Pregnant people’s experiences discussing their cannabis use with prenatal care providers in a state with legalized cannabis

• Published in: Drug and alcohol dependence Vol. 227; p. 108998
• Main Authors: Woodruff, Katie, Scott, Karen A., Roberts, Sarah C.M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-10-2021; Elsevier Science Ltd
• Subjects: Cannabis; Cannabis legalization; Child; Child welfare; Children; Counseling; Decriminalization; Drug use in pregnancy; Ethnicity; Fear & phobias; Female; Hallucinogens; Health care; Health care industry; Health services; Humans; Interviews; Legalization; Legislation, Drug; Marijuana; Medical personnel; Minority & ethnic groups; Patient counseling; Patients; Postpartum Period; Pregnancy; Prenatal Care; Prenatal substance use; Race; Socioeconomic factors; Sympathy; Marijuana; Cannabis; Prenatal substance use; Drug use in pregnancy; Patient counseling; Cannabis legalization
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2021.108998

•We explored how cannabis legalization affects patient-provider interactions re: prenatal use.•We interviewed a diverse sample of people who used cannabis in pregnancy post-legalization.•Most did not disclose use to providers, due to fear of child protective services (CPS) reporting.•Those who did discuss cannabis with providers reported a mix of health messages and legal threats.•Despite cannabis legalization, fear and threat of CPS inhibits patient-provider interactions.
As cannabis legalization spreads, so do concerns about potential harms from use during pregnancy. Legalization may facilitate improved patient-provider interactions about cannabis use. Yet little is known about pregnant people’s discussions of cannabis use with healthcare providers in an environment where recreational cannabis is legal.
In May-August 2019, we conducted semi-structured in-depth interviews with 33 pregnant or postpartum people in California who used cannabis during pregnancy, and explored their discussions with healthcare providers about their cannabis use. We audio-recorded and transcribed interviews, and conducted thematic analysis using inductive and deductive methods.
Participants were diverse by age, race/ethnicity, and socio-economic position. Most reported daily cannabis use, both before and during pregnancy. Most participants did not disclose their cannabis use to their prenatal care providers, due to fears of being reported to child protective services (CPS), or fears of provider judgment. Participants reported that few providers initiated any discussions about cannabis use in pregnancy with them; some participants interpreted this omission as tacit endorsement of cannabis use in pregnancy. When participants and providers did discuss cannabis use in pregnancy, participants heard a wide range of sometimes-conflicting health messages, as well as some legal threats.
This study documents notable deficits in patient-provider interactions about cannabis. Pregnant patients’ fears of being reported to CPS and separated from their children for cannabis use persist despite cannabis legalization. Providers’ role as potential reporters to CPS appears to pose a significant barrier to comprehensive, compassionate counseling and education on cannabis use in pregnancy.