Testing Birth Mothers for Drug and Alcohol Use Raises Complex Issues


Joanne Thalken
Focus on Adoption magazine

In a recent interview with a social worker with the Ministry for Children and Family Development, it was stated that the majority of children in care of the Ministry are there because of parental drug and alcohol use. Hair, urine, and meconium testing is becoming more and more influential in child custody cases and when the Ministry is determining whether children should be returned or removed from the home. Whereas traditionally, social workers have relied on urine analysis to determine whether parents are using drugs or alcohol, they are now turning to hair and meconium testing as a more reliable method. The courts are also accepting hair analysis as evidence in custody cases.

This testing can work for birth parents if they want to prove they have not used drugs and, of course, against them if they have denied drug use and the test proves that they have been using. The testing can also provide valuable information to adoptive and foster parents and social workers and medical professionals who work with the child.

The Motherrisk Program at the Hospital for Sick Children in Toronto (where Dr. Gideon Koren is a prominent researcher in the field) and the Denning Health Group in Surrey perform hair and meconium testing for the MCFD. In the case of hair testing, samples are collected either by social workers or physicians. Motherrisk regularly tests children’s hair to detect in utero exposure, passive exposure to crack or cigarettes and direct exposure of children to drugs. The tests are most often used in child protection cases, but are also used by custodial or non-custodial parents to support or refute claims of parental drug use.  Adoptive parents could also test their infants’ hair to determine prenatal drug exposure (newborn infant hair can give a history of the past three months of exposure).

At the lab, hair is washed to remove contaminants. Drugs within the hair are extracted using methanol and allowed to incubate overnight. The extracts are then analyzed. The entire process takes three days. Because hair grows at a rate of about half an inch per month, tests can be conducted to numerous sections of a longer hair sample to determine concentrations in various sections of the hair. In this way, scientists can provide a “diary” of drug use over a one-year period. Hair analysis can uncover use of a number of different substances, including cocaine, opiates, and amphetamines. As Motherrisk states in its literature, “the window of detection is limited only by the length of the hair.”  The testing has a great advantage over blood and urine testing, where drugs can only be detected within a few days of use. Hair testing will also eliminate the need to subject individuals to “constant” testing. It is the only drug testing method that can distinguish between a heavy drug user, and an occasional user who may only have been tested at an inopportune time.

In cases where it is suspected that maternal reporting is under-estimating the amount of alcohol consumed, a direct test of the infants’ meconium (the newborn’s first bowel movement) can yield information on second and third trimester alcohol exposure. Alcohol is extracted from the meconium and analyzed. Unfortunately, currently the level of alcohol in the meconium cannot be directly related to the number of drinks the mother had. It can be shown that the mother did drink throughout the pregnancy, but not exactly how much she drank. However, because knowledge of gestational exposure to alcohol is crucial to the diagnosis and treatment of FASD, social workers and doctors are more and more requesting this testing. 

Although social workers have had concerns about the intrusiveness of the tests—they have to cut different strands of the hair themselves—many believe the advantages of having the detailed information it provides outweigh the privacy issues. An MCFD social worker gave the example of a pregnant birth mom she was working with whom she suspected was not giving accurate information about drug and alcohol use.  She in fact denied having any problem with drug and alcohol use. Her social worker obtained her consent to use hair analysis to obtain accurate information about her drug use and the test came back positive. It was then possible to alert the hospital the mother attended to deliver the child and they were able to do much better planning for the birth. They were aware of the possibility of Neonatal Abstinence Syndrome, and were better prepared to help the child. 

The child was removed at birth and an adoption plan giving the adoptive parents information on neonatal drug use was made. In this case, it enabled the hospital to be more prepared, it allowed social workers to have a better idea of the special needs of the child and it gave prospective adoptive parents more information and awareness of the child’s risk of special needs.

This example shows the positive and negative aspects of the testing.  The birth mom was denying drug use and social workers were convinced she was using drugs. The test provided them with the evidence they needed to remove the child. However, such situations could negatively affect the relationships between social workers and their clients. The use of testing increases the power imbalance and may stop birth parents from volunteering information. In order to give information freely, parents have to feel some level of trust. Birth parents may feel pressured to give their consent for the tests because they feel threatened. They may continue to deny drug use, a position that then can work against them in court. Birth parents in this situation are seen as uncooperative and untrustworthy, when in fact they are reacting out of guilt and fear—fear of being labelled as a ‘bad parent’ and of losing their children.

Social workers often have to make difficult decisions and are often faced with dilemmas when requesting testing. The social worker I interviewed, who states she only requests the testing when she can see no alternative, has seen some negative ramifications of drug testing within the hospital setting. Birth parents have been treated badly by staff when the results of the testing is positive for drug exposure. Using hair and meconium testing as a means of obtaining information can also easily disrupt the level of trust a skilled social worker builds with her clients. 

Nancy Kato, who works with birth parents through the Forget-Me Not Family Society, believes that testing should not be used when there is any other way of obtaining the information from the birth parents themselves. She sees it as a human rights issue in terms of the power differential, even when there is informed consent, and as an ethical issue in that social workers should be using counseling to encourage disclosure rather than testing to force it. There are race as well as gender issues to consider. The reliability of the tests is in some question and some research has shown that coarse black hair holds drug residues for a longer period than blond hair. She also had a concern that representation from an advocate should be available to birth parents and that drug and alcohol issues should be looked at within the context of the woman’s life—they may not be problems significant enough to justify the removal of a child.

Hair testing for drug exposure and meconium testing for alcohol use are valuable methods for researchers to look at the effects of different levels of drug and alcohol use on the fetus. Daphne Chan and Gideon Koren at the University of Toronto are doing research in this field. Hair testing is a more reliable method than self-reporting for research purposes in certain respects. Birth mothers may not remember accurately the exact amounts of drugs and alcohol they used at specific times in their pregnancy.

Testing will hopefully provide medical professionals with much more information to support, educate and inform. These methods of detecting drug and alcohol use yield data that is extremely important in diagnosis and treatment of NAS and FASD. The reason for testing which is more controversial is where birth parents are not comfortable giving the detailed information that social workers and hospital staff need for planning for the child. Birth parents need to be treated in a non-judgemental manner if they are going to share information.

While testing has its place in giving information, its use must not become standard practice without looking at alternatives. On an individual birth parent level, on a women’s advocacy level, on a general social level, the situation looks complex and challenging.  

by Joanne Thalken