Will my healthcare provider ask me about opioid use during my pregnancy?
Most likely. At your first prenatal visit, your healthcare provider will ask you about a range of things that could affect your pregnancy and the health of your baby, including prescription and illegal drug use. You might receive a questionnaire to fill out or be asked in person.
There are pros and cons to answering these questions. On the one hand, withholding information could mean you miss out on support and treatment you might need for a healthy pregnancy and baby. The American College of Obstetricians and Gynecologists (ACOG) recommends that providers offer treatment options to patients who need them.
(If you're using opioids during pregnancy, don't stop taking them cold turkey. It's not safe to stop taking these drugs suddenly. ACOG recommends that you get into a treatment program to help you transition to a medication that will prevent opioid withdrawal symptoms that might harm you or your baby.)
On the other hand, providers in some states are required to report you to child welfare authorities if you admit to misusing drugs, or if they even suspect you are.
If you're uncomfortable with your provider's attitude about opioid use during pregnancy, you have the right to seek a different provider.
Will I be tested for opioids during pregnancy or delivery?
Some providers may test your urine for drugs (including opioids) when you provide a sample at prenatal care visits. In a few states (Iowa, Kentucky, Louisiana, Minnesota, North Dakota, and Rhode Island), healthcare providers are required to test you for opioids and other substances if they suspect you're using drugs. They are also required report you to child welfare authorities if you test positive. Even in these states, however, your provider must first obtain your consent.
Most hospitals test your urine for drugs when you're admitted for delivery. Healthcare workers need to know whether you have substances in your body that could affect the labor process or require special care for your baby after birth. In some states, hospital officials must report you to child protective services if you test positive for drugs.
Legally, healthcare providers are required to obtain your consent before testing you for opioids or other drugs. If they're following ACOG's guidelines on drug testing, they should also inform you of what could happen if the test is positive.
Unfortunately, not all hospitals make it clear to patients when you're consenting to a drug test. Language about the testing may be buried in general consent paperwork you're given to sign. Before choosing a practice or hospital you might want to ask for copies of their policies and read them carefully.
Is it possible to get a false-positive result on a drug test?
Yes. Between 5 and 15 percent of urine drug tests generate a false-positive. This means the urine shows a positive result for a substance that's not actually there.
Occasionally, women test positive because they took a medication that contained opioids, such as a prescription painkiller, without realizing it. (This can include drugs administered by doctors during labor and delivery.) Nasal sprays, some antibiotics, poppy seeds, and tonic water have also been known to produce positive drug test results.
Unfortunately, false-positive drug results can have serious consequences for you and your family, especially if you're in a state that mandates suspected drug use in pregnancy to be reported to child welfare authorities.
If you think a test result is wrong, ask the medical provider to request a more comprehensive confirmatory test. This test should be done using a technique called "mass spectrometry and liquid or gas chromatography."
Because confirmatory testing is more complicated than a simple urine test, it could take up to a week to get the results back. The hospital or doctor should refrain from reporting a positive test result to authorities (if that's required in your state) until the result is confirmed, but that depends on their policy.
What happens if I test positive for opioids during pregnancy?
If you test positive for opioids, your provider will likely talk to you to find out what type of drugs you've taken and whether they were prescribed by a doctor. If your provider suspects you're misusing or addicted to opioids, she should refer you for treatment.
If you live in certain states, your healthcare provider must report you to child protective services, but any provider may do this, and it will trigger a child abuse investigation. Most mainstream medical organizations disagree with this approach, but it is a reality.
Two states, Minnesota and South Dakota, may require pregnant women suspected of drug abuse to be committed to an in-patient treatment facility. Wisconsin may take a pregnant woman into custody and force her into a residential drug treatment program, mental hospital, or jail.
What happens if I test positive for opioids during labor or delivery?
In the best-case scenario, a medical provider will discuss the test results with you and try to determine whether you're addicted to opioids and if so, whether you're receiving treatment for addiction. If you have an untreated opioid addiction, you should be given information about treatment and postnatal support programs.
Your baby may be screened for drugs after birth and may also be kept in the hospital for several days to watch for withdrawal symptoms. If necessary, your baby will get medication to treat those symptoms. Or you may be sent home with advice on how to care for your baby if he or she is likely to suffer withdrawal symptoms.
Studies show that babies experiencing withdrawal recover more quickly and are healthier if allowed to "room in" with their mothers and breastfeed, but babies are often separated from their mothers and unnecessarily sent to the NICU and instead. Ask if your baby can stay with you as much as possible.
Unfortunately, it's difficult to predict exactly what a hospital or healthcare provider will do if you admit you've taken drugs or test positive for opioids. Even in states that don't mandate reporting, you could be reported to the authorities.
Would I be charged with child abuse or lose custody of my child?
It's possible. About half of all states classify substance use during pregnancy as child abuse or neglect under child welfare law, which means you could lose custody of your child if you're reported to authorities. But this could happen anywhere. Mothers accused of drug use during pregnancy have been charged with child neglect or abuse in every state.
Mainstream medical organizations, including ACOG, disagree with this approach and recommend that doctors offer support and treatment to pregnant women with substance use disorders. These organizations oppose such punishments as criminal or civil prosecution and separating parents from their children solely because of substance use.
And many states are trying to help rather than punish pregnant women who have a substance use disorder. Almost 20 states fund substance use treatment programs especially for pregnant women, and 17 give pregnant women priority access to state-funded drug treatment programs.
To get a general idea of the laws in your state, visit the Guttmacher Institute's webpage on state policies on drug use in pregnancy.
If you're pregnant and think you have a substance use disorder, it's a good idea to seek help from a trustworthy provider as early as possible to protect your own health and the health of your baby. An increasing number of providers and treatment centers offer help to pregnant women in this situation. See our article on how to get treatment for opioid addiction.
If you need legal assistance, contact the National Women's Law Center to see if they can refer you to a lawyer who can help. National Advocates for Pregnant Women may be able to provide free legal assistance to women who are charged with a crime related to being pregnant or giving birth.
The following experts contributed to this article:
National Advocates for Pregnant Women
Kelli Garcia, Director of Reproductive Justice Initiatives and Senior Counsel, National Women's Law Center
Dr. Mishka Terplan, MD MPH FACOG FASAM, Professor in Obstetrics and Gynecology and Psychiatry and Associate Director of Addiction Medicine at Virginia Commonwealth University. Addiction Medicine Consultant for DMAS (Department of Medicaid Services, VA) and consultant for the National Center on Substance Abuse and Child Welfare