New Jersey Requires Hospitals to Confirm Drug Tests on New Mothers

New Jersey has adopted regulations requiring hospitals to confirm the results of drug tests given to pregnant patients before reporting new parents to child welfare authorities, becoming one of the first states in the country to impose that safeguard. The rules respond to investigations showing that the rapid urine screens hospitals rely on can return false positives at rates as high as 50 percent.

The change, formalized in state child welfare regulations and announced this week, addresses a practice that funneled thousands of families into investigations. New Jersey child welfare officials received more than 2,300 reports of newborns allegedly exposed to drugs in the womb between mid-2018 and mid-2023, according to data obtained by The Marshall Project, whose reporting with Reveal News prompted the reforms.

What the new rules require

Under the regulations, hospitals must verify an initial positive screen with a second, more precise confirmatory test before sharing the result with the state's child protection agency. The rules explicitly describe rapid test results as "preliminary" and acknowledge their potential for error. Providers may still contact child welfare officials when a patient discloses substance use during pregnancy.

Existing New Jersey law already held that a positive drug test alone does not constitute child abuse or neglect and does not have to be reported. In practice, hospitals often reported positive screens anyway, triggering assessments and investigations of mothers in the first days after childbirth.

The stakes of an unconfirmed result are well documented. Parents around the country have been separated from newborns over positive tests caused by poppy seeds, prescribed medications, and drugs administered by hospital staff during labor and delivery. A 2024 investigation found that not a single state at the time required hospitals to confirm results before contacting child welfare officials.

A new reporting portal aims to connect families with help

Alongside the testing rules, the New Jersey Department of Children and Families launched an online portal that lets healthcare providers share information about a family without identifying them. The portal generates a list of support services — including counseling and addiction treatment — that providers can offer to parents. When a provider believes a newborn is genuinely unsafe, the system prompts a separate report that can open a formal investigation.

State officials say the two-track design will keep families who need services out of the child protection system. The regulations state the process "will prevent unnecessary involvement with the child protection system."

Relief for patients in addiction treatment

The reforms carry particular weight for pregnant patients taking prescribed medications for opioid use disorder. Methadone and buprenorphine are the standard of care during pregnancy, yet both can trigger positive hospital screens — and fear of a child welfare report has pushed some patients to consider stopping medication-assisted treatment against medical advice.

Jennifer Kirkman, an assistant director at the Department of Children and Families, said providers have found the new rules reassuring for those patients. Medical centers "can finally tell their individuals who are pregnant in their programs, 'You don't have to worry about child welfare,'" she said.

That reassurance aligns with a growing research consensus: a large BMJ study published in April found no link between buprenorphine treatment during pregnancy and neurodevelopmental problems in children, adding to the evidence that staying on treatment protects both mother and baby.

Consent requirements and racial disparities

The New Jersey Department of Health issued companion guidance directing hospitals to obtain informed consent before administering drug tests. The guidance flags concerns that non-White, immigrant, and low-income patients are tested at disproportionate rates.

Research bears that out. Studies have found Black women are more likely than White women to be drug tested at childbirth and more likely to be reported to child welfare authorities. A new Marshall Project analysis estimated that mothers of Black newborns in eight states are about 2.5 times more likely than mothers of White newborns to be referred to law enforcement over alleged substance use during pregnancy. New Jersey was not included in that analysis; unlike most of the states examined, it does not automatically route such allegations to law enforcement.

Molly Linhorst, a staff attorney with the ACLU of New Jersey, called the regulations "a huge step forward for New Jersey." The organization filed complaints on behalf of two mothers who were drug tested during childbirth in 2023; since then, at least three dozen women have come forward saying they were tested without consent, several of whom tested positive because of prescribed medications or poppy seeds, Linhorst said.

Ashley Sawyer, senior policy counsel at the advocacy group Pregnancy Justice, said requiring consent often leads providers to recognize a test is not medically necessary. "There is this unfortunate misconception that doctors need to know if the person has been using substances in order to change how they will treat the newborn or how they will treat the mom," Sawyer said. "But actually that information is primarily used to report them."

Other states are moving in the same direction

New Jersey's reforms arrive amid a broader shift. Virginia passed a law earlier this year clarifying that taking prescribed addiction treatment medications during pregnancy is not child abuse or neglect. Massachusetts in 2024 removed a requirement that providers report every newborn exposed to substances in the womb.

Bills in New York, Arizona, and Tennessee that would have required consent before hospital drug testing failed to pass in their most recent legislative sessions, though New York's version cleared the State Senate before stalling in the Assembly — a vote advocates described as the first time a legislative chamber anywhere in the country affirmatively backed informed consent for drug testing in childbirth.