![]() ![]() Millions of people are affected by this epidemic, which does not discriminate by age, gender, race, geographic area, or socio-economic status ( Manchikanti et al., 2012 Metz et al., 2018). In the 21st century, North America has experienced an increase in the use of prescription and non-prescription opioids, so large and rapid that it has become an epidemic ( Okie, 2010 Metz et al., 2018). Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels. However, women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. They also have great promise for public health monitoring, policy development, and resource allocation. Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis. The drive for ever greater accuracy and sensitivity must be balanced with the necessities of medical practice requiring minimally invasive sampling, rapid turnaround, and techniques that can be realistically utilized in a clinical laboratory. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques. A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair neonatal meconium, urine, and hair and placenta and umbilical cord tissues. The prevalence of drug misuse in pregnancy is not well quantified due to the lack of good validated tests, cooperation between clinicians and scientists developing tests, and consensus as to who should be tested and how results should be used. Pregnant women are not immune to the ravages of substance misuse which affects themselves, their pregnancies, and the wider community. North America is currently suffering from one of the worst epidemics of illicit drug use in recent history: the opioid crisis. ![]()
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