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Study breakdown

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

Retrospective CohortPreliminary evidence
The takeaway

Among 75 pregnant women who reported cannabis as their primary drug concern, cannabis use was documented in only 34% of their ER visits and substance screening was done in only 45%.

Emergency physicians, obstetricians, hospital quality improvement teams, substance use counselors.

Only 34% of ER visits documented cannabis use

What the researchers found

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.

Why it matters

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.

The numbers in context

75 patients. 232 ED presentations. 183 hospital admissions. Cannabis documented in 34% of ED visits, 53% of admissions. Screening done in 45% of ED/53% of admissions. Referral to SUPPS: 7% of admissions, 0% from ED. Withdrawal documented in 3% of ED/13% of admissions.

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Preliminary: small retrospective audit (N=75) from a single service, though findings are consistent with broader healthcare documentation gaps.

When this study was published

2025 study (data from 2015-2020)

The bigger picture

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.

Questions still open

  • Would systematic ED screening and referral protocols improve outcomes for pregnant cannabis users? Why is there such a disconnect between specialty identification and acute care documentation? Are similar gaps present for alcohol and other substances?

Common questions

Do hospitals screen pregnant women for cannabis use?
In this Australian study, even among women already identified as having cannabis concerns, substance use screening was done in less than half of ER visits and hospital admissions.
Were pregnant cannabis users referred for help?
Referrals to substance use support services were made in only 7% of hospital admissions and never from the emergency department, representing significant missed opportunities for intervention.

Read the original research

A retrospective medical record audit of the management of cannabis-related emergency department presentations, hospital admissions and hyperemesis of pregnant women who self-reported non-medicinal cannabis use to a substance use in parenting and pregnancy service.

Drug and alcohol review, 44(4), 1036-1048

Citation

Qian, Siyu; Seddon, Sarah. (2025). A retrospective medical record audit of the management of cannabis-related emergency department presentations, hospital admissions and hyperemesis of pregnant women who self-reported non-medicinal cannabis use to a substance use in parenting and pregnancy service.. Drug and alcohol review, 44(4), 1036-1048. https://doi.org/10.1111/dar.14059

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