According to a newly published federally-funded study by the American Medical Association, removing marijuana as an isolated reason for urine drug screens during pregnancy is associated with “improved racial equity in testing and reportage” of the test results to Child Protective Services, and that there was no evidence of decreased detection of non prescribed and non cannabis substances, and “no significance association” between the intervention, and measured neonatal outcomes.
In a report published in JAMA Network Open on Monday, the authors note that prenatal care is often guided by urine drug testing during pregnancy. Some states also require positive urine drug screening results to be reported by child protection services.
Washington University St. Louis authors suggest, however, that this practice can sometimes be harmful and outweighs the benefits. They wrote that eliminating marijuana from the list of reasons to conduct drug tests would better protect families, and also promote equality by “reducând[ing] “Racial discrimination in drug testing and reporting of child abuse to the Child Protective Services does not impact on clinically significant substance use.”
This report states that black patients are “significantly more likely” than whites to have a peripartum urine screening (UDS) performed and then reported to child protection services (CPS).
Fear of CPS reports and the possible loss of parental custody can prevent parents from providing needed health care. This can increase racial disparities.
It says that fear of reporting mandates is often a concern expressed by pregnant people. In Missouri, Black pregnant women are four times as likely to die in the first year after pregnancy as White pregnant women. Reducing barriers and improving access to excellent and safe care is of paramount importance.
This study comes after an improvement in racial justice was made to the urine drug screen policy. According to the new policy, UDS is no longer required if there was “isolated” cannabis use detected during a verbal test. Patients who receive limited prenatal care were not routinely subjected to urine testing.
Clinical decision support and the removal of limited prenatal and isolated cannabis care from UDS as indications was linked to improved racial justice in UDS tests and CPS reporting.
A clinical decision-support tool (CDS) also asks providers to enter justifications when ordering urine drug tests.
The new policy seemed to be more equitably treating people based on their race. Overall drug screening was reduced and the number of non-prescribed substances detected increased.
Our study revealed that intervention led to a 75% decrease in UDS overall and improved racial balance, according to the research team of 12 authors. The 12-member research team wrote that “this reduction correlated with a more than 2-fold increase in the number of patients tested who were positive for either non-cannabis or non-prescribed, non-cannabis substances, respectively. And a threefold decline in only cannabis positive results.”
The researchers stressed that the findings do not condone marijuana use in pregnancy nor are they meant to imply that child protective services should be notified of dangerous situations. The findings are meant to help parents balance the risk to their child and themselves.
The authors stated that “we acknowledge that CPS referral may be beneficial in certain clinical situations, and it is definitely indicated in cases of abuse.” “However, the authors challenge the assumption of parental substance use, especially cannabis which is legal in Missouri, as such a scenario.”
Research into mandatory reporting of CPS to The highlighted that “significant potential harms are associated with this practice. These include incarceration and the loss of custody for a newborn child, as well as involuntary committment, housing loss, or even incarceration.”
Evidence does not support UDS or LPNC for cannabis isolated use, which are practices that affect Black patients disproportionately.
This report states, “Removing isolated marijuana use as an indication for UDS orders will raise natural concerns about the effect of maternal cannabis on the developing foetus.”
Cannabis is used more often than alcohol during pregnancy. It notes that “Several observational study have shown negative correlations between fetal exposure to cannabis and fetal outcomes, neurocognitive and neonatal development, and fetal outcome,” and cites the advice of American College of Obstetricians and Gynecologists, which advises women who are expecting or planning a pregnancy not to use cannabis.
Although we agree with ACOG, the authors went on to say that cannabis use in pregnancy is not a sign of a potential inability to parent. Indeed, ACOG explicitly states that ‘seeking obstetric-gynecologic care should not expose a woman to criminal or civil penalties for marijuana use.'”
In drug tests, isolated marijuana usage is “poorly prescriptive for other substances”, the team claimed. It’s not also a good indicator of unfit parenting.
“Supporting this argument is the finding that 196 of 197 patients (>99%) who tested positive for cannabis after undergoing UDS for isolated cannabis use in a previous study were discharged home with custody of the newborn,” the report says, “suggesting that this practice has low predictive value for identifying what CPS would deem unsafe for a newborn.”
There were no associations with other demographic factors, neonatal outcomes or substance-related withdrawal diagnosis in neonates.
This report was partially funded by a grant provided to the National Institute on Drug Abuse.
In October of last year, the American Medical Association published two more federally-funded reports that also addressed cannabis and pregnancy. Two other federally funded reports published by the American Medical Association also examined issues of cannabis and pregnancy.
A separate report released late last year by a reproductive-rights organization revealed that the number of prosecutions for pregnancy was at an all time high following the Supreme Court ruling in 2022 that ended abortion rights nationwide. Most pregnant women are accused of using marijuana, or any other drug during pregnancy.
According to the study, prosecution rates varied dramatically across the nation. Alabama was, for instance, responsible for almost half the prosecutions with 104. Oklahoma had 68, and South Carolina ten. Majority of those charged with pregnancy-related crimes are also low-income.
In Oklahoma, local news in 2022 began reporting that prosecutors there were targeting pregnant women for using medical marijuana, resulting in felony child neglect charges being filed against 26 mothers. Oklahoma can punish the crime with up to life in prison.
In 2023, NIDA Director Nora Volkow blasted the criminalization of drug use by pregnant people and new parents, arguing that the resulting stigmatization is harming families and contributing to the overdose crisis.
She stated that “family support, not criminalization” is needed.
In July last year, an Illinois state court decided that no one could be charged with child neglect if they were legally using medical cannabis while pregnant.
Rep. Anthony Moore, (R), the speaker of the State’s House, recently filed legislation to make medical marijuana use while pregnant illegal.
As for other American Medical Association (AMA)-published research, a study late last year found that psilocybin-assisted therapy in a group of frontline clinicians during the COVID-19 pandemic “resulted in a significant, sustained reduction of symptoms of depression.”
In a study published by the AMA and funded with federal funds, a review of product listings in renowned marijuana advertisements revealed that more than half (50%) were “flavored” based on product descriptions. Researchers raised concerns that those flavors—along with cannabis-infused edibles, products like concentrates and merely listing retailers and products online—may make marijuana more appealing to young people.
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