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.
Hospital administrators, maternity care providers, health equity researchers, policy makers
Racial disparity in testing eliminated: 4.5% vs 3.6% post-intervention
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Moderate: large quality improvement study with clear before-after comparison, but single center and unable to isolate individual intervention components
When this study was published
Published in 2025 (JAMA Network Open) using 2021-2024 data
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.
Questions still open
- 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?
Common questions
Did removing cannabis from screening criteria lead to missed substance use?
Why were Black patients tested at higher rates before the change?
Read the original research
Racial Equity in Urine Drug Screening Policies in Labor and Delivery.
JAMA network open, 8(3), e250908
Citation
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