Removing Cannabis From Drug Screening Criteria Improved Racial Equity in Maternity Care
After a hospital removed cannabis use and limited prenatal care as reasons for drug testing, racial disparities in testing and child protective services reporting nearly disappeared.
Quick Facts
What This Study Found
Before the intervention, Black patients were screened at more than double the rate of White patients (23.2% vs 11.1%). After removing cannabis as a testing indication and adding clinical decision support, screening rates dropped to 4.5% and 3.6% respectively, eliminating the racial disparity. CPS reporting disparities also resolved.
Key Numbers
9,396 patients total. Pre-intervention: 23.2% of Black vs 11.1% of White patients screened. Post-intervention: 4.5% vs 3.6% (no significant difference). CPS reports: 11.3% vs 5.8% pre-intervention; 4.2% vs 3.5% post-intervention (no significant difference). No change in detection of non-cannabis substance use.
How They Did This
Quality improvement study at a single tertiary care center comparing peripartum urine drug screening and CPS reporting rates before (June 2021-September 2022) and after (October 2022-January 2024) removing isolated cannabis use and limited prenatal care as screening indications, with added clinician decision support.
Why This Research Matters
Black pregnant patients have historically been disproportionately subjected to drug testing and CPS involvement. This study shows that changing which substances trigger screening can substantially reduce racial disparities without missing clinically important substance use.
The Bigger Picture
Cannabis-focused drug testing in maternity settings has been a key driver of racial disparities in CPS involvement. This intervention demonstrates that policy changes can improve equity without compromising patient safety.
What This Study Doesn't Tell Us
Single center in one Midwestern city. Cannot fully separate the effect of removing cannabis indication from the clinical decision support component. Unmeasured confounders may exist.
Questions This Raises
- ?Would these results replicate at other institutions?
- ?How do affected families perceive these policy changes?
- ?Are there long-term outcomes for infants born to cannabis-using mothers that this approach might miss?
Trust & Context
- Key Stat:
- Racial disparity in testing eliminated: 4.5% vs 3.6% post-intervention
- Evidence Grade:
- Moderate: large quality improvement study with clear before-after comparison, but single center and unable to isolate individual intervention components
- Study Age:
- Published in 2025 (JAMA Network Open) using 2021-2024 data
- Original Title:
- Racial Equity in Urine Drug Screening Policies in Labor and Delivery.
- Published In:
- JAMA network open, 8(3), e250908 (2025)
- Authors:
- Azimi, Vahid, Trammel, Cassandra, Nacke, Lauren, Rubin, Alexandra, Stevenson, Lori, Vaughn, Brittaney, Roper, Stephen M, Zaydman, Mark A, Jackups, Ronald, Riaz, Noor, Schamel, Kim P, Kelly, Jeannie C
- Database ID:
- RTHC-05986
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
Did removing cannabis from screening criteria lead to missed substance use?
No. The rate of positive tests for non-cannabis, non-prescribed substances did not change significantly (2.5% before vs 2.0% after). The intervention reduced unnecessary testing without reducing detection of clinically relevant substance use.
Why were Black patients tested at higher rates before the change?
Cannabis use and limited prenatal care were among the screening indications. These criteria disproportionately flagged Black patients. Removing them shifted screening to more clinically relevant indicators, which applied more equally across racial groups.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-05986APA
Azimi, Vahid; Trammel, Cassandra; Nacke, Lauren; Rubin, Alexandra; Stevenson, Lori; Vaughn, Brittaney; Roper, Stephen M; Zaydman, Mark A; Jackups, Ronald; Riaz, Noor; Schamel, Kim P; Kelly, Jeannie C. (2025). Racial Equity in Urine Drug Screening Policies in Labor and Delivery.. JAMA network open, 8(3), e250908. https://doi.org/10.1001/jamanetworkopen.2025.0908
MLA
Azimi, Vahid, et al. "Racial Equity in Urine Drug Screening Policies in Labor and Delivery.." JAMA network open, 2025. https://doi.org/10.1001/jamanetworkopen.2025.0908
RethinkTHC
RethinkTHC Research Database. "Racial Equity in Urine Drug Screening Policies in Labor and ..." RTHC-05986. Retrieved from https://rethinkthc.com/research/azimi-2025-racial-equity-in-urine
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.