PROJECT SUMMARY/ABSTRACT The opioid crisis has escalated dramatically among women: from 1999 to 2019, the rate of opioid-related overdoses among females increased from 1.4 to 9.3 per 100,000 population. Women face many unique challenges in obtaining treatment for opioid use disorder (OUD). These barriers include caretaking responsibilities and child custody concerns. Additionally, through a phenomenon known as “telescoping,” women have a shorter duration of opioid use before meeting the clinical criteria for OUD compared to men. Further complicating the treatment landscape for women with OUD is that they often present for treatment with more severe comorbidities than men do. These gendered differences highlight the importance of women- centered strategies for engagement in care, a critical step in the OUD Cascade of Care. To address these gendered needs and barriers to care, a novel women-centered recovery navigation system is proposed. Patient navigator programs are an evidence-based intervention that address disparities and destigmatize seeking care for vulnerable populations. While available for a range of chronic health issues, they have not been widely implemented or evaluated for women with OUD. Ultimately, the proposed recovery navigation system will combine a web-based platform with personalized, women-centered recovery navigator services, and will use a hybrid approach that connects women to both virtual and in-person services. This recovery navigation system will serve as a gateway to services that meet women’s unique needs through increasing awareness of service and resource availability, as well as normalizing and destigmatizing seeking treatment for OUD among women. Women in recovery from OUD will guide development through a structured community- engaged intervention development framework. The objectives of this project are to advance understanding of barriers to engagement in care for women with OUD and to create a women-centered recovery navigation system. These objectives will be achieved through the following specific aims: 1) identify key barriers to engagement in care for women with OUD, as well as potential solutions; 2) develop and evaluate a pilot women-centered recovery navigator program; and 3) develop and evaluate a web-based recovery platform to engage women with OUD in care. Analyses will be completed using both qualitative and quantitative methods. Upon completion of the proposed 5-year project and under the guidance of my mentorship team, I will advance my expertise in (1) community-engaged research strategies, (2) the theory and neurobiology of opioid dependence among women, and (3) intervention design. I will also have the data necessary to scale up and refine this women-centered recovery navigation system, and will submit an R01 application to do so by the beginning of year 5 of the award period. Taken together, I will be in a position to establish myself as an independent investigator focused on developing and adapting evidence-based, women-centered interventions that tangibly improve the health outcomes of women struggling with OUD and addiction across the life course.

PROJECT NARRATIVE The opioid crisis has escalated dramatically among women, but women face many unique challenges in obtaining treatment for opioid use disorder (OUD), highlighting the importance of women-centered strategies for engagement in care. To address these gendered needs and barriers to care, we propose a novel women- centered recovery navigation system. The proposed research will 1) identify key barriers to engagement in care for women with OUD, as well as potential solutions; 2) develop and evaluate a pilot women-centered recovery navigator program; and 3) develop and evaluate a web-based recovery platform to engage women with OUD in care.