Evidence for Supportive Prenatal Substance Use Policies

Pregnant Woman in White Top and Blue Denim Jeans

Photo by Pavel Danilyuk.

Increased prevalence of illicit substance use during pregnancy in the past decade has renewed national attention to prenatal substance use policies (PSUPs).

Currently, there are punitive policies that criminalize drug use during pregnancy or define prenatal substance use as child maltreatment in child welfare statutes. If newborns are found to have prenatal exposure to substances or are born with neonatal abstinence syndrome, these states may charge the pregnant person with substance use disorder with child abuse or terminate their parental rights.

In contrast, states that adopt supportive policies provide pregnant women with priority access to substance use disorder treatment programs, as well as create or fund targeted substance use disorder treatment programs for pregnant women. Supportive treatments are recommended by American College of Obstetricians and Gynecologists to build trust and connections with the health care systems.

Some prenatal substance use policies date back to the 1980s, when states adopted measures that were intended to reduce adverse maternal and newborn health outcomes during the crack cocaine epidemic. Despite the limited body of research assessing the effectiveness of these policies, PSUPs have grown more punitive over time.

New publications authored by CHERISH Research Affiliates Angélica Meinhofer, Johanna Catherine Maclean, Ali Jalali, and Shashi Kapadia, and CHERISH investigators Yuhua Bao and Jake Morgan evaluate the effectiveness of PSUPs on newborn health and analyze the impact of PSUPs on maternal outcomes among populations with opioid use disorder. The findings from these studies provide evidence that punitive PSUPs are potentially harmful and supportive PSUPs can have positive effects.

Prenatal Substance Use Policies and Infant Maltreatment Reports

takeaway of study

Authors Johanna Catherine Maclean, Allison Witman, Christine Piette Durrance, Danielle N. Atkins, and Angélica Meinhofer led a study to examine the effects of punitive and priority treatment prenatal substance use policies on infant maltreatment reports. The authors used differences-in-differences and quasi-experimental methods to analyze maltreatment reports from the National Child Abuse and Neglect Data System (NCANDS). Published in Health Affairs, the authors arrived at three key findings:

  • Punitive prenatal substance use policies increased total infant maltreatment reports by 19% and substantiated infant maltreatment reports by 33.3% during the study period.
  • Punitive prenatal substance use policies increased infant maltreatment reports in which the mother was the perpetrator across nearly all racial and ethnic groups.
  • There is no evidence that priority treatment prenatal substance use policies affected infant maltreatment reports.

The study offers several policy implications with renewed emphasis on strengthening families, improving the well-being of both mothers and infants, and accentuating supportive evidence-based services to address prenatal substance use.

Johanna Catherine Maclean, PhD, is an associate professor at Temple University.

Angélica Meinhofer, PhD, is an assistant professor of population health sciences at Weill Cornell Medicine.

Yuhua Bao, PhD, is an associate professor of population health sciences at Weill Cornell Medicine.

Prenatal Substance Use Policies and Newborn Health

Published in Health Economics, Angélica Meinhofer, Johanna Catherine Maclean, Allison Witman, and Yuhua Bao suggest supportive approaches may be more effective for improving perinatal health. Their study found that:

  • Neonatal drug withdrawal syndrome increased by 10% to 18% following the implementation of a punitive policy that criminalizes prenatal substance use, or defines prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for termination of parental rights.
  • Priority treatment policies, measures that grant pregnant women priority access to substance use disorder treatment programs, are associated with small reductions in low gestational age (2%) and low birth weight (2%), along with increases in prenatal care use.

This study strengthens previous qualitative studies and leading medical organizations’ stances to oppose punitive PSUPs. Further research is needed to understand the impact of PSUPs using different outcomes and subpopulations and provide evidence-based approaches for improving pregnancy outcomes for perinatal populations affected by substance use disorder.

Impact of Prenatal Substance Use Policies on Commercially Insured Pregnant Females with Opioid Use Disorder

Published in the Journal of Substance Abuse Treatment, Nadia Tabatabaeepour, Jake Morgan, Ali Jalali, Shashi Kapadia, and Angélica Meinhofer found that supportive approaches may improve health outcomes among commercially insured pregnant females with opioid use disorder while punitive prenatal substance use policies may worsen health outcomes.

The authors used commercial claims data to study maternal outcomes including medications for opioid use disorder (MOUD) treatment; psychosocial services for substance use disorder (SUD) treatment; opioid prescriptions; and opioid overdoses among commercially insured pregnant females with opioid use disorder. Their study had three key findings:

  • The proportion of any MOUD increased 11% and the proportion of opioid overdoses decreased 45% following the adoption of PSUPs creating or funding targeted SUD treatment programs.
  • SUD treatment priority PSUPs were not associated with statistically significant changes in maternal outcomes or increased dispensing of OUD medications.
  • Punitive PSUPs were associated with statistically significant reductions in the proportion of pregnant females receiving psychosocial services for SUD and methadone.

Additionally, psychotherapy (12%) and methadone (30%) services decreased following punitive PSUP implementation. Opioid overdoses also increased by 45% in states with criminalizing policies only. Altogether, the study lends new evidence to fund supportive PSUPs that improve access to treatment and medications for opioid use disorder.

Photo of Jake Morgan

Jake Morgan, PhD, is a research assistant professor in the Department of Health Law, Policy, and Management at the Boston University School of Public Health.

Ali Jalali

Ali Jalali, PhD, MA, is an assistant professor of population health sciences at Weill Cornell Medicine.

Shashi Kapadia, MD, MS, is an infectious diseases physician and health services researcher at Weill Cornell Medicine.

The studies were supported by funding from the Robert Wood Johnson Foundation, Gerber Foundation, and National Institute on Drug Abuse. The study, “Prenatal Substance Use Policies and Newborn Health,” was published in Health Economics on April 20, 2022; “Prenatal Substance Use Policies and Infant Maltreatment Reports,” was published in Health Affairs in May 2022; and, “Impact of prenatal substance use policies on commercially insured pregnant females with opioid use disorder,” was published in the Journal of Substance Abuse Treatment on May 10, 2022.

CHERISH Returns to Conferences in Person

close up of hands writing on a notebook

Photo by Ono Kosuki.

This June, CHERISH colleagues, Research Affiliates, pilot grant recipients, and Advisory Board members are returning to conferences in person to present innovative work and learn alongside leading experts in the field of health services, health economics, and substance use research.

Use the following schedule, featuring nearly 200 entries, to connect with colleagues and friends of CHERISH and explore the breadth of their work.

AcademyHealth Annual Research Meeting (ARM)

June 4 – 7, 2022, Washington, DC
The AcademyHealth #ARM22 program below is in Eastern Time (ET).
*An asterisk indicates presenter.

The College on Problems of Drug Dependence (CPDD) 84th Annual Scientific Meeting

June 11 – 15, 2022, Minneapolis, MN
The #CPDD22 program below is in Central Time (CT).
*An asterisk indicates presenter.

Logo of Society for Epidemiologic Research

Society for Epidemiological Research Meeting (SER)

June 14 – 17, 2022, Chicago, IL
The #SER2022 program below is in Central Time (CT)

logo of ASHEcon

American Society of Health Economists (ASHEcon)

June 26 – 29, 2022, Austin, TX
The #ASHEcon22 program below is in Eastern Time (ET).

CHERISH Appoints Margaret Lowenstein as the Dissemination and Policy Core Co-director

Profile image of Margaret Lowenstein

Margaret Lowenstein, MD, MSHP, is a former pilot grant recipient and CHERISH Research Affiliate. Follow her on Twitter @m_lowenstein.

The Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) is proud to welcome Margaret Lowenstein, assistant professor at the Perelman School of Medicine and senior fellow at the Leonard Davis Institute of Health Economics (LDI) at the University of Pennsylvania, as the new co-director of the Dissemination and Policy Core. Lowenstein succeeds Janet Weiner who retired earlier this year.

“I appreciate the opportunity to amplify the important research at CHERISH and work alongside colleagues with diverse and complementary expertise in substance use disorder research. I’m going to miss Dr. Weiner because her work is incredible. The latest CHERISH and Penn LDI brief distilling complicated research and policy questions is a great example of Janet’s contributions,” Lowenstein said.

Lowenstein’s interest in substance use disorder care took off during her Internal Medicine residency training at the University of California, San Francisco. “I really loved caring for patients with substance use disorders. Working as a primary care doctor, I’m excited that people get their blood pressure or their diabetes under control. That’s important, but when you get somebody’s substance use disorder under control, their life is immediately changed. I find the clinical work incredibly gratifying.”

Drawing from her experience as a general internist and addiction care physician, Lowenstein’s research focuses on expanding evidence-based treatment and harm reduction strategies for patients with substance use disorders, and particularly on leveraging ‘reachable moments’ to engage patients in care.

“I’m excited about low threshold treatment strategies in non-traditional settings,” she says. “It goes back to how I got interested in this work. Many patients who are struggling with substance use never made it to my primary care clinic. But there are reachable moments in the emergency department or community settings like libraries where patients may go to address immediate needs or access resources. These are important opportunities to meet patients where they are and offer treatment and harm reduction.”

Her latest work with colleagues at the University of Pennsylvania appeared in JAMA Open Network and highlights an opportunity to support emergency department-based naloxone distribution efforts. Lowenstein also received a 2022 Junior Faculty Scientific Presentation Award from the Society of General Internal Medicine for her paper, “Exploring Patient Perspectives on Low-Threshold Treatment for Opioid Use Disorder.”

Working alongside Dissemination and Policy Core Director Zachary Meisel, Lowenstein will continue to increase the visibility and impact of health economics research on substance use treatment policy. Outside research, Lowenstein enjoys indulging in Philadelphia’s diverse cuisines and embracing the growth of her two-year-old daughter.

Providing Naloxone in the Emergency Department Can Save Lives

This article originally appeared and was produced in conjunction with the University of Pennsylvania Leonard Davis Institute.

an emergency sign in red text is centered

New study suggests that text messaging can be used to interact with individuals at high risk for opioid use and overdose, and this automated system offers an opportunity to augment and support ED-based naloxone distribution efforts.

thumbnail of margaret lowenstein

Senior author and former CHERISH pilot grant recipient Margaret (Maggie) Lowenstein, MD, MPhil, is the CHERISH Dissemination and Policy Core co-director.

Overdose deaths continue to be a national tragedy. More than 800,000 Americans died from an overdose between 1999-2019, and the annual rate of overdoses has increased dramatically during the pandemic, according to the latest data from the Centers for Disease Control and Prevention.

Roughly 7 in 10 current overdose deaths involve opioids, which means that many of them could be prevented with naloxone. Naloxone, also known by its brand name Narcan, acts to reverse opioid overdoses and save lives when used in time. It is easy to carry and use, and studies have demonstrated that laypeople can administer it safely and effectively to reverse overdoses.

But many of the people who are most likely to witness an overdose, including individuals who use opioids and their friends and family members, may not have easy access to naloxone. Strategies are needed to increase uptake, carrying, and administration of naloxone, especially among at-risk individuals in the community who may not be engaged in routine health care or with community naloxone distribution efforts.

However, many at-risk individuals find themselves in the emergency departments (ED), either because of an overdose or other complication of substance use. For this reason, we recently examined the potential for ED visits as a critical, reachable moment to engage high-risk individuals in overdose prevention. As we reported recently in JAMA Network Open, we reached out to at-risk patients prescribed naloxone in the ED to understand whether they had obtained their naloxone during or after their ED visit, whether they were carrying it, and their plans to carry it in the future.

To collect data, we sent the patients a text messaging-based survey following their ED encounter. Of the 205 patients sent the survey, 41 (20%) completed it, a promising response rate for a historically difficult-to-reach population. The novel survey approach created a space for patients to provide input and feedback, a component important for future interventions to motivate behavior change.

The survey asked patients about their experiences and perceptions following the ED encounter related to accessing, using, and carrying naloxone. Findings included:

  • Most of the patients did not carry naloxone prior to their ED, but over a third reported having a personal history of an overdose requiring naloxone and more than a quarter had used naloxone to reverse an overdose for another person in the past.
  • Approximately half of the patients said that they were carrying naloxone after their ED visit and two-thirds planned to continue carrying.
  • Of patients not carrying naloxone prior to their ED visit, 54% reported a plan to continue carrying in the future.

These findings on patient perspectives and experiences using naloxone indicate that EDs represent an opportunity to improve naloxone carrying. These early insights are key in helping quality improvement, operational, and administrative efforts to support addiction-based care and to save lives within the community.

The Biden Administration recently announced that for the first time, harm reduction services are a federal drug policy priority, and specifically highlighted EDs and hospitals as key settings for naloxone distribution. Although the plan included few specifics, our work suggests that bolstering funding to provide naloxone directly to patients in the ED may be an effective strategy to promote naloxone carrying and use among people who are highly likely to witness an overdose.

Increasing naloxone distribution should include not only EDs, but also extend into health centers, outpatient and inpatient settings, and nontraditional venues (e.g. libraries or public vending machines). Our work reinforces the need to focus on harm reduction methods across the spectrum of public health. This should include efforts at the local and federally level to sponsor widespread and low-cost access to naloxone, especially within high-risk communities. Similar to historical efforts to increase access to defibrillators (also called AEDs) within public spaces for cardiac arrest, a synergistic approach to make naloxone easy and simple to access is paramount to preventing overdose deaths.

The study, Assessment of Patient-Reported Naloxone Acquisition and Carrying With an Automated Text Messaging System After Emergency Department Discharge in Philadelphia, was published in JAMA Network Open, March 24, 2022. Authors include Anish K. Agarwal, Hareena Sangha, Anthony Spadaro, Rachel Gonzales, Jeanmarie PerroneM. Kit Delgado, and Margaret Lowenstein.

Why Does the Opioid Mortality Rate Continue to Rise?

Image features speaker of webinar

The University of Pennsylvania’s Leonard Davis Institute of Health Economics’ event was co-sponsored with the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH).

From April 2020 through April 2021, there were 100,300 drug overdose deaths across the country according to the CDC — a 28.5% increase over the previous year. Some 75% of these were opioid-related overdoses that killed an average of nine users an hour around the clock throughout the year. Looking forward, the just-published Stanford-Lancet Commission on the North American Opioid Crisis predicts that 1.2 million more opioid users will die of overdoses by 2029.

Against this background, the University of Pennsylvania’s Leonard Davis Institute of Health Economics (Penn LDI) convened a March 4, 2022, panel of four top experts to discuss the current efforts to address this rapidly growing public health crisis. The panel included the head of the Stanford-Lancet Commission as well as the former Acting Director of the Office of National Drug Control Policy, the Associate Dean for Social Justice at the University of Southern California’s School of Medicine, and moderator Shoshana Aronowitz, PhD, MSHP, LDI Senior Fellow, and Penn School of Nursing researcher whose work is focused on equitable access to substance use treatment and harm reduction services.

The virtual event was co-sponsored with the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH).

Synopsizing the bottom line of the national challenge to reduce this overdose epidemic, panelist and USC Professor Ricky Bluthenthal, PhD — who has been researching substance use interventions for 30 years — pointed to the lack of coherent government action and policies.

Ricky Bluthenthal, PhD
Ricky Bluthenthal, PhD
Professor of Populations and Public Health Sciences at the University of Southern California

Step Up Our Game

“We haven’t had the kind of local, state, and national response to this crisis that we need to,” Bluthenthal said. “We actually have many effective solutions, most of which involve engagement with people with lived experience, and the distribution of things like naloxonesafe injection suppliesdrug consumption sites, and the like. There are a lot of things we could be doing if we were willing to take them to scale, but we now need to step up our game in terms of things that we can do right now that would facilitate access to medications for opioid use disorder and provide delivery systems that actually get those services to the people who need them.”

Regina LaBelle, JD, Director of the Addiction and Public Policy Initiative at Georgetown University’s O’Neill Institute for National and Global Health Law, noted: “When the April 2021, numbers were announced, there was a lot of shock, but anyone who had been paying attention could see this building in the various models being done. Some policy improvements were made in the Obama and Biden administrations, but some of the basic conditions remain. We have a lack of evidenced-based treatment availability. We have huge amounts of stigma associated with both people who may use drugs as well as stigma about even seeking treatment.”

Regina LaBelle, JD
Regina Labelle, JD
Director of the Addiction and Public Policy Initiative at Georgetown University’s O’Neill Institute for National and Global Health Law

Aronowitz noted that, although alarming, the latest mortality statistics fail to convey the full scope of the problem because they don’t count near-fatal overdoses. “Emergency department numbers for overdoses are five times those of deaths — and half of overdoses are self managed,” she said. “Non-fatal overdoses strongly predict eventual overdose death. Are we using this information to agitate for change?”

LaBelle acknowledged the enormity of that data collection challenge. “Traditionally, we measure how well we’re doing based on the rate of overdose deaths, when that’s only the tip of the iceberg,” she said. “We just don’t have great data on overdoses that don’t end in death. That underscores for me why naloxone should be more widely available. I don’t see the reason why it has to be prescribed rather than made readily available over the counter to substance users at great risk.”

The Number One Thing

Stanford Professor of Psychiatry and Behavioral Sciences Keith Humphreys, PhD, pointed out that “naloxone distribution is the number one thing the Stanford-Lancet Commission model found to save lives — we need a dramatic expansion of naloxone distribution,” he said. “If we could boost current levels of availability by a third, we would reduce hundreds of thousands of deaths over this next decade.”

At the same time, Humphreys emphasized that the overall policy focus has to be greatly broadened because overdose deaths and near deaths occur in the extreme downstream of the crisis.

Keith Humphreys, PhD
Keith Humphreys, PhD
Esther Ting Memorial Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University

“We have to understand that much the same as monoclonal antibodies are great for people who are intubated with serious cases of COVID-19, naloxone serves only the immediate condition of overdose. But you will never solve either epidemic by just taking care of people at that extreme downstream end,” Humphreys said. “You have to go upstream. In COVID, that means preventive measures like vaccines, masks, social distancing, and such. In substance use disorder, that means investing in kids — I’m not talking about ‘just say no’ programs, but rather things like nurse-family partnerships, Head Start, pre-K. We need interventions that set kids off on a good start in life, particularly kids in low-income neighborhoods and places that have already gone through a generation of addiction. It has been very hard to persuade politicians and the public to make 20-year investments, but we really need to think that way.”

“It also means we need to make sure we separate our health care institutions, our regulators, and our educational institutions from corporate interests that profit from the spread of addiction,” Humphreys continued. “We need to tighten up the regulatory system. There is no reason why 10 years from now we couldn’t have another epidemic like this one started in the health care system with a different drug, like stimulant medications or benzodiazepines, or we would not have approved ketamine that’s now out there. We may soon approve MDMA. And the holes that companies like Purdue Pharma walked through largely remain. The political influence of the industry and their ability to advertise beyond any sane amount needs to be fixed on the preventive side. I know it’s hard to think long term when we’ve got a crisis on our hands, but we have to do both things. We have to manage those people who have the problem, and we have to stop future generations from going through the same thing.”

Medicaid and Prisons

Along with much wider naloxone availability, evidence-based MOUD treatments, Emergency Department engagement programs, and retaining the new pandemic-driven flexibilities in telehealth and other treatment modalities, the panelists emphasized two other areas of policy reform that could have potentially outsize impact. The first is expanding Medicaid in those states that haven’t yet done so to provide coverage for in-patient and out-patient substance use treatment. The second is overhauling the addiction-related regulations and practices in correctional facilities that house such large populations of drug users.

LaBelle noted, “We know that you’ve got up to a 40 percent greater chance of overdosing if you are not treated with a Medication for Opioid Use Disorder (MOUD) while you are incarcerated. First of all, it’s against the law to force someone on methadone or buprenorphine to stop and go into withdrawal when they enter corrections. From federal court cases we know that’s a violation of the Americans with Disabilities Act. It’s also a violation of the Eighth Amendment.”

“At Georgetown,” LaBelle continued, “we worked with the Sheriffs’ Association and the Bureau of Prisons on this issue, and there is a great interest in expanding access to treatment and corrections to evidence-based treatment. Groups like the National Sheriffs’ Association and others are calling for the elimination of the Medicaid Exception (that bars the use of Medicaid funds to cover inmate health care services). So the proposed Medicaid Reentry Act would allow incarcerated individuals to get Medicaid coverage for addiction treatment starting 30 days before their release.” Once released, the former inmates are again eligible for ongoing Medicaid coverage of their continuing treatment.

“We know from Rhode Island’s experience how they decreased overdose deaths in the reentry population by 60 percent and six percent overall in the state by implementing Medicaid-based treatment in corrections,” LaBelle said.

“Like Being in Combat”

Humphreys, who has visited that Rhode Island Department of Corrections prison in Cranston, agreed. “It’s really a terrific model of continuity of care,” he said. “You have the same provider when people are incarcerated and when they go back out into the community. This is so important because we lose a lot of people in that first two weeks after prison — the death rate is just appalling. It’s like being in combat. It’s not enough to say, ‘Well, there’s a clinic out there somewhere. Good luck finding it.’ Instead, they have someone they know meeting them at the exit gate and taking them to treatment somewhere they already know. It’s remarkable how lifesaving this is.”

While that Rhode Island program works well, Bluthenthal pointed out that not-in-my-backyard (NIMBY) political resistance frequently preventing the siting of treatment facilities is a major reason easily accessible treatment sites are in critically short supply.

“Currently, the kinds of treatment and harm reduction services available to people are better understood by politics rather than need,” Bluthenthal said. “It has a devastating consequence for people of color and other minority populations because they end up not getting the service they need or they get the negative intervention — mass incarceration. It’s a problem with our politics — these NIMBY-driven decisions are very narrow minded.”

Shoshana Aronowitz, PhD
Shoshana Aronowitz, PhD, MSHP, FNP-BC
Moderator and Assistant Professor in the Department of Family and Community Health at Penn Nursing

As the session ended, Aronowitz asked the three panelists their thoughts on the most important thing that needs to be done more or differently to better address the opioid crisis. Their answers:

Humphreys: “We need the criminal justice system to stop punishing and start engaging in rehabilitation, and the health care system to take on substance use disorder permanently as an enduring condition of life like heart disease or cancer, so that every single health care system is competent to provide treatment. And we need to fix the holes in the pharmaceutical regulatory framework.”

Bluthenthal: “To make all the things we’ve been talking about work, we need to have an infrastructure that reaches these populations. We have to invest in community-based organizations and people with lived experience to staff them so they have the jobs and can connect the effective treatment services to the people who need them.”

LaBelle: “At Georgetown, I’ve started a year-long Master’s of Science in Addiction Policy and Practice program to marry science research with policy. We have a class of 10 people now; and every year, I’m going to have more coming through this program so we can have an addiction policy that’s based on science, evidence, and compassion.”

Image features speaker of webinar

Reducing Opioid Overdose Deaths

Watch the full video at PennLDI.

Meet Ane-Kristine Finbraten: Harkness/Norwegian Institute of Public Health Fellow, Physician, and Researcher on Hepatitis C Elimination

Ane-Kristine Finbraten and husband atop the Empire State Building

Commonwealth Fund Harkness Fellows can be placed anywhere in the United States. Ane-Kristine Finbraten, MD, PhD, photographed with her husband, chose New York City and CHERISH as her preferred placement.

Coming to New York City was an easy decision for Harkness Fellow Ane-Kristine Finbraten. The city has one of the most robust hepatitis C elimination efforts to learn from. A founding member of the Centre for Elimination of Hepatitis C in Norway and an infectious diseases provider, Finbraten was elected as a 2021-2022 Commonwealth Fund Harkness/Norwegian Institute of Public Health Fellow to conduct original research and gain exposure to policy development in the United States.

“I wanted to understand more about policy work and learn how I can help more people by working at the health systems level,” Finbraten said. At the Centre for Elimination of Hepatitis C, Finbraten and her team document the hepatitis C elimination processes in Norway and develop treatment models to further the World Health Organization’s global initiative to eradicate viral hepatitis C. One treatment model in development is Opportuni-C, in which her team studies the effect of initiating rapid hepatitis C treatment for people who inject drugs and are hospitalized.

Through the Commonwealth Fund, Finbraten connected with Bruce Schackman, CHERISH director and Saul P. Steinberg Distinguished Professor at Weill Cornell Medicine; Shashi Kapadia, CHERISH Research Affiliate and infectious diseases physician at Weill Cornell Medicine; and Benjamin Eckhardt, infectious diseases clinician researcher and assistant professor at New York University. During Finbraten’s one-year placement at the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) in New York City, Schackman, Kapadia, and Eckhardt serve as collaborators and advisors on her research and provide health economics, epidemiological, and policy perspectives.

“Choosing these advisors was not difficult after understanding what CHERISH does and offers. I have the best team supporting me to make my project and learning experience successful and meaningful,” she said. Finbraten’s primary research compares low-threshold hepatitis C treatment models in New York City and Norway. Additional studies Finbraten is working on address barriers to care for people who inject drugs and are co-infected with HIV and hepatitis C.

Ane-Kristine Finbraten atop a hike in Northern Norway

Finbraten enjoys calm summer hikes back at home in Norway.

Finbraten is also eager to learn how to conduct qualitative research and design treatment models with patients in mind. “I am a fan of developing research questions that ask about the outcomes that matter to the patient. When developing treatment models, we need to know how the patient feels. A model cannot be useful unless it is accepted by the people who are receiving the care,” she said. As her team in Norway is expanding to incorporate more qualitative research, Finbraten looks forward to bringing home new research methods and treatment strategies that integrate the voices of people who inject drugs.