Reporting Highlights
- No Settlement on Requirements: Drug take a look at outcomes are sometimes based mostly on discretionary requirements. The extent of medicine at which a take a look at is taken into account optimistic varies from take a look at to check and lab to lab.
- Massive Disparities: Baby welfare methods’ thresholds for positives fluctuate extensively. One state’s stage is so low, an Air Pressure pilot can fly with as much as 400 occasions extra opiates of their system.
- Path Ahead Is Unclear: There’s no consensus on what ought to be finished. The Trump administration disbanded the professional panel that was in control of proposing scientifically legitimate ranges.
These highlights had been written by the reporters and editors who labored on this story.
Kaitlin spent the primary weeks of her new child son’s life in a panic. The hospital the place she gave beginning 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 her residence 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 response to courtroom paperwork — was so minuscule that if she had been an Air Pressure pilot, she might have had 200 occasions 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 presupposed to be a joyous event” for the household, in response to a lawsuit filed in 2024 by New Jersey’s lawyer common in opposition to the hospital system, Virtua Well being.
The hospital mentioned in a press release that it has “a relentless dedication to evidence-based, equitable care for each household.” In court documents, it denied the lawsuit’s allegation that it discriminated in opposition to pregnant sufferers and famous that Kaitlin consented to the take a look at. It additionally mentioned that New Jersey legislation mandates it to submit studies of “substance-affected infants” to the state’s Division of Baby Safety and Permanency. The lawsuit is pending and a decide has referred it to mediation.
Drug-testing labs sometimes report ends in 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 can be wholly discretionary. For instance, almost 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 fluctuate 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, mentioned Larry Broussard, a toxicologist who wrote an academic journal article on “rising proof” that poppy seeds in bagels and muffins provoke optimistic take a look at outcomes. (Kaitlin ate a bagel shortly earlier than taking her drug take a look at, in response to courtroom paperwork.) There’s extra consensus for another medicine, however labs nonetheless disagree on acceptable cutoff ranges for frequent medicine akin to THC (the compound in marijuana that creates a excessive) and meth, mentioned Broussard.
A Hospital Stated Kaitlin Examined Constructive for Codeine, However the Army Would Have Stated the Take a look at Was Unfavourable Even at Ranges 200 Instances as Excessive
In 2022, the identical 12 months Kaitlin examined optimistic for codeine, the Division of Protection seen 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 means 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 informed ProPublica. In response, the Division of Protection in March 2024 doubled the navy’s cutoff stage for codeine tests 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 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 courtroom information, labs’ contracts with authorities businesses and scientific journals, in addition to in interviews with toxicologists. We discovered that the cutoff ranges utilized by the kid welfare methods fluctuate 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 had been “scientifically unsupportable.”
Ted Simon, an professional toxicology witness and a board member of the nonprofit Heart for Reality in Science, which advocates for objectivity in analysis, mentioned businesses 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 information 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 approach to assess the relevance to people,” Simon mentioned. This can lead to conditions like Kaitlin’s, the place the hospital’s cutoff was close to the decrease restrict of what refined 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 consultants see a necessity for uniform ranges however acknowledge it will require prolonged vetting earlier than toxicologists and different stakeholders agree on what’s acceptable. Others keep that so long as labs are clear and assist their selections with analysis, they need to proceed selecting their very own ranges. “The labs do what works for the devices that they’ve,” mentioned Simon.
Baby welfare businesses make use of a patchwork of drug testing requirements, in response to contracts and procurement paperwork.
Some, like Los Angeles County’s Division of Youngsters and Household Providers, require labs to make use of excessive cutoff ranges that defend in opposition to false positives. Different businesses’ contracts with their drug testing providers don’t specify cutoff ranges, leaving the choice to the lab.
A number of giant businesses 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 simply attempt to detect, the extra seemingly you’re to get false optimistic outcomes,” mentioned toxicologist Paul Cary, who wrote a information to testing for drug courts, which intention to handle the addictions of individuals accused of drug-related crimes and keep away from incarceration.
Some Baby Welfare Businesses’ Thresholds for a Constructive Drug Take a look at Are Decrease Than the Federal Authorities’s
The degrees at which varied businesses think about a drug take a look at optimistic for meth fluctuate extensively. “The smaller the focus that you simply attempt to detect, the extra seemingly you’re 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 Youngsters and Household Providers
Orange County, California, Social Providers Company
Utah Division of Baby and Household Providers
Georgia Division of Household and Youngsters Providers
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 embrace 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 amenities. For many years, this system was recognized for a rigorous scientific evaluate 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 liable for the testing requirements program, and dismissed half of its staff. It additionally disbanded the professional panel that proposed scientifically legitimate cutoff ranges, the Drug Testing Advisory Board. “There might be points for nationwide safety or security delicate points that is perhaps impacted given the current 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 virtually 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 beneficial ranges. The CEO of a laboratory firm specializing in testing for probation departments, little one welfare businesses 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 businesses had 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 optimistic for medicine can’t be punished till their outcomes are scrutinized by medical evaluate officers, physicians who confirm that optimistic drug take a look at outcomes aren’t being triggered by legit drugs. (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 street drugs in a number of kinds of drug exams.) However medical evaluate of take a look at outcomes is dear, and few state businesses require it for little one welfare instances or for testing individuals on probation. One lab competing for a contract to check probationers and juveniles in a residential facility in Kansas discouraged using medical evaluate officers, saying it will “end in further expense and further time for outcomes supply.” Different state businesses, particularly people who oversee parole, probation or prisons, skip affirmation testing solely 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 response to contracts between state courts and labs.
Businesses “are successfully saying, ‘Most of those individuals in all probability did use medicine. And, yeah, OK, there’s a handful that didn’t. However it will bankrupt us to have to substantiate all of those,’” mentioned Karen Murtagh, government 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 along 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 along with her life.) At a listening to on her case, a foster care employee testified that it was going properly, in response to 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 through 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 had 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 accordance with 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 might have had greater than 4 occasions as a lot of the drug in her saliva and nonetheless been cleared to fly a airplane.
However Herrera’s optimistic take a look at from December 2019 prompted the decide to remove her unsupervised parenting time, in response to courtroom information.
“The optimistic drug exams turned my world the other 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 lift — 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 response to 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 seen conflicting outcomes between its exams and people ordered by legislation enforcement businesses, according to public records. 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 agency and Averhealth present each had been involved that low cutoffs won’t be “forensically defensible” on account of “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 a press release, Averhealth, the lab that processed Herrera’s exams, mentioned the mismatch in outcomes that involved Michigan directors “by no means calls into query the accuracy or reliability” of its testing. “Inconsistencies occurred when several types of exams had been performed (saliva or hair) or when the person was examined days later,” the corporate mentioned, noting that “several types of testing have totally different limitations.” The corporate mentioned its take a look at outcomes “merely attest as to whether a drug is current in a specimen and, if that’s the 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 “seemingly signify 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 courtroom 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 decide. “I wasn’t grateful about what they had been doing to me,” she says.
Herrera’s parental rights had been terminated in 2021, lower than a 12 months after Michigan raised its cutoff ranges for cocaine in saliva. In denying Herrera’s attraction, a decide 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 might 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 fully.”
Even after elevating its cutoffs, Michigan’s ranges had been nonetheless far decrease than these used for federal employees. The state declined to remark, however a memo said that officers thought-about the federal ranges inappropriate as a result of they “don’t assess the impacts of how these substances could have an effect on an individual’s habits” or “how that use could affect little one security.”
Drug testing coverage consultants say it’s not attainable for any take a look at, irrespective of the cutoff stage, to reliably predict little one 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 protected,” mentioned Nancy Ok. Younger, government director of Youngsters and Household Futures, which consults for little one welfare businesses, and co-author of a Substance Abuse and Psychological Well being Providers Administration coverage paper on drug testing for little one welfare businesses. Younger mentioned directors ought to think about take a look at outcomes as “only one information level” and rely extra on “casework and a relationship with the household” to find out whether or not a baby is protected and properly.
