according to data Published in the journal Hospital pediatricsPatients selected to undergo drug screening during labor and delivery for cannabis are disproportionately Hispanic or African American and were also more likely to be on subsidized health insurance plans.
The team of researchers from the American Academy of Pediatrics looked at describing the characteristics of people who undergo toxicology tests at birth only to indicate cannabis use along with assessing the rate of unexpected positive test results among the group to identify additional social and clinical risk factors. Results.
The disproportionate effect of perinatal drug testing
The retrospective cohort study included pairs with a maternal history of cannabis use who underwent perinatal toxicology testing between 2016 and 2020 at five maternity hospitals in Massachusetts.
The researchers reviewed a total of 60,608 live births, of which 1,924 infants underwent toxicology tests. Of this group, 614 (31.9%) were tested for the sole indication of cannabis use. The data revealed that significantly older patients in the cannabis group were under 25, non-Hispanic, Hispanic or Latino, and generally insured.
Specifically, Hispanic patients were twice as likely to be tested (30.5% vs 15.5% of the native population) and black patients were four times as likely to be tested (32.4% vs 8.1%). Patients younger than 25 were more than five times more likely to be tested (32.4% vs. 6.1%), and patients on public health care plans were more than twice as likely to be tested than for previous cannabis exposure (39.9% vs. 15.6%). ) ).
In terms of positive results, eight of the 614 pairs (1.3%) had an unexpectedly positive toxicology test result, including two (0.3%) who tested unexpectedly positive for opioids. Seven couples (1.1%) had false positive test results for the unexpected material.
And doctors rarely took any follow-up actions or made changes to the clinical management of patients after they tested positive for cannabis, because only one test result changed clinical management: monitoring and no medication for neonatal opioid withdrawal syndrome.
The study authors concluded, “Toxicology testing of patients for the sole indication of cannabis use, without other risk factors, may be of limited usefulness in explaining other substance use and may exacerbate existing discrepancies in perinatal outcomes.”
Echoes of previous research
The results are consistent with previous studies. And she is one Stady Released just last month and published in Academic Pediatrics It similarly found that younger individuals and people of color were more likely to test for cannabis use or maternal medical complications than non-Hispanic white individuals. This study found that the disproportionate ratios were greater than 1.0 for individuals under the age of 25 (3.8), Hispanic individuals (1.6), non-Hispanic black individuals (1.8) to individuals of other races (1.8) and those with public insurance (Medicaid). 2.6; Medicare 10.6).
While this is one of the most recent studies looking at the topic, a number of studies from past years have found similar numbers. One Stady Posted in Journal of Women’s Health reported that black women and their newborn babies were 1.5 times more likely to be screened for illegal drugs than non-black women.
Post posted in New England Journal of Medicine showed that although black and white women had similar rates of illicit drug use during pregnancy, “black women were reported [to health authorities] 10 times the rate of white women.”
Drug abuse, drug testing and childbirth: a complex issue
False positive test results for THC are generally uncommon in adults, and can be somewhat prevalent among newborns. For example, a 2012 study It was found that soaps and laundry products commonly used for newborn and infant care, such as Johnson’s Head-to-Toe Baby Wash and CVS Baby Wash, often interact with an immunoassay test and can cause false-positive results for carboxy-THC.
“[The] The authors concluded that adding infant head-to-toe lotion to drug-free urine produced a dose-dependent, measurable response in the immunoassay for THC. Addition of commercially available baby soap produced similar results, and subsequent testing identified specific surfactant chemicals that interacted with the THC immunoassay. … Given these results, it is important for laboratories and providers to be aware of this potential source of positive screening results. falsehood and to consider confirmation before initiating interventions.”
although Hospital pediatrics The study has few follow-up procedures after the positive test, which isn’t always the case. last The study is from 2018 It points out the importance of considering a number of technical, medical, ethical, legal and social issues when screening pregnant women for drug use.
Specifically, it notes that people who are born “could have been arrested for positive drug tests with preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. Balancing the scientific, medical, public health, legal, and ethical aspects of drug screening tests in Pregnancy It is critical to help address this crisis at all levels.”
The study concluded that the medical field largely lacks a good understanding of the pharmacokinetics of drugs during pregnancy. While there is a clear need for testing, the authors note that there is a lack of pharmacological knowledge, compounded by a “general misunderstanding of addiction and substance abuse/misuse within the medical profession” that is further complicated when working with pregnant women and their children.
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