\n<\/p>\n
These highlights were written by the reporters and editors who worked on this story.<\/p>\n
Kaitlin spent the first weeks of her newborn son\u2019s life in a panic. The hospital where she gave birth in October 2022 had administered a routine drug test, and a nurse informed her the lab had confirmed the presence of opiates. Child welfare authorities opened an investigation.<\/p>\n
Months later, after searching her home and interviewing her older child and ex-husband, the agency dropped its investigation, having found no evidence of abuse or neglect, or of drug use.<\/p>\n
The amount of opiates that upended Kaitlin\u2019s life \u2014 18.4 nanograms of codeine per milliliter of urine, according to court documents \u2014 was so minuscule that if she were an Air Force <\/strong>pilot, she could have had 200 times more in her system and still have been cleared to fly.<\/p>\n But for Kaitlin, the test triggered an investigation with potentially life-altering consequences. (ProPublica is using Kaitlin\u2019s first name because her full name has been redacted from court documents. She declined to be interviewed for this story.)\u00a0<\/p>\n The ordeal \u201ctempered what was otherwise supposed to be a joyous occasion\u201d for the family, according to a lawsuit filed in 2024 by New Jersey\u2019s attorney general against the hospital system, Virtua Health.<\/p>\n The hospital said in a statement that it has \u201ca relentless commitment to evidence-based, equitable care for every family.\u201d In court documents, it denied the lawsuit\u2019s allegation that it discriminated against pregnant patients and noted that Kaitlin consented to the test. It also said that New Jersey law mandates it to submit reports of \u201csubstance-affected infants\u201d to the state\u2019s Division of Child Protection and Permanency. The lawsuit is pending and a judge has referred it to mediation.<\/p>\n Drug-testing labs typically report results in black and white: positive or negative. But a little-known fact about the industry is that those results are often based on standards that are wholly discretionary. For example, nearly all states use a threshold of 0.08% blood alcohol content to decide if a motorist is intoxicated. But for other drugs detected in urine, saliva and hair, cutoff levels vary from test to test and lab to lab \u2014 including Kaitlin\u2019s test for opiates.<\/p>\n There\u2019s no consensus among labs on what level should confirm the presence of codeine in urine, said Larry Broussard, a toxicologist who wrote an academic journal article on \u201cgrowing evidence\u201d that poppy seeds in bagels and muffins provoke positive test results. (Kaitlin ate a bagel shortly before taking her drug test, according to court documents.) There\u2019s more consensus for some other drugs, but labs still disagree on appropriate cutoff levels for common drugs such as THC (the compound in marijuana that creates a high) and meth, said Broussard.<\/p>\n 18 ng\/ml<\/p>\n Kaitlin\u2019s results<\/p>\n 2,000 ng\/ml<\/p>\n Federal workers cutoff<\/p>\n 4,000 ng\/ml<\/p>\n Department of Defense cutoff<\/p>\n 4,000 ng\/ml<\/p>\n Department of Defense cutoff<\/p>\n 2,000 ng\/ml<\/p>\n Federal workers cutoff<\/p>\n 18 ng\/ml<\/p>\n Kaitlin\u2019s results<\/p>\n \t\t\t\t\t\t\tNote: Ng\/ml is nanograms per milliliter. Cutoffs are the level at which each organization considers the presence of codeine in urine to be confirmed by mass spectrometry (gas or liquid chromatography).<\/span><\/p>\n In 2022, the same year Kaitlin tested positive for codeine, the Department of Defense noticed a surge in personnel on military bases blaming positive tests on poppy seeds. Scientists at the military\u2019s labs concluded that a change in the manufacturing process of some poppy seeds had led to contamination, causing service members to be falsely accused of abusing drugs.<\/p>\n So far, 62 positive tests for codeine have been \u201coverturned and adjusted in Army records,\u201d an Army spokesperson told ProPublica. In response, the Department of Defense in March 2024 doubled the military\u2019s cutoff level for codeine tests to avoid false positives triggered by poppy seed muffins, bagels and other foods. Service members are now cleared for duty with up to 400 times more codeine in their urine than is used to justify child welfare investigations in some states, ProPublica found.<\/p>\n ProPublica reviewed cutoff levels used to confirm the presence of common drugs, including opiates, meth, THC and cocaine, as cited in court records, labs\u2019 contracts with government agencies and scientific journals, as well as in interviews with toxicologists. We found that the cutoff levels used by the child welfare systems vary widely from jurisdiction to jurisdiction. One large state agency, Michigan\u2019s Department of Health and Human Services, contractually required a lab to use levels that it later acknowledged were \u201cscientifically unsupportable.\u201d\u00a0<\/p>\n Ted Simon, an expert toxicology witness and a board member of the nonprofit Center for Truth in Science, which advocates for objectivity in research, said agencies are better off consulting with labs to set cutoff levels. That\u2019s because \u201csome labs do validation testing to ensure the accuracy of their cutoffs based on knowledge of human biology.\u201d But even when labs set levels, they don\u2019t always get them right. Some labs \u201cjust use the sensitivity of the chemical analysis to measure vanishingly tiny concentrations with no way to assess the relevance to humans,\u201d Simon said. This can result in situations like Kaitlin\u2019s, where the hospital\u2019s cutoff was near the lower limit of what sophisticated lab instruments can detect, he said after reviewing her case.<\/p>\n Meanwhile, \u201clabs tell their clients what they want to hear and are hesitant to disclose the uncertainty inherent in their methods,\u201d Simon said.<\/p>\n There\u2019s no industry consensus on what, or if anything, should be done about the differing standards. Some experts see a need for uniform levels but acknowledge it would require lengthy vetting before toxicologists and other stakeholders agree on what\u2019s appropriate. Others maintain that as long as labs are transparent and support their decisions with research, they should continue choosing their own levels. \u201cThe labs do what works for the instruments that they have,\u201d said Simon.<\/p>\n Child welfare agencies employ a patchwork of drug testing standards, according to contracts and procurement documents.<\/p>\n Some, like Los Angeles County\u2019s Department of Children and Family Services, require labs to use high cutoff levels that protect against false positives. Other agencies\u2019 contracts with their drug testing services do not specify cutoff levels, leaving the decision to the lab.<\/p>\n A few large agencies require labs to use ultra-low levels, which catch more users but come with risks. Incidental exposure to a substance in the environment and over-the-counter medications can trigger positives. \u201cThe smaller the concentration that you try to detect, the more likely you are to get false positive results,\u201d said toxicologist Paul Cary, who wrote a guide to testing for drug courts, which aim to address the addictions of people accused of drug-related crimes and avoid incarceration.<\/p>\n The levels at which various agencies consider a drug test positive for meth vary widely. \u201cThe smaller the concentration that you try to detect, the more likely you are to get false positive results,\u201d said toxicologist Paul Cary.<\/p>\n 250 ng\/ml 125 ng\/ml<\/p>\n 100 ng\/ml<\/p>\n 0<\/p>\n Federal workers cutoff<\/p>\n Los Angeles County Dept. of Children and Family Services<\/p>\n Orange County, California, Social Services Agency<\/p>\n Utah Division of Child and Family Services<\/p>\n Georgia Division of Family and Children Services<\/p>\n Less meth needed to trigger positive result \t\t\t\t\t\t\tNote: Ng\/ml is nanograms per milliliter. Squares show the level at which each organization considers the presence of meth in urine to be confirmed by mass spectrometry (liquid or gas chromatography). <\/span><\/p>\n The federal government sets standards for drug testing 14 million people. These include public-sector employees as well as workers whose performance affects the safety of others, known as safety-sensitive roles, like airline pilots, truck drivers and those working in nuclear facilities. For decades, the program was known for a rigorous scientific review and inspection process to ensure accuracy.\u00a0<\/p>\n In 2025, President Donald Trump\u2019s second administration overhauled the Substance Abuse and Mental Health Services Administration, the federal agency responsible for the testing standards program, and dismissed half of its staff. It also disbanded the expert panel that proposed scientifically valid cutoff levels, the Drug Testing Advisory Board. \u201cThere could be issues for national security or safety sensitive issues that might be impacted given the recent changes,\u201d said Hyden Shen, former regulatory and policy oversight lead at the health agency\u2019s division of workplace programs. In the spring, Shen resigned alongside almost half of his division. He spoke to ProPublica after leaving federal employment.<\/p>\n Private labs have long been free to set their own standards, independent of the federal government\u2019s recommended levels. The CEO of a laboratory company specializing in testing for probation departments, child welfare agencies and courts testified in a lawsuit that in 2018 the lab had lowered cutoff levels for cocaine in hair follicle tests by a factor of five without amending its contract with the state child welfare agency. The company said that the change was to align its levels with scientific updates and that state agencies were made aware of the new cutoffs when it reported test results. The lawsuit was settled with the lab denying wrongdoing.<\/p>\n Federal workers who test positive for drugs can\u2019t be punished until their results are scrutinized by medical review officers, physicians who verify that positive drug test results aren\u2019t being triggered by legitimate medications. (For example, without a special follow-up called an isomer test, over-the-counter Vicks VapoInhaler is indistinguishable from street drugs in multiple types of drug tests.) But medical review of test results is expensive, and few state agencies require it for child welfare cases or for testing people on probation. One lab competing for a contract to test probationers and juveniles in a residential facility in Kansas discouraged the use of medical review officers, saying it would \u201cresult in extra expense and extra time for results delivery.\u201d Other state agencies, especially those that oversee parole, probation or prisons, skip confirmation testing entirely and rely instead on cheaper, less accurate immunoassay tests, unless someone contests their result and can afford to pay out of pocket for a follow-up, according to contracts between state courts and labs.\u00a0<\/p>\n Agencies \u201care effectively saying, \u2018Most of these people probably did use drugs. And, yeah, OK, there\u2019s a handful that didn\u2019t. But it would bankrupt us to have to confirm all of these,\u2019\u201d said Karen Murtagh, executive director of Prisoners\u2019 Legal Services of New York, which has represented inmates in drug testing cases.<\/p>\n Marie Herrera at the park where she used to take her children to play<\/span> Liz Moughon\/ProPublica<\/span><\/p>\n In the spring of 2019, Marie Herrera was working to reunite with her four kids in Michigan\u2019s foster care system. (ProPublica is referring to Herrera by her middle name at her request, to maintain her privacy as she moves forward with her life.) At a hearing on her case, a foster care worker testified that it was going well, according to a filing from her attorney: \u201cMother had attended all eleven parenting times, had procured employment, was in therapy, lived in three-quarters housing, and tested negative for illegal drugs during the current reporting period.\u201d<\/p>\n Then that July, Herrera\u2019s saliva tested positive for cocaine. Herrera admitted to being in recovery from an addiction but denied using the drug. Over the next eight months, two more of her drug tests were confirmed positive for cocaine by the state\u2019s lab. She sought testing from an outside lab, which didn\u2019t detect illegal drug use.<\/p>\n According to her test results from the state\u2019s lab, which Herrera shared with ProPublica, the levels of cocaine and its metabolite in her system ranged from 1.065 to 1.774 ng\/ml, just above the state\u2019s cutoff of 1 ng\/ml in saliva. If the positive-test threshold for federal workers had been applied to Herrera\u2019s tests, she could have had more than four times as much of the drug in her saliva and still been cleared to fly a plane.<\/p>\n But Herrera\u2019s positive test from December 2019 caused the judge to take away her unsupervised parenting time, according to court records.<\/p>\n \u201cThe positive drug tests turned my world upside down and ruined my life,\u201d said Herrera. What she didn\u2019t know is that behind the scenes, Michigan\u2019s child welfare agency was reviewing \u2014 and preparing to raise \u2014 its cutoff levels.<\/p>\n Michigan\u2019s levels for cocaine and other drugs in saliva had been set by its drug testing vendor, Forensic Fluids, in 2018, according to public records. (Forensic Fluids did not respond to a request for comment.) Michigan contractually required the same levels when it signed with a new lab, Averhealth, in 2019.\u00a0<\/p>\n But the child welfare agency noticed conflicting results between its tests and those ordered by law enforcement agencies, according to public records. Some individuals who tested positive for a drug with one agency tested negative with another.<\/p>\n In November 2020, at the urging of its new lab, the agency raised its levels. Communications between the agency and Averhealth show both were concerned that low cutoffs might not be \u201cforensically defensible\u201d due to \u201cuncertainty around environmental exposure.\u201d<\/p>\n \u201cCurrent levels \u2026 are scientifically unsupportable,\u201d Michigan\u2019s child welfare agency wrote in a memo about the change.<\/p>\n A 2020 memo from Michigan\u2019s Department of Health and Human Services to its Children\u2019s Services Agency recommends raising agency drug testing levels because current levels are \u201cscientifically unsupportable.\u201d<\/span> Obtained by ProPublica. Highlight added by ProPublica.<\/span><\/p>\n In a statement, Averhealth, the lab that processed Herrera\u2019s tests, said the mismatch in results\u00a0 that concerned Michigan administrators \u201cin no way calls into question the accuracy or reliability\u201d of its testing. \u201cInconsistencies occurred when different types of tests were conducted (saliva or hair) or when the individual was tested days later,\u201d the company said, noting that \u201cdifferent types of testing have different limitations.\u201d The company said its test results \u201csimply attest to whether a drug is present in a specimen and, if so, in what quantity. It is left to the courts to decide what, if any consequences, follow.\u201d<\/p>\n In Herrera\u2019s case, the lab said, low-level cocaine positives \u201clikely represent ingestion of cocaine\u201d and that \u201cpassive exposure as an explanation is highly doubtful.\u201d The company also pointed out that Herrera had several high-level positive tests for methamphetamine in the fall of 2020, nine months after the court took away her unsupervised parenting time.\u00a0<\/p>\n Herrera admits she\u2019s relapsed at times. But she also says that being labeled a cocaine user early on in her case, when she says she wasn\u2019t using, derailed her recovery. Herrera believes it set her up to fail by creating an adversarial relationship with her caseworker and judge. \u201cI wasn\u2019t grateful about what they were doing to me,\u201d she says.<\/p>\n Herrera\u2019s parental rights were terminated in 2021, less than a year after Michigan raised its cutoff levels for cocaine in saliva. In denying Herrera\u2019s appeal, a judge cited her refusal to participate in further drug tests, additional failed tests when she did comply, and her lack of housing and income, among other things.<\/p>\n When Herrera was told she could never again see her kids, she said, she was devastated and relapsed again. \u201cFuck it, if they say I\u2019m an addict, then I\u2019ll numb the pain.\u201d<\/p>\n \u201cI think about my kids every single day,\u201d she said. \u201cIt\u2019s affected me completely.\u201d<\/p>\n Even after raising its cutoffs, Michigan\u2019s levels were still far lower than those used for federal workers. The state declined to comment, but a memo stated that officials considered the federal levels inappropriate because they \u201cdo not assess the impacts of how those substances may affect a person\u2019s behavior\u201d or \u201chow that use may impact child safety.\u201d<\/p>\n Drug testing policy experts say it\u2019s not possible for any test, no matter the cutoff level, to reliably predict child safety.<\/p>\n \u201cA drug test doesn\u2019t tell you if a person has a substance use disorder, if they are in recovery, or whether a child is safe,\u201d said Nancy K. Young, executive director of Children and Family Futures, which consults for child welfare agencies, and co-author of a Substance Abuse and Mental Health Services Administration policy paper on drug testing for child welfare agencies. Young said administrators should consider test results as \u201cjust one data point\u201d and rely more on \u201ccasework and a relationship with the family\u201d to determine whether a child is safe and well.<\/p>\n For codeine, meth and cocaine graphics, the cutoff for federal workers is from the Substance Abuse and Mental Health Services Administration\u2019s Mandatory Guidelines for Federal Workplace Drug Testing Programs.<\/p>\n Codeine Graphic:<\/strong> Kaitlin was tested at Virtua Voorhees Hospital in New Jersey. Source for the Department of Defense cutoff is an agency press release, and sources for test results and hospital cutoff are court records.<\/p>\n Meth Graphic:<\/strong> Los Angeles County Department of Children and Family Services data is from the agency\u2019s 2023 invitation for bids. Orange County Social Services Agency data is from the agency\u2019s 2021-2024 contract with its drug testing provider. Utah Division of Child and Family Services data is taken from an individual\u2019s drug test results from 2022. Georgia Division of Family and Children Services data is from an individual\u2019s drug test results from 2020.\u00a0<\/p>\n Cocaine Graphic:<\/strong> Cutoffs are the level at which each organization considers the presence of cocaine in saliva to be confirmed by mass spectrometry (gas or liquid chromatography). Ng\/ml is nanograms per milliliter. The cocaine cutoff levels used by the Michigan Department of Health and Human Services for testing in saliva are drawn from public records, including contracts, communications between the agency and its labs, and agency employee emails obtained via a public records request.\u00a0 Marie Herrera provided ProPublica with her test results.<\/p>\n","protected":false},"excerpt":{"rendered":" Reporting Highlights No Agreement on Standards: Drug test results are often based on discretionary standards. The level of drugs at which a test is considered positive varies from test to test and lab to lab. Big Disparities: Child welfare systems\u2019 thresholds for positives vary widely. One state\u2019s level is so low, an Air Force pilot<\/p>\n","protected":false},"author":1,"featured_media":40496,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[55],"tags":[252,319,6514,2318,4108,247,21756,13008,76,286,14662],"class_list":{"0":"post-40495","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-social-issues","8":"tag-drug","9":"tag-federal","10":"tag-negative","11":"tag-parenting","12":"tag-positive","13":"tag-propublica","14":"tag-restricted","15":"tag-standards","16":"tag-test","17":"tag-time","18":"tag-wouldve"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/40495","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=40495"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/40495\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/40496"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=40495"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=40495"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=40495"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}A Hospital Said Kaitlin Tested Positive for Codeine, But the Military Would Have Said the Test Was Negative Even at Levels 200 Times as High<\/h3>\n
Some Child Welfare Agencies\u2019 Thresholds for a Positive Drug Test Are Lower Than the Federal Government\u2019s<\/h3>\n
meth<\/p>\n
\u2193<\/span><\/p>\nGraphics Notes<\/h3>\n