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Skelton K, Nyarko S, Iobst S. Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: A qualitative study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100274. [PMID: 39280985 PMCID: PMC11401156 DOI: 10.1016/j.dadr.2024.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024]
Abstract
Background Cannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women's lived experiences of being screened for cannabis use during pregnancy. Objective To explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period. Methods We conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors. Findings Most participants were 25-34 years of age (75 %, n=12), Black (75.00 %. n=12), and had less than a bachelor's degree (68.75 %, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use. Conclusions Findings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.
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Affiliation(s)
- K Skelton
- Department of Health Sciences, College of Health Professions, 251 Towson Way, Towson, MD 21204, United States
| | - S Nyarko
- Department of Health Sciences, College of Health Professions, 251 Towson Way, Towson, MD 21204, United States
- Department of Nursing, College of Health Professions, 251 Towson Way, Towson, MD 21204, United States
| | - S Iobst
- Department of Nursing, College of Health Professions, 251 Towson Way, Towson, MD 21204, United States
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Kurtz T, Charron E, Shakib J, Smid MC. Drug Testing Interpretation in the Peripartum Setting: Results of Clinician Survey. J Addict Med 2024; 18:595-598. [PMID: 38842171 DOI: 10.1097/adm.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The objectives of this study were to (1) survey obstetrical and pediatric clinicians' experience, confidence, and training in maternal and neonatal drug testing interpretation; (2) determine their proficiency in drug test interpretation; and (3) assess predictors of correct interpretation. METHODS We conducted a cross-sectional survey of clinicians caring for pregnant people or newborns at an urban academic center. We assessed clinicians' demographic characteristics, experience, confidence, and prior training in interpretation of maternal and newborn drug tests. We assessed proficiency in interpreting drug tests using 11 clinical vignettes and categorized scores as poor (0-2), fair (3-5), and good (≥6) performance to facilitate data interpretation. We used descriptive statistics to summarize responses. Multinomial logistic regression was used to determine associations of clinician characteristics and score category (reference category: poor performance). RESULTS In total, 103 respondents completed the survey including 60 obstetrical clinicians (58.3%), 19 family medicine physicians (18.5%), 21 pediatric clinicians (20.4%), and 3 social workers (2.9%) (response rate, ~40%). The mean correct response was 4.1 (SD, 2.17; range, 0-11). Most respondent scores were fair (n = 47.6%), followed by good (n = 28.2%) and poor (n = 24.3%). Increased frequency, confidence, and training in interpreting maternal screening and confirmatory tests were associated with higher proficiency. Increased confidence and training in interpreting neonatal screening and confirmatory tests, but not frequency, were associated with higher proficiency. CONCLUSIONS Most clinicians demonstrated fair proficiency in interpreting drug tests. Predictors of proficiency were confidence and prior training for drug test interpretation, suggesting that educational interventions could improve proficiency.
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Affiliation(s)
- Theresa Kurtz
- From the Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT (TK, MCS); Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK (EC); and Department of General Pediatrics, University of Utah Health, Salt Lake City, UT (JS)
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Brown HM, Roper SM, Dietzen DJ, Crews BO. High-sensitivity neonatal urine drug testing has similar positivity rates to meconium for detecting in utero exposure to methamphetamine and cocaine. J Anal Toxicol 2024; 48:99-103. [PMID: 37952088 DOI: 10.1093/jat/bkad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
Current guidelines recommend universal screening for substance use disorders in obstetric patients, and neonatal drug testing is also frequently performed. Meconium is often the preferred specimen type to detect neonatal drug exposure due to a longer window of detection compared to urine, but most laboratories send out meconium testing to specialized reference laboratories, which can delay results for several days or more. Here, we evaluate a rapid and definitive liquid chromatography-tandem mass spectrometry method for neonatal urine drug testing and compare results obtained using this method to paired meconium drug testing in 1,424 neonates for amphetamines, cocaine, cannabinoids, opiates, oxycodone and phencyclidine. Urine testing showed equivalent sensitivity to current meconium methods for detecting in utero exposure to amphetamines and cocaine.
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Affiliation(s)
- Hannah M Brown
- Department of Pathology & Immunology, Washington University School of Medicine, 425 So Euclid Ave., St. Louis, MO 63110, USA
| | - Stephen M Roper
- Department of Pathology & Immunology, Washington University School of Medicine, 425 So Euclid Ave., St. Louis, MO 63110, USA
- Department of Pediatrics, Washington University School of Medicine, 425 So Euclid Ave., St. Louis, MO 63110, USA
| | - Dennis J Dietzen
- Department of Pathology & Immunology, Washington University School of Medicine, 425 So Euclid Ave., St. Louis, MO 63110, USA
- Department of Pediatrics, Washington University School of Medicine, 425 So Euclid Ave., St. Louis, MO 63110, USA
| | - Bridgit O Crews
- Department of Pathology & Immunology, Washington University School of Medicine, 425 So Euclid Ave., St. Louis, MO 63110, USA
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Ceasar RC, Gould E, Laughter J, Granacki J, Kirsch K, Chauca E, Santos JJ, Becerra L, Cazares L, Habre R, Farzan S, Tamatam S, Nguyen RM, Breton CV, Bastain TM. "They might take my baby away:" Black and Latina peoples' experiences of using cannabis during pregnancy in California while engaged in perinatal care. J Perinatol 2023; 43:1497-1499. [PMID: 37731045 PMCID: PMC10716035 DOI: 10.1038/s41372-023-01781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Rachel Carmen Ceasar
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Erin Gould
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jen Laughter
- Department of Sociology, California State University, Fullerton, Fullerton, CA, USA
| | - Jordan Granacki
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Edward Chauca
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jasmeen Joy Santos
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lizbeth Becerra
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shohreh Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shreya Tamatam
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Mikeala Nguyen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kurtz T, Smid MC. Office-Based Management of Perinatal Substance Use and Substance Use Disorder for the General Obstetrician-Gynecologist. Obstet Gynecol Clin North Am 2023; 50:609-627. [PMID: 37500220 DOI: 10.1016/j.ogc.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
This is a review of substance use and substance use disorder in pregnancy, intended for the generalist obstetrician-gynecologist. Herein, the authors discuss legal considerations, outline definitions, review screening tools, introduce special considerations and harm reduction, caution the use of urinary toxicology testing, and touch on the screening, brief intervention, and referral to treatment model. Furthermore, the authors provide a brief overview of the prevalence, maternal and neonatal risks, and treatment approaches for commonly used substances.
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Affiliation(s)
- Theresa Kurtz
- Department of Obstetrics and Gynecology, University of Utah Health, 30 North 1900 East #2B200 SOM, Salt Lake City, UT 84132, USA.
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, University of Utah Health, 30 North 1900 East #2B200 SOM, Salt Lake City, UT 84132, USA
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Urine Drug Screening for Isolated Marijuana Use in Labor and Delivery Units. Obstet Gynecol 2023; 141:620. [PMID: 36800853 DOI: 10.1097/aog.0000000000005090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Urine Drug Screening for Isolated Marijuana Use in Labor and Delivery Units: Correction. Obstet Gynecol 2023; 141:422. [PMID: 36657149 DOI: 10.1097/aog.0000000000005063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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