Drug screening in an obstetric population: Cost analysis

OBJECTIVE: To evaluate a policy of random drug screening in an inner-city, indigent population. METHODS: All women receiving care in our OB clinic complete a questionnaire about drug use and have a urine drug screen (UDS) at their first visit. Women with a history of drug use or a positive UDS are retested at monthly intervals, intrapartum, and with the development of complications. Each UDS is analyzed for 4 substances: marijuana (THC), cocaine (COQ, opiates (OPU), and phencyclidine (PCP). The laboratory charges $28/anaIyte tested for a total of $112/screen. Drug test results are stored in the laboratory database. Women seen in the clinic, L&D triage area, and OB inpatient senice were identified and the UDS results transferred into a database (SAS). RESULTS: To date, 1218 OB patients with UDS were identified. One hundred and three women (7.8%) had at least one positive UDS; of which 95 (92%) were detected with the first UDS. The questionnaire was completed by 94 of the 103 women; with 23 (25%) admitting current drug use. In women with a positive UDS on the first visit, an additional 128 UDS were performed at a cost of $14,336. Sixty seven women with a negative initial UDS were retested (ninety five tests). These additional tests cost $10,640 and identified 9 women, 2 known drug abusers. The most commonly detected drug of abuse was THC (38/1516 tests, 6%) followed by COC (38/1516 tests, 2.5%), OPU (22/1516, 1.5%) and PCP (8/1516, 0.5%). A total of $169,792 was spent to identify 103 women who use drugs or $1648/case. CONCLUSIONS: The incidence of drug use in our clinic was 7.8%; with 92% identified with the first UDS. A policy of routine UDS even in a high risk population is expensive. $1648/case identified. If routine UDS is to be used, it should be limited to those drugs commonly detected. For example, if" PCP were eliminated from our testing scheme, $42,448 would be saved. UDS in women who report drug use or are detected on UDS are unnecessary, unless it is part of an integrated substance abuse prevention program. The money spent on retesting women would have paid for a full time counselor in our clinic.