Black, Hispanic Patients More Likely To Be Tested for Perinatal Cannabis Use

according to data It was published in the magazine hospital pediatricspatients selected to undergo drug screening during the cannabis labor and delivery process were more likely to be Hispanic or African American and to have subsidized health insurance plans.

A team of researchers from the American Academy of Pediatrics assessed the proportion of unexpected positive results within a cohort to identify additional social and clinical risk factors, as well as births solely to demonstrate cannabis use. At times I have tried to characterize people undergoing toxicology testing. result.

Disproportionate impact of perinatal drug testing

A retrospective cohort study included two pairs with a history of maternal cannabis use who underwent perinatal toxicology testing at five Massachusetts maternity hospitals between 2016 and 2020.

Researchers examined a total of 60,608 live births, of which 1,924 had toxicology tests. Of that group, 614 (31.9%) were tested for the sole indication of cannabis use. The data revealed that significantly more patients in the cannabis cohort were under the age of 25, non-Hispanic black, Hispanic or Latino, and had public insurance.

Specifically, Hispanic patients were twice as likely to be required to be tested (30.5% vs. 15.5% of the childbearing population) and black patients were four times more likely (32.4% vs. 8.1%). Patients under the age of 25 were more than five times more likely (32.4% vs. 6.1%) to be required to be tested, and patients enrolled in a public health plan were more likely to be tested for past cannabis exposure2 more than doubled (39.9% vs. 15.6%). ).

In terms of positive results, 8 of the 614 pairs (1.3%) had an unexpectedly positive toxicology test result, of which 2 (0.3%) were unexpectedly positive for opioids. Seven pairs (1.1%) had false positive test results for the unexpected substance.

Physicians also rarely changed clinical management or followed up with patients after being diagnosed positive for cannabis. This is because a single test result of monitoring and drug-free neonatal opioid withdrawal syndrome changed clinical management.

“Toxicology testing of patients for the sole indication of cannabis use, without other risk factors, may be of limited utility in elucidating other substance use and may be of perinatal It may exacerbate existing disparities in late-stage outcomes,” the study authors concluded.

Echoes of previous research

Our findings are consistent with previous studies. i.e. 1 study just released last month academic pediatrics Similarly, young individuals and people of color were found to be more likely to be tested for cannabis use or maternal medical complications compared to white, non-Hispanic individuals. The study included individuals under the age of 25 (3.8), Hispanic individuals (1.6), non-Hispanic black individuals (1.8), individuals of other races (1.8), and individuals with public insurance. (Medicaid 2.6; Medicare 10.6).

This is one of the most recent studies investigating this topic, but many studies over the past few years have found similar numbers.one study Published in women’s health journal Black women and their newborns are reportedly 1.5 times more likely to be tested for illegal drugs than non-Black women.

Another announced in New England Journal of Medicine showed that black women were “reported,” even though black and white women had similar rates of illicit drug consumption during pregnancy. [to health authorities] About 10 times more likely than white women. ”

Drug Use, Drug Testing, and Birth: Complex Issues

False-positive test results for THC are generally rare in adults and may be fairly prevalent among newborns. for example, 2012 study Common soaps and wash products used in neonatal and infant care, such as Johnson’s Head-to-Toe Baby Wash and CVS Baby Wash, often cross-react with immunoassay tests, causing false-positive results for carboxy THC. It turns out that there is a possibility.

“[The] Adding head-to-toe baby wash to drug-free urine produced a dose-dependent and measurable response in the THC immunoassay,” the researchers concluded. Additional results were similar, and subsequent testing identified specific chemical surfactants that reacted with the THC immunoassay.…Given these results, laboratories and health care providers should It is important to be aware of the sources of potential false-positive screening results and to consider confirmation before initiating interventions.”

apart from, hospital pediatrics Studies have found very few follow-up actions after a positive test, but this is not always the case. study from 2018 It is important to consider technical, medical, ethical, legal and social issues when screening pregnant women for drug use.

Specifically, a birth could be arrested for a positive drug screen where even provisional results were used to remove the child from custody, before a rigorous confirmatory test was completed, and the actual arrest could be made. Balancing the scientific, medical, public health, legal, and ethical aspects of drug screening during pregnancy is critical to addressing this crisis at all levels.”

This study concludes that the medical field lacks a good understanding of the pharmacokinetics of drugs during pregnancy. While the need for testing is clear, the authors note that pharmacological knowledge is lacking and is exacerbated by “general misconceptions about addiction and substance use/misuse among health professionals.” doing. .