Her Parenting Time Was Restricted After a Optimistic Drug Check. By Federal Requirements, It Would’ve Been Destructive. — 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 check, and a nurse knowledgeable her the lab had confirmed the presence of opiates. Youngster welfare authorities opened an investigation.

Months later, after looking her house and interviewing her older little one 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 keeping with court docket paperwork — was so minuscule that if she have been an Air Drive pilot, she may have had 200 occasions extra in her system and nonetheless have been cleared to fly.

However for Kaitlin, the check triggered an investigation with doubtlessly life-altering penalties. (ProPublica is utilizing Kaitlin’s first title as a result of her full title has been redacted from court docket 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 keeping with a lawsuit filed in 2024 by New Jersey’s lawyer common towards the hospital system, Virtua Well being.

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

Drug-testing labs usually report leads to black and white: optimistic or adverse. However a little-known reality in regards to the business is that these outcomes are sometimes based mostly on requirements which are wholly discretionary. For instance, practically all states use a threshold of 0.08% blood alcohol content material to resolve if a motorist is intoxicated. However for different medicine detected in urine, saliva and hair, cutoff ranges range from check to check and lab to lab — together with Kaitlin’s check for opiates.

There’s no consensus amongst labs on what stage ought to verify the presence of codeine in urine, mentioned Larry Broussard, a toxicologist who wrote a tutorial journal article on “rising proof” that poppy seeds in bagels and muffins provoke optimistic check outcomes. (Kaitlin ate a bagel shortly earlier than taking her drug check, in keeping with court docket paperwork.) There’s extra consensus for another medicine, however labs nonetheless disagree on acceptable cutoff ranges for frequent medicine comparable to THC (the compound in marijuana that creates a excessive) and meth, mentioned Broussard.

In 2022, the identical 12 months Kaitlin examined optimistic for codeine, the Division of Protection observed a surge in personnel on navy bases blaming optimistic 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 medicine.

Thus far, 62 optimistic exams for codeine have been “overturned and adjusted in Military information,” an Military spokesperson advised 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 obligation with as much as 400 occasions extra codeine of their urine than is used to justify little one welfare investigations in some states, ProPublica discovered.

ProPublica reviewed cutoff ranges used to substantiate the presence of frequent medicine, together with opiates, meth, THC and cocaine, as cited in court docket 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 programs range extensively from jurisdiction to jurisdiction. One massive state company, Michigan’s Division of Well being and Human Companies, 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, mentioned 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 based mostly on data of human biology.” However even when labs set ranges, they don’t all the time get them proper. Some labs “simply use the sensitivity of the chemical evaluation to measure vanishingly tiny concentrations with no solution to assess the relevance to people,” Simon mentioned. This may end up in conditions like Kaitlin’s, the place the hospital’s cutoff was close to the decrease restrict of what subtle lab devices can detect, he mentioned 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 mentioned.

There’s no business consensus on what, or if something, ought to be finished in regards to the differing requirements. Some specialists 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 preserve 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,” mentioned Simon.

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

Some, like Los Angeles County’s Division of Kids and Household Companies, 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 massive companies require labs to make use of ultra-low ranges, which catch extra customers however include dangers. Incidental publicity to a substance within the atmosphere and over-the-counter drugs can set off positives. “The smaller the focus that you just attempt to detect, the extra possible you might be to get false optimistic outcomes,” mentioned toxicologist Paul Cary, who wrote a information to testing for drug courts, which purpose to handle the addictions of individuals accused of drug-related crimes and keep away from incarceration.

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

The degrees at which varied companies think about a drug check optimistic for meth range extensively. “The smaller the focus that you just attempt to detect, the extra possible you might be to get false optimistic outcomes,” mentioned 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 Companies

Orange County, California, Social Companies Company

Utah Division of Youngster and Household Companies

Georgia Division of Household and Kids Companies

Much less meth wanted to set off optimistic end result
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The federal authorities units requirements for drug testing 14 million individuals. These embody public-sector workers in addition to employees whose efficiency impacts the protection of others, referred to as safety-sensitive roles, like airline pilots, truck drivers and people working in nuclear amenities. 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 Companies Administration, the federal company liable 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 may very well be points for nationwide safety or security delicate points that is perhaps impacted given the latest modifications,” mentioned Hyden Shen, former regulatory and coverage oversight lead on the well being company’s division of office applications. Within the spring, Shen resigned alongside nearly half of his division. He spoke to ProPublica after leaving federal employment.

Personal 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, little one 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 little one welfare company. The corporate mentioned 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 check outcomes. The lawsuit was settled with the lab denying wrongdoing.

Federal employees who check optimistic for medicine can’t be punished till their outcomes are scrutinized by medical evaluation officers, physicians who confirm that optimistic drug check outcomes aren’t being triggered by professional drugs. (For instance, with no particular follow-up referred to as an isomer check, over-the-counter Vicks VapoInhaler is indistinguishable from road medicine in a number of kinds of drug exams.) However medical evaluation of check outcomes is pricey, and few state companies require it for little one welfare circumstances or for testing individuals on probation. One lab competing for a contract to check probationers and juveniles in a residential facility in Kansas discouraged the usage of medical evaluation officers, saying it could “lead to further expense and additional time for outcomes supply.” Different state companies, particularly people who oversee parole, probation or prisons, skip affirmation testing completely and rely as a substitute on cheaper, much less correct immunoassay exams, until somebody contests their end result and might afford to pay out of pocket for a follow-up, in keeping with contracts between state courts and labs. 

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

Within the spring of 2019, Marie Herrera was working to reunite along with her 4 children in Michigan’s foster care system. (ProPublica is referring to Herrera by her center title at her request, to keep up her privateness as she strikes ahead along with her life.) At a listening to on her case, a foster care employee testified that it was going nicely, in keeping with a submitting from her lawyer: “Mom had attended all eleven parenting occasions, had procured employment, was in remedy, lived in three-quarters housing, and examined adverse for unlawful medicine in the course of the present reporting interval.”

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

In line with her check 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 occasions as a lot of the drug in her saliva and nonetheless been cleared to fly a aircraft.

However Herrera’s optimistic check from December 2019 triggered the choose to remove her unsupervised parenting time, in keeping with court docket information.

“The optimistic drug exams turned my world the wrong way up and ruined my life,” mentioned Herrera. What she didn’t know is that behind the scenes, Michigan’s little one welfare company was reviewing — and getting ready to boost — its cutoff ranges.

Michigan’s ranges for cocaine and different medicine in saliva had been set by its drug testing vendor, Forensic Fluids, in 2018, in keeping 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 little one welfare company observed conflicting outcomes between its exams and people ordered by legislation enforcement companies, in accordance to public information. Some people who examined optimistic for a drug with one company examined adverse 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” resulting from “uncertainty round environmental publicity.”

“Present ranges … are scientifically unsupportable,” Michigan’s little one welfare company wrote in a memo in regards to the change.

In an announcement, Averhealth, the lab that processed Herrera’s exams, mentioned the mismatch in outcomes  that involved Michigan directors “under no circumstances calls into query the accuracy or reliability” of its testing. “Inconsistencies occurred when various kinds of exams have been carried out (saliva or hair) or when the person was examined days later,” the corporate mentioned, noting that “various kinds of testing have totally different limitations.” The corporate mentioned its check outcomes “merely attest as to whether a drug is current in a specimen and, in that case, in what amount. It’s left to the courts to resolve what, if any penalties, observe.”

In Herrera’s case, the lab mentioned, low-level cocaine positives “possible characterize ingestion of cocaine” and that “passive publicity as an evidence is extremely uncertain.” The corporate additionally identified that Herrera had a number of high-level optimistic exams for methamphetamine within the fall of 2020, 9 months after the court docket took away her unsupervised parenting time. 

Herrera admits she’s relapsed at occasions. 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 along 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 12 months after Michigan raised its cutoff ranges for cocaine in saliva. In denying Herrera’s enchantment, 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 revenue, amongst different issues.

When Herrera was advised she may by no means once more see her children, she mentioned, 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 mentioned. “It’s affected me utterly.”

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 little one security.”

Drug testing coverage specialists say it’s not potential for any check, regardless of the cutoff stage, to reliably predict little one security.

“A drug check doesn’t inform you if an individual has a substance use dysfunction, if they’re in restoration, or whether or not a toddler is secure,” mentioned Nancy Okay. Younger, govt director of Kids and Household Futures, which consults for little one welfare companies, and co-author of a Substance Abuse and Psychological Well being Companies Administration coverage paper on drug testing for little one welfare companies. Younger mentioned directors ought to think about check outcomes as “only one information level” and rely extra on “casework and a relationship with the household” to find out whether or not a toddler is secure and nicely.