Black Newborns Were Drug-Tested More Often Than White Newborns Even Without Risk Factors, and Cannabis Legalization Did Not Reduce the Disparity
In a study of 26,366 births, clinicians ordered newborn drug tests more frequently for Black newborns (7.3%) than White (1.9%) even when no prenatal drug testing had been done, and while THC-positive tests increased after recreational cannabis legalization, the racial disparity persisted unchanged.
Quick Facts
What This Study Found
NDT was ordered for 7.3% of Black vs. 1.9% of White newborns when no prenatal urine drug test was done. 43.3% of positive NDTs detected only THC. THC positivity was higher in Black (67.2%) vs. White (51.8%) newborns. Opioid positivity was higher in White (22.2%) vs. Black (9.4%) newborns. THC-positive NDTs increased significantly after legalization (50.3% to 68.9%). Racial disparities persisted unchanged after legalization.
Key Numbers
N=26,366 births. NDT ordered: 4.7% overall. Black without prenatal testing: 7.3% vs. White: 1.9%. THC-only positive: 43.3%. Post-legalization THC positivity: 68.9% vs. pre: 50.3%. Racial disparity unchanged after legalization.
How They Did This
Retrospective cohort study of 26,366 live births at an academic medical center in the Midwestern US from 2014-2020, examining variations in NDT ordering and results by birthing parent race/ethnicity before and after 2018 recreational cannabis legalization.
Why This Research Matters
Disproportionate newborn drug testing of Black families, particularly without clinical indication, can trigger Child Protective Services investigations that disrupt families. Cannabis legalization was hypothesized to reduce this disparity, but it did not.
The Bigger Picture
This study illuminates how institutional practices in healthcare can perpetuate racial disparities even in the context of changing drug policy. The fact that Black newborns are tested more without clinical justification points to implicit bias in clinical decision-making.
What This Study Doesn't Tell Us
Single academic medical center. Cannot determine why clinicians ordered NDTs (implicit bias vs. undocumented clinical factors). NDT ordering criteria may vary by institution. Pre-post legalization comparison cannot control for all concurrent changes. Retrospective design.
Questions This Raises
- ?Would standardized NDT protocols based on clinical criteria reduce racial disparities?
- ?Should cannabis be excluded from newborn drug testing panels in states where it is legal?
Trust & Context
- Key Stat:
- Black newborns were drug-tested at 3.8x the rate of White newborns without clinical indication
- Evidence Grade:
- Well-designed retrospective cohort study with large sample size at a single institution. Findings may not generalize to all hospitals.
- Study Age:
- Published in 2023 (JAMA Network Open) using data from 2014-2020.
- Original Title:
- Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization.
- Published In:
- JAMA network open, 6(3), e232058 (2023)
- Authors:
- Schoneich, Sebastian, Plegue, Melissa, Waidley, Victoria, McCabe, Katharine, Wu, Justine, Chandanabhumma, P Paul, Shetty, Carol, Frank, Christopher J, Oshman, Lauren
- Database ID:
- RTHC-04920
Evidence Hierarchy
Frequently Asked Questions
Are newborn drug tests applied equally across races?
No. In this study, Black newborns were tested at 3.8 times the rate of White newborns even when no prenatal drug testing had been done, suggesting the disparity is not based on clinical risk factors alone.
Did cannabis legalization reduce testing disparities?
No. While THC-positive test rates increased after legalization, the racial disparity in who gets tested persisted unchanged.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-04920APA
Schoneich, Sebastian; Plegue, Melissa; Waidley, Victoria; McCabe, Katharine; Wu, Justine; Chandanabhumma, P Paul; Shetty, Carol; Frank, Christopher J; Oshman, Lauren. (2023). Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization.. JAMA network open, 6(3), e232058. https://doi.org/10.1001/jamanetworkopen.2023.2058
MLA
Schoneich, Sebastian, et al. "Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization.." JAMA network open, 2023. https://doi.org/10.1001/jamanetworkopen.2023.2058
RethinkTHC
RethinkTHC Research Database. "Incidence of Newborn Drug Testing and Variations by Birthing..." RTHC-04920. Retrieved from https://rethinkthc.com/research/schoneich-2023-incidence-of-newborn-drug
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.