Do doctors test for drugs or alcohol while pregnant?
The American College of Obstetricians and Gynecologists (ACOG) recommends only verbal screening for drugs and alcohol during all prenatal visits.ⓘ
Physicians are supposed to have informed consent before drug testing a pregnant patient. But, drug testing without consent does happen.ⓘ In many states, including Illinois, patients may refuse a drug screen even if drug or alcohol use is suspected.
NOTE: Newborn drug testing is required and can measure repeated drug use during pregnancy, even if substance use was stopped 4-5 months before delivery. (Read more below).
Do doctors report drug or alcohol use of pregnant patients?
In most states and situations, OBGYN physicians and hospital workers do report failed drug screens and even suspected drug use of pregnant women to state agencies. Alcohol use is less likely to be reported.
While reporting is not always mandated, it can give pregnant women the resources to stop the substance use while still pregnant. Results of newborn drug and alcohol screens are mandated to be reported anyway, but too late for prevention.
As an addiction treatment provider, we do not report opioid drug screens while pregnant. But, we can provide positive drug screen results to an OBGYN if the patient signs a release of information. Showing compliance in a treatment program is the best way to limit any child welfare involvement.
Examples: Illinois & Texas
The Department of Human Services notifies the local Infant Mortality Reduction Network and child welfare to:
- Refer the parents to a treatment program for an assessment to determine whether they have an alcohol or other drug abuse problem and need treatment.
- Complete a client service plan that describes monitoring and services for the family; the treatment plan for the parents; and the medical plan for the infant.
Following the client service plan, especially compliance with the addiction treatment program dramatically reduces the likelihood of further actions like removing the newborn.
Texas has a program called Pregnant and Parenting Intervention (PPI) that can help women get treatment and resources. Being successful in a treatment program is the best way to limit any consequences. While it can depend on the county, Texas is generally much harsher with these laws than other states.
Do hospitals drug test newborns?
All newborns are given a toxicology screen as part of a routine newborn physical assessment, which shows exposure to drugs, alcohol and MAT medications. Hospitals are required to report any exposures to Child Protective Services (CPS) under the Child Abuse Prevention and Treatment Act (CAPTA).
Each hospital sets its own protocols around how and when newborn testing occurs. Testing the meconium (the baby’s first feces) is common and detects drug and alcohol use in the last 4 to 5 months of pregnancy. Meconium testing can also detect the severity of the substance use.
Newborn Drug Screen Options
Do hospitals test newborns for Suboxone?
Yes, MAT medications like Suboxone and methadone are included in the routine newborn screen. If a mother has not self-reported MAT use to their OBGYN, this could create an unwanted investigation and delay in being able to take the newborn home since the reporting physician would not be able to validate the prescription. Illegal use of MAT medications usually trigger an investigation.
Do hospitals test newborns for alcohol?
Yes, alcohol is part of the routine newborn screening. But, only the alcohol use in the 2-3 days prior to delivery are likely to show. A newborn testing positive for alcohol or showing signs of Fetal Alcohol Spectrum Disorder are required to be reported to CPS.
Can women be prosecuted for using drugs or alcohol during pregnancy?
Drug use during pregnancy usually triggers an investigation that could result in loss of custody rights. Alcohol or marijuana use aren’t always included in these laws, which vary by state.
Even in conservative states, there is usually no criminal prosecution or jail time for alcohol or drug use while pregnant. Progressive states do more to help pregnant women find treatment since studies show punishment is ineffective in preventing substance use during pregnancy.
Each patient’s monitoring and intervention by CPS is on a case-by-case basis, depending on the actions and compliance of the mother. Showing success in an addiction treatment program always helps the outcome of a case.
Examples: Illinois & Texas
Alcohol and marijuana are not included in Illinois legislation.
A newborn testing positive for drugs other than marijuana triggers a Department of Children and Family Services (DCFS) investigation.
After medical records are validated, a DCFS investigator will:
- Conduct a thorough risk assessment including evaluating the environment where the infant will live and evaluating the caregiver and other adults or children living in or frequenting the home.
- Take temporary protective custody if there are risk factors that place the child in imminent danger.
- Open a child welfare for a comprehensive assessment and ongoing plan.
Even if a case gets closed, these investigations can take three months and the file can remain open for five years.
Illinois enacted the Reproductive Health Act (RHA) in 2019 to protect women from being criminally prosecuted for drug or alcohol use while pregnant – meaning no incarceration or other criminal consequences.
When a report is received in Texas that a newborn was exposed to alcohol or drugs, a caseworker must complete a risk assessment within 30 days. The Department of Family and Protective Services (DFPS) may schedule a family conference to develop a safety plan for the newborn.
Newborn exposure to a controlled substance is counted as neglectful supervision in Texas. Controlled substances in Texas include marijuana, as well as methadone or Suboxone without prescription, but not alcohol. Though, no Texas news outlet has reported a woman prosecuted solely for drug abuse during pregnancy since 2017.
The court may order the termination of the parent-child relationship if the parent used drugs in a manner that endangered the health or safety of the child, and:
- Failed to complete a court-ordered substance abuse treatment program
- After completion of a court-ordered substance abuse treatment program, continued to abuse a controlled substance
- Been the cause of the child being born addicted to alcohol or a controlled substance, other than by legal prescription
- That termination is in the best interests of the child
The laws are harsher in Texas than other states, but showing compliance with an addiction treatment program always improves the outcome of a case.
Can you force a pregnant woman to go to a treatment program?
In most states and situations, there is no specific law that allows a loved one to commit a pregnant woman to a hospital, rehab or outpatient addiction treatment program.
Though other involuntary commitment laws for substance abuse can apply like the Marchman Act in Florida, Casey’s law in Kentucky/Ohio and Health & Safety Code § 463.062 in Texas. (A bill for involuntary commitment for substance abuse was proposed, but not passed in Illinois in 2017).
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