Muristek
In Reply We appreciate the comments by Drs Minkoff and Ecker on our Research Letter and value the opportunity to clarify the prenatal substance use screening process used by Kaiser Permanente Northern California (KPNC). Pregnant patients are advised of all recommended laboratory tests, including the urine toxicology test, and they have the option to decline any or all of them. This process reduces concerns about race-based testing while still respecting patients’ rights to choose which tests they undergo. In California, a positive toxicology test result during pregnancy on its own is not enough to file a child abuse or neglect report. For this reason, KPNC can offer universal and confidential urine toxicology testing in a way that is supportive and nonpenalizing, thus increasing participation in our effective and easily accessible Early Start program. This program, which offers substance use assessment, education, and patient-centered, nonpunitive counseling linked to prenatal care for all patients who use substances during pregnancy, has been associated with improved perinatal outcomes and reduced health care costs.
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