How cannabis legalization is changing prenatal screening practices

This qualitative study examines how healthcare systems across the United States screen, test, and report prenatal cannabis use—and how these practices vary depending on whether states have legalized recreational cannabis. Researchers interviewed 22 registered nurses from 15 states with different cannabis legalization statuses. The findings reveal significant inconsistencies with clinical guidelines: while universal verbal screening occurred in nearly all states, about one-quarter of states reported universal maternal toxicology testing despite this not being recommended by clinical standards. Most concerning, nurses in most states described policies of reporting positive results to social work or child protective services, even though these practices lack strong clinical justification.

The study uncovered several troubling patterns that highlight ethical concerns in current practice. When prenatal cannabis use was detected, some healthcare providers discouraged breastfeeding—a response not supported by evidence and one that could harm mothers and infants, particularly in vulnerable populations. Nurses also reported ethical violations including biased testing rationales, lack of informed consent, and using threats of legal consequences to pressure pregnant women into testing. These practices reflect a significant gap between what clinical guidelines recommend and what actually happens in hospitals and clinics across different states.

The research suggests that state-level cannabis legalization does influence screening and testing policies, but not always in positive directions. Rather than clarifying practices, legalization appears associated with confusion about appropriate clinical protocols. The findings underscore the need for standardized, evidence-based guidelines that balance legitimate medical concerns with ethical practices, informed consent, and health equity—ensuring pregnant women receive care based on science rather than state policy or clinical assumptions about cannabis use.