Urine Drug Testing in the OB/GYN office

In 2010 James J. Nocon, MD, JD, Chairman of the Indiana Prenatal Substance Abuse Commission and Director of the Prenatal Recovery Clinic At Wishard Memorial Hospital did a power point presentation titled, “Incorporating Screening for Substance use into Routine Prenatal Care”.  The purpose of this excellent presentation was to, “help physicians recognize the ethical and legal duty to screen for substance use in pregnancy” and to “advocate detection and treatment of addiction during pregnancy”.  While Dr. Nocon noted that screening for hypertension, diabetes and STD’s is recognized standard of care in pregnancy, he boldly claims drug use results in more fetal harm and preterm delivery than all three of these combined.  We all realize the controversial emotions this subject raises, however none of us can deny the importance of protecting the unborn child as well as the mother.  Currently 18 states have some form of legislation that considers illegal drug usage during pregnancy child abuse.  At this time only the state of Tennessee has made it a criminal act. Prior to the government getting involved with legislating, the percentage of women who willingly self reported the use of illegal drugs was low. Due to the current environment, the self reporting percentage appears to be dropping even more.  The fact still remains, if the pregnant mother is not drug tested, the physician does not know if she is using an illegal substance.  All providers recommend expecting mothers refrain from alcohol and nicotine, yet statistics show among women who use both alcohol and nicotine 20.4% use marijuana and 9.5% use cocaine.  In his presentation Dr. Nocon states, “Detection alone will result in 50-55% of patients using ATOD to stop using during pregnancy”. One overused argument against universal drug screening for pregnant women is the cost of testing, however facts reveal preterm delivery accounts for the greatest amount of infant mortality, morbidity and medical costs in the first year of life.  If the process of detection is, in fact, intervention as Dr. Nocon states, and it is the health care providers duty to intervene when the health of the baby could be in jeopardy, drug screening of pregnant women should also be standard in prenatal care.  According to the JAMA, the rate of NAS (Neonatal Abstinence Syndrome) rose by 300 percent from 2000 through 2009.  In 2012 it was published in The Study Journal of the AMA that one drug dependent baby is born every hour in the US. Yes this also included those women who used alcohol which is included in a normal screen. Ultimately until the government legislates universal drug testing for pregnant women, the choice is still in the hands of the Ob/Gyn whether to drug screen or not, however, the unborn child does not get to choose alcohol, nicotine or other drugs if the mother is using.