Abstract
North America is currently suffering from one of the worst epidemics of illicit drug use in recent history: the opioid crisis. Pregnant women are not immune to the ravages of substance misuse which affects themselves, their pregnancies, and the wider community. The prevalence of drug misuse in pregnancy is not well quantified due to the lack of good validated tests, cooperation between clinicians and scientists developing tests, and consensus as to who should be tested and how results should be used. A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair; neonatal meconium, urine, and hair; and placenta and umbilical cord tissues. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques. The drive for ever greater accuracy and sensitivity must be balanced with the necessities of medical practice requiring minimally invasive sampling, rapid turnaround, and techniques that can be realistically utilized in a clinical laboratory. Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis. They also have great promise for public health monitoring, policy development, and resource allocation. However, women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels.
Highlights
In the 21st century, North America has experienced an increase in the use of prescription and non-prescription opioids, so large and rapid that it has become an epidemic (Okie, 2010; Metz et al, 2018)
Post-birth screening may be a useful tool if the neonate has been admitted to the neonatal intensive care unit (NICU), with signs of neonatal abstinence syndrome (NAS)
Urine sampling is very useful in situations where a rapid diagnosis is needed, such as in a neonate suspected of having NAS, with the drawback that only recent maternal drug use can be detected
Summary
In the 21st century, North America has experienced an increase in the use of prescription and non-prescription opioids, so large and rapid that it has become an epidemic (Okie, 2010; Metz et al, 2018). Certain US States including Alabama, South Carolina, and Tennessee have charged women who have taken drugs in pregnancy with child abuse and mothers who use illicit drugs are at high risk of losing custody of their newborns (Young et al, 2007; Stone, 2015). While these laws were originally designed to protect the fetus, the fear instilled in women can prevent them from enrolling in treatment programs and accessing medical care throughout pregnancy. Decisions regarding the type of screens being performed, and the results of screening, need to be made based on a balance between scientific, medical, public health, legal, and ethical considerations around drug testing
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