Her Parenting Time Was Restricted After a Optimistic Drug Check. By Federal Requirements, It Would’ve Been Detrimental. — ProPublica

Kaitlin spent the primary weeks of her new child son’s life in a panic. The hospital the place she gave delivery in October 2022 had administered a routine drug take a look at, and a nurse knowledgeable her the lab had confirmed the presence of opiates. Baby welfare authorities opened an investigation.

Months later, after looking out her house and interviewing her older baby and ex-husband, the company dropped its investigation, having discovered no proof of abuse or neglect, or of drug use.

The quantity of opiates that upended Kaitlin’s life — 18.4 nanograms of codeine per milliliter of urine, in line with courtroom paperwork — was so minuscule that if she have been an Air Drive pilot, she may have had 200 instances extra in her system and nonetheless have been cleared to fly.

However for Kaitlin, the take a look at triggered an investigation with doubtlessly life-altering penalties. (ProPublica is utilizing Kaitlin’s first identify as a result of her full identify has been redacted from courtroom paperwork. She declined to be interviewed for this story.) 

The ordeal “tempered what was in any other case speculated to be a joyous event” for the household, in line with a lawsuit filed in 2024 by New Jersey’s legal professional normal towards the hospital system, Virtua Well being.

The hospital stated in an announcement that it has “a relentless dedication to evidence-based, equitable care for each household.” In courtroom paperwork, it denied the lawsuit’s allegation that it discriminated towards pregnant sufferers and famous that Kaitlin consented to the take a look at. It additionally stated that New Jersey legislation mandates it to submit reviews of “substance-affected infants” to the state’s Division of Baby Safety and Permanency. The lawsuit is pending and a choose has referred it to mediation.

Drug-testing labs sometimes report leads to black and white: constructive or unfavorable. However a little-known truth concerning the trade is that these outcomes are sometimes primarily based on requirements which can be wholly discretionary. For instance, practically all states use a threshold of 0.08% blood alcohol content material to determine if a motorist is intoxicated. However for different medication detected in urine, saliva and hair, cutoff ranges differ from take a look at to check and lab to lab — together with Kaitlin’s take a look at for opiates.

There’s no consensus amongst labs on what stage ought to affirm the presence of codeine in urine, stated Larry Broussard, a toxicologist who wrote an instructional journal article on “rising proof” that poppy seeds in bagels and muffins provoke constructive take a look at outcomes. (Kaitlin ate a bagel shortly earlier than taking her drug take a look at, in line with courtroom paperwork.) There’s extra consensus for another medication, however labs nonetheless disagree on acceptable cutoff ranges for widespread medication similar to THC (the compound in marijuana that creates a excessive) and meth, stated Broussard.

In 2022, the identical yr Kaitlin examined constructive for codeine, the Division of Protection seen a surge in personnel on navy bases blaming constructive exams on poppy seeds. Scientists on the navy’s labs concluded {that a} change within the manufacturing technique of some poppy seeds had led to contamination, inflicting service members to be falsely accused of abusing medication.

Thus far, 62 constructive exams for codeine have been “overturned and adjusted in Military information,” an Military spokesperson informed ProPublica. In response, the Division of Protection in March 2024 doubled the navy’s cutoff stage for codeine exams to keep away from false positives triggered by poppy seed muffins, bagels and different meals. Service members at the moment are cleared for responsibility with as much as 400 instances extra codeine of their urine than is used to justify baby welfare investigations in some states, ProPublica discovered.

ProPublica reviewed cutoff ranges used to substantiate the presence of widespread medication, together with opiates, meth, THC and cocaine, as cited in courtroom information, labs’ contracts with authorities companies and scientific journals, in addition to in interviews with toxicologists. We discovered that the cutoff ranges utilized by the kid welfare methods differ extensively from jurisdiction to jurisdiction. One giant state company, Michigan’s Division of Well being and Human Providers, contractually required a lab to make use of ranges that it later acknowledged have been “scientifically unsupportable.” 

Ted Simon, an knowledgeable toxicology witness and a board member of the nonprofit Heart for Fact in Science, which advocates for objectivity in analysis, stated companies are higher off consulting with labs to set cutoff ranges. That’s as a result of “some labs do validation testing to make sure the accuracy of their cutoffs primarily based on data of human biology.” However even when labs set ranges, they don’t at all times get them proper. Some labs “simply use the sensitivity of the chemical evaluation to measure vanishingly tiny concentrations with no method to assess the relevance to people,” Simon stated. This can lead to conditions like Kaitlin’s, the place the hospital’s cutoff was close to the decrease restrict of what subtle lab devices can detect, he stated after reviewing her case.

In the meantime, “labs inform their purchasers what they need to hear and are hesitant to reveal the uncertainty inherent of their strategies,” Simon stated.

There’s no trade consensus on what, or if something, must be achieved concerning the differing requirements. Some consultants see a necessity for uniform ranges however acknowledge it could require prolonged vetting earlier than toxicologists and different stakeholders agree on what’s acceptable. Others keep that so long as labs are clear and help their choices with analysis, they need to proceed selecting their very own ranges. “The labs do what works for the devices that they’ve,” stated Simon.

Baby welfare companies make use of a patchwork of drug testing requirements, in line with contracts and procurement paperwork.

Some, like Los Angeles County’s Division of Kids and Household Providers, require labs to make use of excessive cutoff ranges that defend towards false positives. Different companies’ contracts with their drug testing companies don’t specify cutoff ranges, leaving the choice to the lab.

A couple of giant companies require labs to make use of ultra-low ranges, which catch extra customers however include dangers. Incidental publicity to a substance within the surroundings and over-the-counter medicines can set off positives. “The smaller the focus that you simply attempt to detect, the extra doubtless you’re to get false constructive outcomes,” stated toxicologist Paul Cary, who wrote a information to testing for drug courts, which goal to deal with the addictions of individuals accused of drug-related crimes and keep away from incarceration.

Some Baby Welfare Companies’ Thresholds for a Optimistic Drug Check Are Decrease Than the Federal Authorities’s

The degrees at which varied companies contemplate a drug take a look at constructive for meth differ extensively. “The smaller the focus that you simply attempt to detect, the extra doubtless you’re to get false constructive outcomes,” stated toxicologist Paul Cary.

250 ng/ml
meth

125 ng/ml

100 ng/ml

0

Federal employees cutoff

Los Angeles County Dept. of Kids and Household Providers

Orange County, California, Social Providers Company

Utah Division of Baby and Household Providers

Georgia Division of Household and Kids Providers

Much less meth wanted to set off constructive outcome
↓

The federal authorities units requirements for drug testing 14 million folks. These embody public-sector workers in addition to employees whose efficiency impacts the security of others, often known as safety-sensitive roles, like airline pilots, truck drivers and people working in nuclear services. For many years, this system was recognized for a rigorous scientific evaluation and inspection course of to make sure accuracy. 

In 2025, President Donald Trump’s second administration overhauled the Substance Abuse and Psychological Well being Providers Administration, the federal company answerable for the testing requirements program, and dismissed half of its employees. It additionally disbanded the knowledgeable panel that proposed scientifically legitimate cutoff ranges, the Drug Testing Advisory Board. “There might be points for nationwide safety or security delicate points that may be impacted given the latest modifications,” stated Hyden Shen, former regulatory and coverage oversight lead on the well being company’s division of office packages. Within the spring, Shen resigned alongside nearly half of his division. He spoke to ProPublica after leaving federal employment.

Non-public labs have lengthy been free to set their very own requirements, unbiased of the federal authorities’s really useful ranges. The CEO of a laboratory firm specializing in testing for probation departments, baby welfare companies and courts testified in a lawsuit that in 2018 the lab had lowered cutoff ranges for cocaine in hair follicle exams by an element of 5 with out amending its contract with the state baby welfare company. The corporate stated that the change was to align its ranges with scientific updates and that state companies have been made conscious of the brand new cutoffs when it reported take a look at outcomes. The lawsuit was settled with the lab denying wrongdoing.

Federal employees who take a look at constructive for medication can’t be punished till their outcomes are scrutinized by medical evaluation officers, physicians who confirm that constructive drug take a look at outcomes aren’t being triggered by authentic medicines. (For instance, with out a particular follow-up referred to as an isomer take a look at, over-the-counter Vicks VapoInhaler is indistinguishable from avenue medication in a number of forms of drug exams.) However medical evaluation of take a look at outcomes is dear, and few state companies require it for baby welfare instances or for testing folks on probation. One lab competing for a contract to check probationers and juveniles in a residential facility in Kansas discouraged using medical evaluation officers, saying it could “lead to additional expense and additional time for outcomes supply.” Different state companies, particularly those who oversee parole, probation or prisons, skip affirmation testing totally and rely as an alternative on cheaper, much less correct immunoassay exams, until somebody contests their outcome and might afford to pay out of pocket for a follow-up, in line with contracts between state courts and labs. 

Companies “are successfully saying, ‘Most of those folks most likely did use medication. And, yeah, OK, there’s a handful that didn’t. However it could bankrupt us to have to substantiate all of those,’” stated Karen Murtagh, govt director of Prisoners’ Authorized Providers of New York, which has represented inmates in drug testing instances.

Within the spring of 2019, Marie Herrera was working to reunite together with her 4 children in Michigan’s foster care system. (ProPublica is referring to Herrera by her center identify at her request, to take care of her privateness as she strikes ahead together with her life.) At a listening to on her case, a foster care employee testified that it was going properly, in line with a submitting from her legal professional: “Mom had attended all eleven parenting instances, had procured employment, was in remedy, lived in three-quarters housing, and examined unfavorable for unlawful medication through the present reporting interval.”

Then that July, Herrera’s saliva examined constructive for cocaine. Herrera admitted to being in restoration from an dependancy however denied utilizing the drug. Over the subsequent eight months, two extra of her drug exams have been confirmed constructive for cocaine by the state’s lab. She sought testing from an out of doors lab, which didn’t detect unlawful drug use.

In response to her take a look at outcomes from the state’s lab, which Herrera shared with ProPublica, the degrees of cocaine and its metabolite in her system ranged from 1.065 to 1.774 ng/ml, simply above the state’s cutoff of 1 ng/ml in saliva. If the positive-test threshold for federal employees had been utilized to Herrera’s exams, she may have had greater than 4 instances as a lot of the drug in her saliva and nonetheless been cleared to fly a aircraft.

However Herrera’s constructive take a look at from December 2019 brought on the choose to remove her unsupervised parenting time, in line with courtroom information.

“The constructive drug exams turned my world the wrong way up and ruined my life,” stated Herrera. What she didn’t know is that behind the scenes, Michigan’s baby welfare company was reviewing — and making ready to lift — its cutoff ranges.

Michigan’s ranges for cocaine and different medication in saliva had been set by its drug testing vendor, Forensic Fluids, in 2018, in line with public information. (Forensic Fluids didn’t reply to a request for remark.) Michigan contractually required the identical ranges when it signed with a brand new lab, Averhealth, in 2019. 

However the baby welfare company seen conflicting outcomes between its exams and people ordered by legislation enforcement companies, in accordance to public information. Some people who examined constructive for a drug with one company examined unfavorable with one other.

In November 2020, on the urging of its new lab, the company raised its ranges. Communications between the company and Averhealth present each have been involved that low cutoffs may not be “forensically defensible” attributable to “uncertainty round environmental publicity.”

“Present ranges … are scientifically unsupportable,” Michigan’s baby welfare company wrote in a memo concerning the change.

In an announcement, Averhealth, the lab that processed Herrera’s exams, stated the mismatch in outcomes  that involved Michigan directors “under no circumstances calls into query the accuracy or reliability” of its testing. “Inconsistencies occurred when several types of exams have been performed (saliva or hair) or when the person was examined days later,” the corporate stated, noting that “several types of testing have totally different limitations.” The corporate stated its take a look at outcomes “merely attest as to if a drug is current in a specimen and, if that’s the case, in what amount. It’s left to the courts to determine what, if any penalties, comply with.”

In Herrera’s case, the lab stated, low-level cocaine positives “doubtless signify ingestion of cocaine” and that “passive publicity as an evidence is very uncertain.” The corporate additionally identified that Herrera had a number of high-level constructive exams for methamphetamine within the fall of 2020, 9 months after the courtroom took away her unsupervised parenting time. 

Herrera admits she’s relapsed at instances. However she additionally says that being labeled a cocaine person early on in her case, when she says she wasn’t utilizing, derailed her restoration. Herrera believes it set her as much as fail by creating an adversarial relationship together with her caseworker and choose. “I wasn’t grateful about what they have been doing to me,” she says.

Herrera’s parental rights have been terminated in 2021, lower than a yr after Michigan raised its cutoff ranges for cocaine in saliva. In denying Herrera’s attraction, a choose cited her refusal to take part in additional drug exams, further failed exams when she did comply, and her lack of housing and earnings, amongst different issues.

When Herrera was informed she may by no means once more see her children, she stated, she was devastated and relapsed once more. “Fuck it, if they are saying I’m an addict, then I’ll numb the ache.”

“I take into consideration my children each single day,” she stated. “It’s affected me fully.”

Even after elevating its cutoffs, Michigan’s ranges have been nonetheless far decrease than these used for federal employees. The state declined to remark, however a memo acknowledged that officers thought of the federal ranges inappropriate as a result of they “don’t assess the impacts of how these substances might have an effect on an individual’s conduct” or “how that use might influence baby security.”

Drug testing coverage consultants say it’s not attainable for any take a look at, irrespective of the cutoff stage, to reliably predict baby security.

“A drug take a look at doesn’t let you know if an individual has a substance use dysfunction, if they’re in restoration, or whether or not a baby is secure,” stated Nancy Okay. Younger, govt director of Kids and Household Futures, which consults for baby welfare companies, and co-author of a Substance Abuse and Psychological Well being Providers Administration coverage paper on drug testing for baby welfare companies. Younger stated directors ought to contemplate take a look at outcomes as “only one knowledge level” and rely extra on “casework and a relationship with the household” to find out whether or not a baby is secure and properly.