Hospitals Often Failed to Screen Pregnant Cannabis Users for Substance Use or Refer Them for Support

Among 75 pregnant SUPPS patients with cannabis as primary drug of concern, their 232 ED presentations and 183 hospital admissions revealed significant gaps: cannabis use history was documented in only 34% of ED visits and 53% of admissions. Substance use screening was done in 45% of ED visits and 53% of admissions. Cannabis use status was asked in only 36% of ED visits. Referral to the substance use support service was made in only 7% of admissions and never from ED.

Retrospective medical record audit of 75 patients from a substance use in pregnancy and parenting service (SUPPS) in Australia who identified cannabis as their primary drug of concern and gave birth between January 2015 and May 2020. Their ED presentations and hospital admissions in the 12 months prior to delivery were examined.

Even among pregnant women already identified as having cannabis use concerns, hospital staff frequently failed to document or screen for substance use during acute care visits. This represents missed opportunities for intervention and support during a critical period for both mother and fetus.

These findings expose a systemic gap between identifying cannabis use as a concern in specialty pregnancy services and acting on that information during routine hospital encounters. The near-complete absence of ED referrals suggests emergency departments may not view cannabis use in pregnancy as warranting intervention.

Small sample (N=75) from a single Australian service. Retrospective audit may miss undocumented conversations. Patients were already engaged with a substance use service, so results may underestimate gaps for unidentified users. Does not assess whether screening or referral would have changed outcomes.