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.
Obstetricians, neonatologists, healthcare equity researchers, child welfare advocates, cannabis policy makers.
Black newborns were drug-tested at 3.8x the rate of White newborns without clinical indication
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Well-designed retrospective cohort study with large sample size at a single institution. Findings may not generalize to all hospitals.
When this study was published
Published in 2023 (JAMA Network Open) using data from 2014-2020.
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.
Questions still open
- 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?
Common questions
Are newborn drug tests applied equally across races?
Did cannabis legalization reduce testing disparities?
Read the original research
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
Citation
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
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide