Black Hispanic patients are more likely to be tested for perinatal cannabis use

According to data published in the journal Hospital Pediatrics, patients selected for drug screening during cannabis labor and delivery are disproportionately Hispanic or African American and were also more likely to have subsidized health insurance plans.

The research team from the American Academy of Pediatrics sought to describe the characteristics of individuals who underwent toxicology testing at delivery solely for the indication of cannabis use and assessed the rate of unexpected positive test results in the cohort to identify additional social and clinical risk factors Results.

The disproportionate impact of perinatal drug testing

The retrospective cohort study included dyads with a history of maternal cannabis use who underwent peripartum toxicology testing at five maternity hospitals in Massachusetts between 2016 and 2020.

Researchers screened a total of 60,608 live births, of which 1,924 dyads underwent toxicology testing. Of this group, 614 (31.9%) were tested for the only clue of cannabis use. The data showed that significantly more patients in the cannabis cohort were under the age of 25, non-Hispanic Black, Hispanic or Latino, and publicly insured.

Specifically, Hispanic patients were twice as likely to be tested (30.5% versus 15.5% of the birth population) and Black patients were four times as likely (32.4% versus 8.1%). Patients under the age of 25 were more than five times more likely to be required to test (32.4% vs. 6.1%), and patients with health insurance plans were more than twice as likely to be tested for prior cannabis exposure (39.9% vs. 15.6%). ).

Regarding positive results, eight of the 614 dyads (1.3%) had an unexpectedly positive toxicological test result, including two (0.3%) that tested unexpectedly positive for opioids. Seven dyads (1.1%) also had false-positive test results for unexpected substances.

Physicians also rarely followed up or changed clinical management of patients after testing positive for cannabis, as only one test result changed clinical management: surveillance and no medication for neonatal opioid withdrawal syndrome.

“Toxicological testing of patients for a single indication of cannabis use in the absence of other risk factors may be of limited use in informing the use of other substances and exacerbate existing disparities in perinatal outcomes,” the study authors concluded.

Echoes of previous research

The results are consistent with previous studies. Similarly, a study published just last month in Academic Pediatrics found that younger people and people of color were more likely to be tested for cannabis use or maternal medical complications compared to white, non-Hispanic people. This study found that the disproportionality ratios were higher among those under 25 years of age (3.8), Hispanic people (1.6), non-Hispanic Black people (1.8), people of other races (1.8), and people with a public Insurance (Medicaid 2.6; Medicare 10.6).

While this is one of the most recent studies on the subject, a number of studies from the past few years have found similar numbers. A study published in the Journal of Women’s Health reported that black women and their newborns were 1.5 times more likely to be tested for illicit drugs than non-black women.

Another study published in the 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] about 10 times as common as white women.”

Drug use, drug testing and childbirth: A complex issue

False positive test results of THC are generally uncommon in adults, they can be quite common in newborns. For example, a 2012 study found that commonly used soap and wash products for newborn and infant care, such as Johnson’s Head-to-Toe Baby Wash and CVS Baby Wash, often cross-react with the immunoassay test and produce false positive results can carboxy-THC.

“[The] The addition of Head-to-Toe Baby Wash to drug-free urine resulted in a dose-dependent measurable response in the THC immunoassay,” the researchers concluded. “Adding other commercially available baby soaps gave similar results, and subsequent testing identified specific chemical surfactants that reacted with the THC immunoassay. … Given these implications, it is important for labs and providers to be aware of this potential source of false positive screening results and to consider confirmation before initiating interventions.”

Although the Hospital Pediatrics study had little follow-up after positive tests, this is not always the case. Another 2018 study points to the importance of considering a range of technical, medical, ethical, legal and social issues when screening pregnant people for drug use.

In particular, it said that people giving birth “can and have been arrested for positive drug tests, with even preliminary results being used to remove children from custody before rigorous confirmatory testing is complete.” Balancing the scientific, medical, health, legal and ethical aspects of drug screening tests in pregnancy is crucial to address this crisis at all levels.”

The study concludes that medicine largely lacks a good understanding of drug pharmacokinetics in pregnancy. While there is a clear need for testing, the authors note a lack of pharmacological knowledge, compounded by a “common misunderstanding of addiction and substance use/abuse within the medical profession” that is further complicated when working with pregnant women and their children becomes .