Community-Wide Estimation of Illicit Drug Use in Delivering Women: Prevalence, Demographics, and Associated Risk Factors

OBJECTIVE:To determine the community-wide prevalence of illicit drug use in delivering women and to compare rates in women delivering in an urban center serving the medically indigent with those delivering in private hospitals. METHODS:Over 6 weeks, 1062 urine samples were obtained anonymously from women presenting for delivery in seven hospitals in the Jacksonville, Florida area. All urine samples were analyzed blindly for illicit drugs using fluorescent polarized immunoassay. RESULTS:The percentage of women with positive urine toxicology was 7.1%. Positive results were more frequent in the public hospital population (12.7%) than the private hospital population (3.9%). The prevalence of cocaine use was 2.1% and marijuana 5.3%. Urine positivity was similar in black and white women, with cocaine metabolites more prevalent in black women and cannabinoids more common in white women. Women with positive screens for cocaine were more likely to use tobacco and alcohol, admit to substance abuse, and receive limited prenatal care. Women with positive screens for marijuana were difficult to differentiate from the urine-toxicology-negative group. CONCLUSIONS:Urine samples positive for illicit drugs were significantly more common in women delivering in an urban center serving the indigent population than in those delivering in private hospitals. Based on associated factors, cocaine users fit a more identifiable profile than marijuana users. The overall incidence of positive urine toxicology was no different in black and white pregnant women, but the more frequent finding of cocaine metabolites in black women may lead to biased over-reporting of substance abuse in this population.