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While few people are criminally prosecuted for substance use during pregnancy, about 1 % of all newborns are reported to CPS related to maternal substance use during pregnancy, including cannabis use . In our study, fears of CPS involvement were reported by participants across racial/ethnic groups, but in actuality there are stark racial inequities in this reporting, with providers reporting 4–5 times more Black than white newborns . While legalization of cannabis may reduce some racial inequities imposed by the racist “War on Drugs” , state legalization does not change the federal status of cannabis as a Schedule 1 substance, nor does it necessarily change the CPS reporting policy in the state; further,vertical grow system CPS reporting policies do not necessarily distinguish between legal and illegal substances.Our research suggests legalizing cannabis for recreational purposes does not resolve the barriers that CPS reporting requirements impose on patient-provider discussion of cannabis use in pregnancy. Our finding that few participants ...
... reported their providers asking about cannabis echoes previous research finding that providers consider cannabis use in pregnancy to be lower priority to address with patients than other substances used in pregnancy , and that many providers do not respond to pregnant patients’ disclosure of cannabis use . This silence may be sending a health message: our study concords with prior research suggesting that some patients interpret providers’ silence on the topic as an indication that cannabis is safe to use in pregnancy . Provider silence on cannabis use in pregnancy is inconsistent with ACOG-recommended practices and educational messages and may limit opportunities for nuanced and patient-centered discussions about risks and benefits of continued use. Even when they do occur, though, patient-provider discussions of cannabis may not be nuanced and patient-centered. In our study, participants who discussed cannabis use with their providers reported hearing a wide range of health/risk messages, from endorsement of cannabis use, to recommended harm-reduction strategies, to what they experienced as threats of CPS reports. The spectrum of messages may reflect some providers’ attempts to acknowledge patients’ range of options on cannabis use in pregnancy . However, the inconsistency may also reflect providers’ uncertainty in the face of nascent and sometimes conflicting evidence on health effects of cannabis use in pregnancy . While this study was not designed to examine providers’ motivations for raising the possibility of a CPS report, this study strongly suggests that patients often interpret providers’ discussion of possible CPS report as a threat. Future research should examine providers’cannabis grow equipment behavior-change philosophies and approaches related to cannabis use in pregnancy, as well as their reasons for and approaches to discussing possible CPS involvement. This work has important implications. First, state-level legalization of cannabis does not address the CPS reporting policies that more commonly punish people who use cannabis during pregnancy. People concerned about pregnant people facing punishment for their cannabis use should focus on changing CPS reporting policies and not only general-population legalization policies. Second, in their committee opinion on cannabis and pregnancy, ACOG included a recommendation that providers inform patients “of the potential ramifications of a positive screen result , including any mandatory reporting requirements” .
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