opioid-using women just prior to delivery, followed by 3-day period of administration to neonate.
    • Another study "A preventive pharmacotherapy for neonatal abstinence syndrome", is investigating a specific drug target to assess the feasibility of developing a new therapy to prevent opioid dependence in utero without interfering with management of maternal pain.
  • Funded
  • Ongoing
  • In addition, NICHD is supporting research designed to optimize buprenorphine dosing for pregnant women, to reduce the risk of maternal relapse and neonatal opioid withdrawal syndrome.
  • Funded
  • Ongoing
NIDA (move to next NIDA)
  • Funded research for treatment for mothers to minimize the effects of prenatal exposure on their infants.
  • Funded
  • Ongoing
  • Continuation of funding for this research to improve treatment strategies which are most effective and safe for both mother and infant.
  • Funded
  • Ongoing
SAMHSA (move to next SAMHSA)
  • Held an expert panel meeting titled 'The Developmental Impacts on Children of Opioid Use During Pregnancy: Pragmatic Approaches to Support Children and Families' to discuss the state of the evidence on the impact of in utero opioid exposure on child development and identify protective/mitigating factors that can reduce or eliminate negative long-term impacts. As an outcome of the meeting, SAMHSA will develop a product that summarizes the literature and strategies from the meeting.
  • Contract funding
  • April 2018
Recommendation Agency Action Funding Milestones/Status
34. Study prenatal opioid treatment for pain and develop an objective risk-benefit analysis for providers and patients to use in making pain management decisions. (Research & Evaluation, Maternal) CDC (move to next CDC)
  • Leading the Treating for Two initiative to identify the safest treatment options for the management of common conditions before and during pregnancy and to improve the availability and quality of data to help inform clinical management decisions for pregnant and reproductive aged women and their healthcare providers. Treating for Two also conducts ongoing research and surveillance of medications commonly used to manage health conditions during pregnancy and associated adverse outcomes including structural birth defects.
  • Unfunded
  • Ongoing
FDA (move to next FDA)
  • Led by the Division of Epidemiology, funded study of first-trimester exposure to opioids and neural tube defects.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Develops best practices guidelines based on evidence-based practice and guidelines and conducts continued review of literature and guidelines and adapting accordingly.
  • Funded
  • Ongoing
NICHD (move to next NICHD)
  • Leading the proposal of an initiative "Prevention and Treatment of Opioid Use Disorders in Women of Reproductive Age" initiative using FY 2019 funds.
  • Funding TBD
  • TBD
  • Obstetric-Fetal Pharmacology Research Unit Network: PK/PD studies on buprenorphine (U54) to determine better way to dose based on objective and physiological parameters of satiety
  • Funded
  • 6/1/2017-9/30/2019
Recommendation Agency Action Funding Milestones/Status
35. Research effective non-pharmacologic and non-opioid pharmacotherapies for pain management during pregnancy, labor and delivery, the postpartum care, and breastfeeding for women with chronic pain or OUD. (Research & Evaluation, Maternal) NICHD (move to next NICHD)
  • Leading the proposal of an initiative "Prevention and Treatment of Opioid Use Disorders in Women of Reproductive Age" initiative using FY 2019 funds which would address research on non-pharmacologic/non-opioid therapies during pregnancy.
  • Funded
  • Ongoing
NIDA (move to next NIDA)
  • Funded research in novel approaches to reduce pain, prescription opioid use and misuse in pregnancy.
  • Funded
  • Ongoing
  • Planning to grow and develop research in this area.
  • Funding TBD
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
36. Establish evidence-based protocols for identifying and managing NAS and NOWS. (Research & Evaluation, Child) CDC (move to next CDC)
  • Funding 13 state Perinatal Quality Collaboratives of which nine are focused on improving care of women with opioid use disorder and infants with NAS including hospital practices related to management of NAS.
  • Funded
  • Ongoing through 2023
  • Planning to collect information on hospital practices related to NAS infants with the mPINC survey.
  • Funded
  • Ongoing
  • Proposes to leverage the public health surveillance infrastructure of the US Zika Pregnancy and Infant Registry and existing birth defects surveillance systems to monitor maternal, neonatal, and pediatric outcomes of infants following sustained prenatal exposure to opioids. Using this two-pronged approach to surveillance, CDC aims to understand the full scope of the opioid epidemic's impact on pregnant women and babies, in order to better address this growing public health concern and improve long-term health of mothers and babies.
  • Funding TBD
  • Proposed, contingent on funding
  • CDC is working with funded PQCs and CSTE to recommend a standardized surveillance definition for NAS.
  • Unfunded
  • Ongoing
FDA
  • Working with sponsors to develop treatments for managing NAS and NOWS
  • Funding TBD
  • Ongoing
IHS (move to next IHS)
  • Standardizing terminology and conceptualization to NOWS from the previously universal terminology of NAS.
  • Funded
  • Ongoing
  • Development of NOWS guideline to include documentation recommendations and uniformed approach to infant assessments.
  • Funded
  • 12 months
  • Distribution and training on the finalized IHS Agency approved guidelines.
  • Funded
  • 12 months
NICHD (move to next NICHD)
  • Neonatal Research Network site is funded to conduct two-year neurodevelopmental follow-up on infants with prenatal substance exposure.
  • Funded
  • Ongoing
NICHD (move to next NICHD)
NIDA move to next NIDA)
ECHO (move to next ECHO)
  • NICHD/NIDA/ECHO have formed a partnership to conduct the "ACT NOW: Advancing Clinical Trials in NOWs" Initiative. The objective of this study is to merge the expertise of NICHD's NRN, which has over 30 years of experience in conducting clinical trials with newborns, and the ISPCTN within the ECHO Program Office to design and conduct a new study called the ACT NOWS to evaluate treatment options and improve clinical care of infants with NAS/NOWS. The goals of ACT-NOW are the following:
    • Develop a survey to obtain information on the sites, local practices, demographics, and volume of patients affected with NOWs.
    • Develop and conduct a retrospective study to obtain data to inform development of a clinical trial.
    • Develop a common protocol(s) to generate evidence to inform best practice for identifying and managing NOWs.
  • Funded
  • Ongoing
NIDA (move to next NIDA)
NICHD (move to next NICHD)
  • NIDA and NICHD recently published a Notice of Interest for studies of methods for screening, identifying and assessing NOWs.
  • Funding TBD
  • Ongoing
OASH
OWH
  • In March 2017, initiated a 1-year partnership with IHS to support work to address the problem of opioid misuse among women of reproductive age in the AI/AN communities, including PPW. Specifically, the IAA supports national training, education, and guidance through development of written recommendations on the screening, diagnosis, and management of opioid dependence among AI/AN women of reproductive age and AI/AN newborns. These documents are being developed with ACOG and the AAP.
  • Funded via IAA and contract in FY17
  • Written recommendations will be released later in 2018 and will then be disseminated throughout the IHS system.
SAMHSA (move to next SAMHSA)
  • Product titled 'Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants' developed and issued to the public.
  • Contract funding
  • February 2018
  • Ancillary factsheets for patients and family members providing information about NAS/NOWS and treatment options are in the clearance process.
  • Contract funding
  • May 2018
Recommendation Agency Action Funding Milestones/Status
37. Determine optimal toxicology screening of the opioid-exposed infant to support effective management with or without NAS/NOWS. (Research & Evaluation, Child) IHS
  • Infant screening recommendations included in AAP/CONACH Guideline.
  • Funded
  • To be implemented in 10-12 months
  • UDS interpretation support may be needed.
  • Funding TBD
  • TBD
NICHD (move to next NICHD)
NIDA move to next NIDA)
ECHO (move to next ECHO)
  • The NICHD/NIDA/ECHO partnership to conduct the "ACT NOW: Advancing Clinical Trials in NOWs" initiative will cover screening of the opioid -- exposed infant.
  • Funded
  • Ongoing
NIDA (move to next NIDA)
NICHD (move to next NICHD)
  • In collaboration with NICHD jointly issued NOT-DA-17-067, "Notice of Interest in Advancing Research about the Effects of Opioids and Opioid Antagonists on the Fetal and Neonatal Brain Development" to study the development of a biomarker that reflects physiologic state, lab on a chip for rapid screening, development of predictive assays for which babies will develop neonatal opioid withdrawal syndrome, require treatment and treatment response.
  • Funded
  • Ongoing
  • Planning to grow and develop research in this area
  • Funding TBD
  • TBD
Recommendation Agency Action Funding Milestones/Status
38. Assess and determine optimal family and development support services for the child who experienced prenatal substance exposure or NAS/NOWS. (Research & Evaluation, Child) ACF
Children's Bureau
  • Funded
  • Ongoing
CMS
  • The EPSDT benefit requires states to assess and determine and to have available all medically necessary services for children under age 21 that are covered under the benefits at section 1905(a) of the Social Security Act. One of the covered benefits is case management under 1905(a)(19) of the Act. Under case management, a child would be assessed to determine the necessary services and would be able to receive those services to assist them in gaining access to needed medical, social, educational and other services.
  • Funded
  • Ongoing
  • Funded
  • Completed 2016
  • Provide TA to states as requested in implementing this requirement.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to evaluate potential optimal family and development support services for the child who experienced prenatal substance exposure or NAS/NOWS.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
  • Potential efforts include identification of children's behavioral health and SUD issues, with the goal of connecting affected children to the appropriate community support services.
  • Ongoing
HRSA
  • Funds an evaluation project called, Evidence-Informed Practices in Home Visiting: Prevention, Identification, and Treatment of Substance Abuse in Families. The goal is to develop a conceptual model for how MIECHV grantees can engage and support families at risk for, recovering from, or currently misusing substances, including opioids. If funded, a second phase will develop study design options to build out the model.
  • Funded
  • Ongoing
NICHD (move to next NICHD)
NIDA move to next NIDA)
ECHO (move to next ECHO)
  • Research on this topic is being covered by the NICHD/NIDA/ECHO partnership to conduct the "ACT NOW: Advancing Clinical Trials in NOWs" initiative and NOT-DA-17-067, "Notice of Interest in Advancing Research about the Effects of Opioids and Opioid Antagonists on the Fetal and Neonatal Brain Development".
  • Funded
  • Ongoing
  • NICHD and the ECHO program are leading the proposal of an initiative "ACT NOW: The Second Act" in which research on a cohort of infants exposed in-utero to opioids will study this particular topic.
  • Funding TBD
  • Under development
NIDA (move to next NIDA)
NICHD (move to next NICHD)
  • Recently published a Notice of Interest for studies of postpartum care and support for women with OUD to optimize maternal and neonatal outcomes. Studies of safe and effective outpatient management strategies for neonatal opioid withdrawal syndrome including optimal follow-up are also of high priority.
  • Funding TBD
  • Ongoing
  • Continue to encourage the submission of grant applications addressing this research.
  • Ongoing
  • Ongoing
SAMHSA (move to next SAMHSA)
  • Held an expert panel meeting titled 'The Developmental Impacts on Children of Opioid Use During Pregnancy: Pragmatic Approaches to Support Children and Families' to discuss the state of the evidence on the impact of in utero opioid exposure on child development and identify protective/mitigating factors that can reduce or eliminate negative long-term impacts. As an outcome of the meeting, SAMHSA will develop a product that summarizes the literature and strategies from the meeting.
  • Contract funding
  • April 2018
  • Project LAUNCH help address coordination of services and in some cases, fund the provision of family interventions. Grantees also help facilitate referrals into early intervention and social emotional/mental health supports for children ages 0-8. Example: working with local child-serving systems to make sure that children at risk for developmental concerns are referred to EI or other supports early on and appropriately.
  • Grant funded
  • Ongoing; first cohort awarded in FY08; new cohort targeting AIAN communities will be awarded in FY18, date TBD
Recommendation Agency Action Funding Milestones/Status
39. Research the long-term developmental effects of prenatal substance exposure so that services can be developed to mitigate any effects. (Research & Evaluation, Child) CDC
  • Provided funds in collaboration with the March of Dimes to conduct a small pilot project in Tennessee to link a cohort of infants identified with NAS through Medicaid claims data to Department of Education data in order to better understand the long-term neurodevelopmental outcomes potentially associated with NAS.
  • Funded co-agreement
  • Completed June 2018
  • Monitor neonatal and pediatric outcomes of children with documented prenatal opioid exposure to increase understanding of co-factors that impact longer-term developmental outcomes of infants with prenatal exposure that may not have been diagnosed with NAS at birth.
  • Funding TBD
  • Proposed, contingent on funding
NICHD (move to next NICHD)
NIDA move to next NIDA)
ECHO
  • This topic is being covered by the NICHD/NIDA/ECHO partnership to conduct the "ACT NOW: Advancing Clinical Trials in NOWs" initiative. NOT-DA-17-067, "Notice of Interest in Advancing Research about the Effects of Opioids and Opioid Antagonists on the Fetal and Neonatal Brain Development" which was jointly issued by NIDA and NICHD requests studies on this topic to be submitted.
  • Funded
  • Ongoing
  • NICHD and the ECHO program are leading the proposal of an initiative "ACT NOW (Advancing Clinical Trials for Neonatal Opioid Withdrawal): The Second Act" in which research on a cohort of infants exposed in-utero to opioids will study the long-term developmental effects of prenatal opioid exposure.
  • Funding TBD
  • Under development
NIDA
NICHD
  • Encouraging research applications that examine the effect of severity of NOWS on brain, cognition, and behavior in neonates, adolescents, and adults.
  • Funding TBD
  • Ongoing
  • Planning to continue research.
  • Funding TBD
  • Ongoing
SAMHSA
  • Held an expert panel meeting titled 'The Developmental Impacts on Children of Opioid Use During Pregnancy: Pragmatic Approaches to Support Children and Families' to discuss the state of the evidence on the impact of in utero opioid exposure on child development and identify protective/mitigating factors that can reduce or eliminate negative long-term impacts. As an outcome of the meeting, SAMHSA will develop a product that summarizes the literature and strategies from the meeting.
  • Contract funding
  • April 2018