Content Analysis of Maternal Toxicology Testing Policies to Inform Equity in Substance Use Disorder Identification

Abstract

Objective: Analyze existing hospital-level policies in New York City (NYC) regarding substance use and substance use disorders (SUDs) during the perinatal period to provide a comprehensive guide for hospital-level policy development, ensuring equitable maternal screening for substance use and SUDs.

Methods: Maternal toxicology policies were collected from eight NYC health systems between 1/1/2021 and 12/31/2022. One policy focused exclusively on neonate toxicology testing and thus was excluded. The remaining seven policies were de-identified and underwent a qualitative thematic content analysis using the Health Equity Impact Assessment framework. Two researchers conducted the thematic analysis, and two others reviewed identified themes for distinctions between policies.

Results: Seven hospital-level policies identified four distinct policy approaches (Types A, B, C, and D). The policies varied in their approach to prenatal substance use and SUD identification, highlighting gaps in knowledge and lack of standard guidelines. The different approaches involved combinations of standardized screening tools, toxicology tests, social service referrals, and patient consent procedures, among others. Researchers found that some policies may inadvertently reinforce stigma and bias due to a focus on high-risk characteristics not necessarily indicative of substance use or SUDs.

Conclusion: Multidisciplinary-informed evidence-based guidelines are needed to address substance use and SUDs during pregnancy. Our findings support the integration of evidence-based screening, brief intervention, and referral to treatment (SBIRT) into policies, and discourage sole reliance on toxicology tests for SUD identification. The study's findings can potentially guide the development of equitable and clinically useful maternal substance use and SUD policies, thereby improving dyad outcomes.

Keywords: Child welfare reporting; Health equity; Hospital policy analysis; Informed consent; Maternal toxicology testing; New York City health systems; Perinatal substance use disorders; Racial disparities in maternal care; SBIRT.