RE: “Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” by Shetty et al

“Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals” shares a thorough qualitative analysis of how structural racism via disproportionate substances testing and subsequent child protective service (CPS) referrals impacts Black families. [1] Marijuana is a frequently highlighted substance in the article’s study. Black families were disproportionately tested for marijuana, leading to higher positive screens and negative downstream ramifications. The recent federal decriminalization of marijuana should be considered when enacting policy regarding substance testing. Doing so may aid in deconstructing racist policy for Black birthing families.

19% of Americans have used marijuana at least once. [2] Marijuana was disproportionately screened for in Black birthing families, though the article has shown that their white counterparts use it just as frequently. In May 2024, the federal government moved to decriminalize marijuana from a Schedule I to Schedule III substance. [3] Tobacco has similar prenatal risks compared to marijuana. Both substances are associated with increased rates of neonatal intensive care unit admissions, lower APGAR scores, lower birth rates, and higher incidence of stillbirths. [4] Since there is no national standard of policy that recommends substance testing on intrauterine tobacco exposure, there should not be for marijuana either. Current American College of Obstetrics and Gynecology recommendations are simply to screen for tobacco use during pregnancy and to assist with cessation. [5] Marijuana use can be treated similarly, which would lead to decreased discriminatory substance testing and subsequent CPS referrals that place undue bias against Black birthing families.

With the decriminalization of marijuana, our efforts should focus on encouraging cessation with structured resources rather than punitive action with biased substance testing. Evidence-based interventions may include patient-centered motivational interviewing and cognitive behavioral therapy sessions. Shifting hospital policies to focus on support will overall reduce discriminatory CPS referrals for Black families. These actions will aid in the dismantling of racist policies in the newborn nursery.
 
References
1. Shetty, Carol, et al. “Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.” The Annals of Family Medicine, vol. 22, no. 4, 1 July 2024, pp. 271–278, www.annfammed.org/content/22/4/271, https://doi.org/10.1370/afm.3139.
2. Substance Abuse and Mental Health Services Administration. “2021 NSDUH Annual National Report | CBHSQ Data.” Www.samhsa.gov, 4 Jan. 2023, www.samhsa.gov/data/report/2021-nsduh-annual-national-report.
3. “U.S. Drug Enforcement Administration Proposes Reclassification of Marijuana | Insights | Holland & Knight.” Www.hklaw.com, www.hklaw.com/en/insights/publications/2024/05/us-drug-enforcement-admin....
4. Zoorob, Roger, and Jeffrey D. Quinlan. “Cannabis Use during Pregnancy.” Family Practice Management, vol. 31, no. 4, 2024, pp. 19–21, www.aafp.org/pubs/fpm/issues/2024/0700/cannabis-during-pregnancy.html.
5. “Tobacco and Nicotine Cessation during Pregnancy.” Www.acog.org, www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/...