Dec 26, 2024 Story by: Editor
In many states, including Michigan, healthcare professionals and social workers are required to report cases to Child Protective Services (CPS) if a newborn tests positive for specific drugs after birth. However, inconsistent guidelines on what triggers these tests have been linked to racial disparities, as revealed by several studies.
A team from Michigan Medicine’s Department of Family Medicine and Antiracism and Health Equity Program conducted research to understand the rates of newborn drug testing and explore whether testing patterns varied by the race and ethnicity of birth parents. The study also examined changes in testing practices following Michigan’s 2018 legalization of recreational cannabis.
Published in JAMA Network Open, the study builds on previous findings that Black newborns are more likely to be tested for prenatal drug exposure than other racial or ethnic groups, even when no risk factors for substance use disorders are present.
The researchers found that racial inequities in newborn drug testing persisted over a seven-year period, both before and after cannabis legalization. Among positive tests for newborn drug exposure, tetrahydrocannabinol (THC), the psychoactive component in cannabis, was the most frequently detected substance.
“In the absence of a standardized newborn drug screening policy, we observed inconsistencies in how and when clinicians ordered drug tests for newborns with a low risk of prenatal drug exposure,” said Dr. Lauren Oshman, senior author of the study and an associate professor of family medicine at the University of Michigan Medical School. “We measured drug testing rates before and after cannabis legalization to see if the change in law improved or worsened these inequities and found it didn’t appear to make any difference.”
Analyzing data from 26,366 births at the University of Michigan Health between 2014 and 2020, researchers noted that newborns born to white parents were 24% less likely to be drug tested than those born to Black parents. However, positive drug tests for opioids were more common among white newborns, suggesting that some white newborns may be under-tested, potentially missing opportunities to identify and treat opioid use disorder.
In response, Michigan Medicine has introduced a policy that uses specific criteria for determining when a drug test is warranted. These criteria include symptoms of withdrawal in a baby or a birthing parent acknowledging drug use during pregnancy. Previously, the decision was left to clinicians’ judgment. To ensure the policy’s effectiveness, the hospital plans to track monthly data.
“It is incumbent upon medical institutions to identify racial inequities that occur as a result of their policies, or lack thereof,” said Dr. Justine Wu, study coauthor and an assistant professor of family medicine at U-M Medical School. “We can’t change what we don’t measure. Self-reflection and community-engaged solutions are essential for promoting health equity.”
The study also observed a rise in positive THC tests among all racial and ethnic groups after cannabis legalization, increasing from 50% to 69%. Nearly 40% of newborn drug tests were positive solely for THC, with Black newborns testing positive at higher rates than white newborns. Nationally, cannabis use during pregnancy has grown, with up to 12% of individuals reporting use during the first trimester from 2016 to 2017, Oshman noted.
Despite the lack of evidence linking cannabis use during pregnancy to child abuse or neglect, state laws still mandate CPS reporting for newborns testing positive for THC. Conversely, prenatal exposure to nicotine, which is known to harm infants’ health, does not trigger the same legal requirements.
“Punitive policies that link prenatal substance exposure to newborn drug testing may disproportionately criminalize Black parents and families,” Oshman said. “We need policy changes at multiple levels to reduce health inequity and promote the well-being of Black birthing people and their newborns.”
Overall, fewer than 6% of newborns tested positive for substances such as amphetamines, cocaine, methamphetamines, and phencyclidine.
This policy shift aligns with Michigan Medicine’s broader efforts to address inequities through implicit bias training, anti-racism research, and specialized clinics like the Partnering for the Future clinic, which supports individuals with substance use disorders during pregnancy. Collaborations with advocacy and community groups aim to advance statewide policy improvements.
“Our leaders, doctors, researchers, nurses, and staff are committed to reducing biases in the health system that lead to inequitable applications of laws and negatively impact treatment and care,” Oshman said. “We hope this research encourages other health systems to evaluate how their policies influence inequities in patient care and outcomes.”
The study received funding from the University of Michigan Office of the Vice President of Research and the National Center for Institutional Diversity. Source: IHPI
