Longitudinal trends in meconium drug detection in 46 US states between the years 2015-2020.

BACKGROUND: Maternal drug use during pregnancy has significant health and socio-legal implications. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes self-reported rates of drug use during pregnancy; however, comprehensive long-term laboratory data on neonatal drug exposure are lacking.

METHODS: Over 175,000 meconium specimens originating from 46 US states were analyzed at ARUP laboratories between the years 2015 and 2020. A retrospective investigation of drug positivity rates, multidrug detection, and median drug concentrations was conducted for 28 compounds in 6 drug classes.

RESULTS: The overall meconium drug positivity rate was lowest in 2015 (47.3%), which increased over six years, reaching a peak in 2020 (53.4%). 11-Nor-9-carboxy-Tetrahydrocannabinol (THC-COOH) was the most frequently detected compound across all six years. The second most frequently detected analyte was morphine in 2015-2016 and amphetamines in 2017-2020. THC-COOH positivity rate rose from 29.7% in 2015 to 38.2% in 2020. The positivity rates for stimulants also increased in the range of 0.4-2.9% in 2020 compared to 2015. Conversely, opioid positivity rates declined in the range of 1.6-2.3% in 2020 as compared to 2015. The most common two-drug combination was THC-COOH¯opioids (2.4%) in 2015-2016, which was replaced by THC-COOH‒amphetam‒ines (2.6%) in 2017-2020. The most common three-drug combination was THC-COOH¯opioids¯amphetamines throughout all six years.

CONCLUSION: Neonatal drug exposure positivity rates have increased over the past six years based on retrospective data analysis from the patient population submitted for testing at ARUP Laboratories.