Discrepancies in Prenatal Urine Drug Screening During Marijuana Legalization in Washington State [12F

Abstract

INTRODUCTION: This study evaluated demographic patterns related to prenatal cannabinoid urine drug screening (UDS) over a five-year period during which recreational marijuana was legalized and became accessible in Washington State. METHODS: Using electronic health record data, we performed a retrospective analysis for deliveries occurring between the 20 months prior to legalization and following legal accessibility. For three cohorts of women (delivering prior to, between, and following legalization and accessibility), the UDS completion rate and screening demographic characteristics were assessed using Chi-squared tests and multivariate logistic regression. RESULTS: 25,514 deliveries occurred between March 2011 and March 2016. Significantly more women underwent UDS post-accessibility (24.5%) compared to pre-legalization (20.0%, P<.001). A corresponding increase was not observed in marijuana-positive UDS in tested patients (22.7% vs. 23.3%, P=.86). African American women were more likely than women of any other race to be screened (aOROtherRace=1.4, aORWhite=1.7, aORAsian=2.1, and aORLatina=2.8, all P<.001). Odds of positive UDS increased only for white women following legalization (aOR 1.29, 95% CI 1.05-1.59, P=.02), but not for any other race. Subsidized insurance status was strongly associated with increased likelihood of testing (aOR 3.5, P<.001). CONCLUSION: Prenatal UDS patterns changed as policy surrounding recreational marijuana possession and accessibility evolved. Demographic discrepancies in testing reveal biases related to race and insurance status. As such they are potential contributors to health outcome disparities. It is important for providers of healthcare and health care systems to examine their practices and ensure they are being equally and justly applied.