“The pregnant woman should be asked to provide informed consent for urine, blood, or saliva screenings for substance use. Although oral informed consent is used in many labor-and-delivery clinics, a signed paper or electronic form is preferred.”
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As we work towards implementing nonjudgmental, universal verbal screening for substance use among pregnant women in our state, questions have been raised about the appropriate and responsible use of urine drug screens (UDS) in this context. While each facility determines what this looks like for themselves, we also want to ensure pregnant women across North Carolina receive equitable and evidence-based care.
Below you’ll find brief summaries of the guidance on these issues from a range of leading professional organizations to help inform these discussions.
Recommended universal, routine verbal screening practices: ACOG, ASAM, SMFM, AAP, the U.S. Preventive Services Task Force and WHO all endorse the use of validated verbal screening tools, administered universally, as the preferred method for initial screening for substance use. ACOG further states, “Routine laboratory testing of biologic samples is not required.”
Indication for UDS: ACOG describes the indication for UDS as follows,
“UDS is useful in monitoring patients with or at high risk of SUD, as well as patients receiving controlled substances as part of pain management or SUD medication assisted treatment. The physician should be aware of metabolism pathways and careful with panel selection as some of the more common drugs of use are not part of the standard panel.”
Informed Consent for UDS: There is broad alignment from leading organizations including ACOG, ASAM, AAP, and SAMHSA in practice recommendations and guidelines around the importance of patient informed consent when a UDS is indicated. SAMHSA specifically recommends the following:
“The pregnant woman should be asked to provide informed consent for urine, blood, or saliva screenings for substance use. Although oral informed consent is used in many labor-and-delivery clinics, a signed paper or electronic form is preferred. The healthcare professional should review with the pregnant woman the risks and limitations of each type of test and the need for confirmatory testing for any positive results (e.g., using gas chromatography/mass spectrometry confirmation) and ensure that she understands the process and meaning of test results before specimen collection (e.g., known false-positive test results may be due to cross-reactions of other substances such as cold medicines, which can produce a positive amphetamine result). It is helpful to ask the pregnant woman what, if anything, she expects might be detected and to give her an opportunity to describe her substance use patterns and behavior.”
ACOG and ASAM further state, “Pregnant women should be informed of the potential ramifications of a positive test result, including any mandatory reporting requirements.”
Substance use screening with pregnant women presents an opportunity for perinatal healthcare providers to further develop partnerships with their patients. Alignment with best practice recommendations around perinatal substance use screening can help to foster an environment where women feel safe and supported – a fundamental element of quality care.
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Don’t be afraid, I’m just like you:
Conversations with helping professionals in recovery
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Join us Wednesday, June 23rd, 12:00 – 1:00 for powerful stories of experience and conversation with Nicole Ross, Dan Pizzo, and Eric Holt - helping professionals in recovery and passionate advocates for women and families experiencing substance use disorder. Bring your lunch and questions to this webinar sure to offer compelling insights into lived experiences at the intersection of substance use disorders; childbirth and parenting, and the healthcare and social service systems.
Nicole Ross, MA, LCAS, NCCPSS, is a mother of four from the mountains of Western North Carolina in long term recovery from drug and alcohol misuse. She is a proud recovery advocate and counselor for women and mothers struggling with substance use disorder. She recognizes that like addiction, recovery has many faces, so there is no “one size fits all” path to wellness and she spends any time she can championing that message, so other women feel less alone in their journeys. She enjoys good books, great coffee, and art journaling and serves as the program director of BHG, a medication-assisted treatment facility in Asheville.
Dan Pizzo has most recently been the Sobriety Treatment and Recovery Team Social Work Supervisor at Buncombe County HHS; it is the first addiction specialty team of its kind at a Child Welfare Agency in NC. He feels privileged to have worked with an amazing team to support families struggling with drug and alcohol use co-occurring with child maltreatment in rapid linkage to intensive treatment and supports in order to minimize separations and keep family units intact through recovery. As a parent in long-term recovery, he personally experiences the joy of reclaiming and rediscovering lost parts of himself as he learns and plays alongside his children and provides a safe and nurturing environment. Dan is passionate about building connections in the community and working in partnership with families and organizations to bring hope and holistic wellness.
Eric Holt, NCCPSS, is in long-term recovery from alcohol and methamphetamine misuse. He is a survivor of sexual assault and is currently thriving as a person living with HIV. Eric feels his greatest assets are his relationships, truth, and integrity. He enjoys giving back to his community what was so freely given to him. Eric married his husband Brian during the pandemic, and they recently purchased a new home in Waynesville, NC. He is an impact associate at Dogwood Health Trust and loves being a part of an organization committed to diversity, equity and inclusion while helping amazing organizations in WNC working to achieve generational change.
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clOUDi Learning Session 2 |
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It’s coming!! clOUDi Learning Session 2 is coming! It is August 18th from 9-12. It is virtual. It will be our last forced virtual session. We are determined to make this a memorable event.
What will make it memorable? You telling us about how you and your team, under great duress, have made strides in working with women and babies dealing with the effects of substance use disorder. The substance use epidemic has risen to even more catastrophic levels as we have dealt with the challenges of Covid. Your efforts to screen women more effectively for substance use disorder and transition care to Eat Sleep and Console for infants at risk for withdrawal need to be shared.
Here is our ask. We would like each of our clOUDi teams to create a short video describing efforts made at your hospital to support the aims of the clOUDi initiative. It is our hope in these videos teams might report on successes of interventions as well as challenges encountered. This video need be no more than 5-10 minutes. Include as many team members and their perspectives as you can. Consider including patients and parents who are willing to speak to your efforts and care. This is how we learn. At a PQCNC learning session all are able to teach and we all are able to learn. Your experiences mean everything. Please share them with us.
We will display videos during our August 18th Learning Session. We will have opportunities for input from all and to discuss and identify what will undoubtedly be critical learning points.
Videos can be any format you like. If you have any questions on how to video, how to share, how to email, how to get your unique and invaluable expereince to us to share with the rest of clOUDi, the man with the plan is Keith Cochran at keith_cochran@unc.edu
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Simple test to predict premature deliveries
Mira Moufarrej, a Stanford bioengineering graduate student has developed simple blood tests that identify pregnancies at risk of preterm birth, as well as
preeclampsia, accurately and early. Read more
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Keith M Cochran
984-974-7871
'Unoffice' hours - click here to schedule a Zoom meeting
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