Indications of Perinatal Substance Abuse, Part 2

by Child Welfare Information Gateway

(Page 3 of 7)

There may be considerable variation in what drugs are routinely included in the laboratory screening process. Toxicology screening procedures vary from laboratory to laboratory. A negative toxicology result does not apply to a drug that was not included in the screen. For example, many laboratories do not routinely screen for PCP or marijuana. Thus, without a special request for PCP or marijuana screening, these substances, even if present in the urine, would not be identified.

The quality of control over specimen handling and collection procedures greatly influence toxicology results. Because there are a number of ways to alter toxicology tests (e.g., providing someone else's urine or diluting the urine sample with toilet water), it is important that the person collecting the urine sample monitor the specimen collection process closely. Because test results also can be affected by diet and temporary abstinence, random screening without prior notice may provide a more accurate indication of drug use.

When screening newborns, it is important to collect the first voided urine. Late collection of urine can yield negative results because metabolites may not be present at a level high enough for detection.

In cases of prenatal substance abuse, it is helpful to test both mother and newborn to provide a more accurate picture of prenatal exposure.

In interpreting toxicology results, an important point warrants emphasis. False positive and false negative results do, at times, occur. Therefore, it is unwise to rely exclusively on toxicology screening to identify use of illicit substances. Rather, toxicology screening should be used in conjunction with history taking and observation for signs and symptoms to corroborate suspected use.

Toxicology testing during pregnancy and at the time of delivery can provide useful diagnostic information for health care purposes. The results of toxicology screens often are used by hospital personnel as a part of a suspected child abuse report. Although they indicate use of, or exposure to, a substance at some prior time, positive toxicology test results do not substantiate child abuse. In addition, false positive and false negative test results do occur. Thus, results should always be used in conjunction with comprehensive case evaluations of suspected child maltreatment.

The possible dual use of toxicology results for both medical and legal purposes also raises important questions about informed consent. Community standards vary for obtaining consent in cases involving prenatal substance abuse. Some medical facilities conduct toxicology testing under a general "conditions of admission" form that authorizes various medically indicated procedures. Other facilities require a special consent specifically authorizing toxicology testing. Other hospitals require that a patient be specifically informed of potential legal consequences before testing is conducted.

Many hospitals conduct toxicology screening of newborns, either under the general admissions "conditions of admission" form or in accordance with State child abuse and neglect laws that allow for certain testing and evaluation procedures without parental consent for the purpose of diagnosing prenatal drug exposure. Other institutions, however, require specific parental consent for toxicology screening. If parents refuse permission for testing, a court order can then be obtained in some States.

Because practices vary, it is important that professionals are aware of alcohol and drug abuse confidentiality regulations (e.g., 42 CFR, Part 2), the standards used within their local communities for obtaining consent for toxicology testing and for disclosing test results to child protection agencies. Hospital protocols also provide guidance for staff as well as help ensure consistency in hospital practice.

Summary

The behavioral changes brought on by various substances differ greatly from drug to drug. Alcohol, for instance, is considered to be a sedative/depressant, whereas cocaine and methamphetamine are stimulants. However, because polysubstance abuse is the most prevalent form of addiction, the effects of individual substances often are difficult to determine in any individual. Thus, if a client admits to cocaine use, it is often helpful for the professional to inquire about possible use of alcohol, marijuana, and/or another substance. The identification of alcohol and/or other drug abuse is a complex process that involves history-taking; observation of an individual's lifestyle and behaviors; and, finally, the use of diagnostic tests such as a breath analyzer, urine toxicology screens, and others described above. Once an individual with a substance abuse problem has been identified, professionals need to collaborate in planning a treatment/supportive services program that is sensitive to that individual's needs and family situation.

About the Author

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Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.