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- Title
Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization.
- Authors
Schoneich, Sebastian; Plegue, Melissa; Waidley, Victoria; McCabe, Katharine; Wu, Justine; Chandanabhumma, P. Paul; Shetty, Carol; Frank, Christopher J.; Oshman, Lauren
- Abstract
Key Points: Question: Do newborn drug testing rates and results differ by birthing parent race and ethnicity at a Midwestern US academic medical center, and did this change after state recreational cannabis legalization? Findings: In a cohort study of 26 366 births from 2014 to 2020, clinicians were more likely to order drug tests for Black newborns (7.3%) compared with White newborns (1.9%) and other racial and ethnic groups when there was no obstetric urine drug test performed during the pregnancy. There was no difference in testing rates or racial inequity after legalization in 2018, but test results were more likely to be positive for tetrahydrocannabinol. Meaning: This study identified racial inequities in newborn drug testing and calls for an exploration of structural and institutional racism as contributing factors to differences in testing patterns. This cohort study examines variations in the incidence and results of newborn drug testing by birthing parent race and ethnicity before and after legalization of recreational cannabis in Michigan. Importance: Thirty-seven US states and the District of Columbia mandate reporting newborns with suspected prenatal substance exposure to the state, and punitive policies that link prenatal substance exposure to newborn drug testing (NDT) may lead to disproportionate reporting of Black parents to Child Protective Services. The impact of recreational cannabis legalization on racial disproportionality in NDT is unknown. Objectives: To examine variations in the incidence and results of NDT by birthing parent race and ethnicity, variables associated with variation, and changes after statewide legalization of recreational cannabis. Design, Setting, and Participants: This retrospective cohort study was conducted from 2014 to 2020 with 26 366 live births to 21 648 birthing people who received prenatal care at an academic medical center in the Midwestern United States. Data were analyzed from June 2021 to August 2022. Exposures: Variables included birthing parent age, race, ethnicity, marital status, zip code, insurance type, prenatal and newborn diagnoses codes, and prenatal urine drug test orders and results. Main Outcome and Measures: The primary outcome was an NDT order. Secondary outcomes were substances detected. Results: Among 26 366 newborns of 21 648 birthing people (mean [SD] age at delivery, 30.5 [5.2] years), most birthing parents were White (15 338 [71.6%]), were non-Hispanic (20 125 [93.1%]), and had private insurance coverage (16 159 [74.8%]). The incidence of NDT ordering was 4.7% overall (1237 newborns). Clinicians ordered more NDTs for Black compared with White newborns (207 of 2870 [7.3%] vs 335 of 17 564 [1.9%]; P <.001) when the birthing parent had no prenatal urine drug test, a presumably low-risk group. Overall, 471 of 1090 NDTs (43.3%) were positive for only tetrahydrocannabinol (THC). NDTs were more likely to be positive for opioids in White compared with Black newborns (153 of 693 [22.2%] vs 29 of 308 [9.4%]; P <.001) and more likely to be positive for THC in Black compared with White newborns (207 of 308 [67.2%] vs 359 of 693 [51.8%]; P <.001). Differences remained consistent after state recreational cannabis legalization in 2018. Newborn drug tests were more likely to be positive for THC after legalization vs before legalization (248 of 360 [68.9%] vs 366 of 728 [50.3%]; P <.001) with no significant interaction with race and ethnicity groups. Conclusions and Relevance: In this study, clinicians ordered NDTs more frequently for Black newborns when no drug testing was done during pregnancy. These findings call for further exploration of how structural and institutional racism contribute to disproportionate testing and subsequent Child Protective Services investigation, surveillance, and criminalization of Black parents.
- Subjects
UNITED States; DRUG use testing laws; DRUG abuse laws; CANNABIS (Genus); ACADEMIC medical centers; AGE distribution; RACE; DISEASE incidence; RETROSPECTIVE studies; DRUG laws; TREATMENT effectiveness; DESCRIPTIVE statistics; RESEARCH funding; MARITAL status; DATA analysis software; LONGITUDINAL method; CHILDREN
- Publication
JAMA Network Open, 2023, Vol 6, Issue 3, pe232058
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.2058