A new study published in the Journal of Racial and Ethnic Health Disparities found significant racial differences in how Black mothers and newborns affected by opioid exposure are screened, assessed, and treated within hospital systems.
Researchers reviewed records from two large Midwestern health systems between 2016 and 2022. They found that Black infants exposed to opioids in utero were significantly less likely than white infants to be screened for neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome. Underscreened infants may be missing critical treatments for NOWS, including morphine (the most common first-line agent) and adjuncts phenobarbital and clonidine.
The study found that Black infants had 59 percent lower odds of receiving a Finnegan score, a commonly used tool to assess withdrawal symptoms in newborns. Even when Black infants were screened, they were less likely to receive scores indicating severe withdrawal, which affected whether they ultimately received treatment.
The findings suggest these inequities may extend beyond individual clinicians and reflect broader systemic issues within maternal substance use care. Differences in hospital protocols, inconsistent screening practices, and subjective clinical assessments may all contribute to unequal treatment.
One concern raised in the study is the use of the Finnegan scoring system itself. Because the tool relies partly on clinician judgment, providers may interpret the same symptoms differently. Previous research cited by the authors found that Black infants displaying similar withdrawal symptoms as white infants were sometimes assigned lower scores, making them less likely to qualify for treatment.
The study notes that these patterns mirror broader racial disparities in healthcare, where Black patients’ symptoms and pain are often underestimated.
The researchers also found inequities in care before delivery. Black women with opioid use disorder are less likely to receive medications for opioid use disorder (MOUD), including methadone or buprenorphine, during pregnancy. Delayed diagnosis, inconsistent screening, stigma, and fear of criminalization or child protective services involvement may discourage some patients from seeking care early.
Hospital systems may unintentionally worsen disparities when screening decisions rely heavily on provider discretion rather than on standardized protocols. Subjective assessments can allow implicit bias to influence which patients receive testing, monitoring, or treatment.
The paper also discusses the increasing use of the “Eat, Sleep, Console” (ESC) model, which prioritizes non-pharmacologic interventions such as breastfeeding, skin-to-skin contact, swaddling, and caregiver soothing before medication is used. ESC was developed in part because of subjectivity issues with the Finnegan scoring system. Researchers caution that even newer care models can perpetuate disparities if supportive interventions are not implemented consistently across racial groups.
The authors outlined several steps hospitals and clinicians can take to improve equity in maternal substance use care:
Guidance from the American College of Obstetricians and Gynecologists (ACOG) reinforces many of the study’s concerns. ACOG recommends universal substance use screening during pregnancy using standardized, validated tools rather than relying on assumptions or stereotypes. The organization also emphasizes nonjudgmental care, warning that stigma and fear of punishment can prevent patients from seeking treatment.
ACOG supports the use of methadone and buprenorphine during pregnancy because abrupt opioid withdrawal can increase relapse risk and harm both mother and baby. The organization also recommends coordinated care between obstetric, addiction, pediatric, and social support teams, along with close monitoring of newborns for withdrawal symptoms.
The study arrives amid growing national attention to racial disparities in maternal and infant health outcomes. Researchers argue that improving outcomes for Black mothers and infants will require more than changing individual attitudes. Hospitals and healthcare systems must examine how policies, workflows, and institutional practices may create unequal treatment pathways, and redesign those systems to provide consistent, equitable care for every patient.
Taken together, the study and ACOG guidance point to the same conclusion: equitable maternal substance use treatment depends on standardized screening, evidence-based care, and reducing the stigma that too often prevents families from receiving support.
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