Perspectives and Preferences of Patients With Substance Use Disorder on Urine Toxicology Testing in Pregnancy

Objectives: Urine toxicology testing is a ubiquitous practice in pregnancy among patients with substance use disorder (SUD). However, little data exists on patient views of this consequential practice. We aimed to explore the perspectives of patients with SUD on the utility of urine toxicology testing in pregnancy and on toxicology processes to inform best practice. Methods: We conducted semistructured interviews with 15 pregnant and postpartum patients with SUD receiving care at an urban interdisciplinary obstetric and SUD clinic. Interviews explored patient experiences with urine toxicology testing, perceptions of risks and benefits, and opinions on optimal testing practices, including perspectives on a recently implemented toxicology testing policy. Interviews were recorded, transcribed, and analyzed using a combined deductive-inductive methodology to identify themes. Results: Participants supported urine toxicology testing as an accountability tool but expressed concerns about testing inaccuracy and its potential legal consequences. Many participants felt that confirmatory testing and a transparent, comprehensive consent process could mitigate these challenges. Experiences in a specialty SUD treatment program helped reduce testing stigma and improved overall care. The newly implemented urine toxicology testing policy, which included a detailed consent process, contrasted favorably with prior experiences of urine toxicology testing, where consent was often implied or incomplete. Conclusions: Clinicians and policymakers considering urine toxicology testing practice changes during pregnancy should consider patient perspectives and preferences as they work to optimize health for patients and their families.