Urine drug tests can be done for every patient in every hospital…but they aren’t. And that lack of testing everyone who is hospitalized could be considered discriminatory, especially when the group of patients all being tested, under the guise of not discriminating, is pregnant people, as if pregnant people are the only ones who may have substance use disorders (SUDs) who are showing up at hospitals.
But wait…they are the only ones carrying another life, so there’s that. And therein lies the dilemma: “universal” urine drug screens aren’t really universal when only pregnant people are tested. Yes, we absolutely want to give neonates their best chance to start life in the healthiest way, but discrimination is discrimination. Whose need supersedes?
If we are truly interested in making sure neonates have the best possible chance to start life in the healthiest way possible, we would universally test those neonates for prenatal exposure to alcohol and other drugs, not test their delivering parent for recent drug use. Throughout the nation we universally screen all neonates for myriad blood disorders – 48 in the state of Wisconsin – with the goal of the Wisconsin Newborn Screening program being “to make sure that all Wisconsin newborns are screened, diagnosed, and treated for certain conditions.” One of the conditions screened for is detected in 1 in 70,000 to 218,000 newborns (Medline); another, 1 in 220,000 births (NCBI); one more is 1 in 100,000 to 230,000 worldwide (Orpha). One, cystic fibrosis, occurs in 1 in 3,000 to 4,000 births in the US each year. The recently added Pompe disease affects 1 in 18,711 births annually in the US (PMC10810242), and sickle cell disease affects 1 out of every 365 Black births and 1 out of every 16,300 Hispanic births in the US (CDC).
I’m not going to outline all 48 different conditions that neonates are screened for, but it seems evident that we aren’t screening for the one that impacts the most neonates: prenatal substance exposure. For those exposed to the mood-altering substances of alcohol, opioids, marijuana, or cocaine before they were born, the ratio is 1 in 12 (TheConversation). That’s 8 percent of the newborn population, a huge percentage of whom we are not testing!
So we’re interested in screening, diagnosing, and treating certain conditions, but one of the most prevalent, that is, prenatal exposure to alcohol and other drugs, we’ve left to chance.
Universal drug testing – and remember that alcohol is one of the most dangerous drugs that is widely used – of umbilical cord tissue is truly showing we want the best for neonates. Self-reports of substance use are notoriously inaccurate, by anywhere from 15% – 60% (PMC4713294; Science), risking the health of those affected neonates who would otherwise never be treated, due to the pregnant person indicating a lack of use despite use having occurred, is a poor approach to health births.
References
https://www.cdc.gov/sickle-cell/data/index.html
https://medlineplus.gov/genetics/condition/argininosuccinic-aciduria/
https://www.ncbi.nlm.nih.gov/books/NBK1458/
https://www.orpha.net/en/disease/detail/134
https://pmc.ncbi.nlm.nih.gov/articles/PMC10810242/
https://pmc.ncbi.nlm.nih.gov/articles/PMC4713294/
https://www.sciencedirect.com/science/article/pii/S089085672300045X
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