In a Kaiser Permanente prenatal program, 80% of 20,398 pregnancies with positive cannabis screening completed substance use assessment, and 88% of those needing intervention attended counseling, showing comprehensive programs can effectively engage this population.
Obstetric providers, prenatal program designers, and health systems implementing substance use screening.
80% of pregnant cannabis users completed substance use assessment
What the researchers found
80.3% of cannabis-positive pregnancies completed assessment. Among 64% needing intervention, 88% attended counseling or treatment. Medicaid, anxiety, depression, and tobacco use disorders predicted higher odds of assessment. Older age (35+), greater parity, and later trimester assessment predicted lower odds. Nearly all psychiatric and substance use disorders predicted referral to addiction medicine treatment.
Why it matters
Prenatal cannabis use is rising, but engagement in assessment and counseling is poorly understood. This study shows a structured program can reach the vast majority of pregnant cannabis users, providing a model for other health systems.
The numbers in context
17,782 individuals; 20,398 pregnancies; 80.3% completed assessment; 88% of those needing intervention attended; 64% needed intervention based on assessment.
How the study worked
Retrospective cohort using EHR data from Kaiser Permanente Northern California Early Start program. 17,782 individuals with 20,398 cannabis-positive pregnancies (2011-2021). GEE multinomial logistic regression for predictors.
What this study cannot tell us
Single health system (Kaiser) may not represent other settings. Cannabis screening methods evolved over the study period. Outcomes limited to program attendance, not cannabis use reduction or pregnancy outcomes.
How to read the evidence
Large cohort (20,398 pregnancies) over a decade with detailed EHR data. Single health system limits generalizability.
When this study was published
2025 publication analyzing 2011-2021 Kaiser Permanente data.
The bigger picture
The high engagement rates suggest that barriers to prenatal substance use treatment are surmountable with systematic screening and integrated care. The lower engagement among older and multiparous women identifies specific groups needing targeted outreach.
Questions still open
- Does Early Start program attendance improve pregnancy outcomes for cannabis users?
- Why are older and multiparous women less likely to complete assessment?
Common questions
Do pregnant cannabis users engage in treatment?
Who is hardest to engage?
Read the original research
Predictors of Participation in Prenatal Substance Use Assessment, Counseling, and Treatment Among Pregnant Individuals in Prenatal Settings Who Use Cannabis.
Journal of addiction medicine, 19(2), 179-186
Citation
Lapham, Gwen T; Chi, Felicia W; Young-Wolff, Kelly C; Ansley, Deborah; Castellanos, Carley; Does, Monique B; Asyyed, Asma H; Ettenger, Allison; Campbell, Cynthia I. (2025). Predictors of Participation in Prenatal Substance Use Assessment, Counseling, and Treatment Among Pregnant Individuals in Prenatal Settings Who Use Cannabis.. Journal of addiction medicine, 19(2), 179-186. https://doi.org/10.1097/ADM.0000000000001399
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