Differences in Patients With a Positive Drug Screen for Opiates Versus Other Substances in Pregnancy [20L

Abstract

INTRODUCTION: Opioid abuse has reached epidemic levels in the past decade drastically changing the landscape of drug abuse in the US. Current guidelines for drug screening in pregnancy may not reflect contemporary patterns of use and over sample women of color and low socioeconomic status. METHODS: This is a retrospective cohort study of obstetric patients who had urine drug screens (UDS) ordered between 2013 and 2015 in a suburban tertiary care hospital. Of those with a positive UDS, we compared the characteristics of those with positive opiate screens to those who screened positive for other substances excluding opiates. RESULTS: 112 UDS were positive during the study period, 45 (40.2%) for opiates and 67 (59.8%) for other substances, most commonly marijuana (n=60), benzodiazepine (n=10), and cocaine (n=8). Subjects with positive opiate screens were more likely to have private insurance compared to other insurances (P < .05). Publicly insured were more likely to test positive for nonopiates than opiates. African Americans were significantly less likely to test positive for opiates compared to subjects of other races (P < .05). Caucasians' use was similar between the two groups (42% opiate, 43% other). A history of substance abuse was more common in those who screened positive for non-opiates whereas subjects whose infants required NICU admissions were more likely to test positive for opiates. Current or former tobacco use was similar between these two groups. CONCLUSION: Women who screen positive for opiates compared to other substances during pregnancy are different. A separate validated screening method for opiate use in pregnancy is needed.