Criminal Podcast Episode Summary: "False Positive"

Criminal, hosted by Phoebe Judge and produced by Vox Media Podcast Network, delves into the complexities of crime and justice through human stories that highlight systemic flaws and personal struggles. In the episode titled "False Positive", released on May 9, 2025, the podcast explores the alarming issue of false-positive drug tests for new mothers, leading to unwarranted interventions by Child Protective Services (CPS). This detailed summary captures the key discussions, personal narratives, expert insights, and the broader implications of flawed drug testing protocols in hospitals.

Introduction to False Positives in Drug Testing

The episode begins by presenting the unsettling reality that false-positive drug tests can have devastating effects on families. These tests, commonly administered to new mothers, are intended to identify illicit drug use but often lack the precision to distinguish between legal substances and illegal drugs. This flaw leads to wrongful accusations and the potential separation of children from their parents.

Susan Horton's Ordeal

Susan Horton, a resident of Santa Rosa, California, becomes the central figure in this narrative. In August 2022, while preparing to welcome her fifth child, Susan undergoes a routine urine test postpartum, which falsely indicates the presence of codeine—a finding that sets off a chain reaction of unjust interventions.

• Birth and Initial Test:
  • "There was a point where I was just like, this is absurd. I want to go home. I have not taken anything." (Susan Horton, 04:18)

Despite her protestations of innocence, the hospital staff proceeds with CPS involvement based solely on the preliminary test result.

• Identification of the False Positive:
  • Susan recalls realizing the mistake after consuming a poppy seed-laden salad—"It was delicious. You know, it had its separate little packages of dressing and it had a separate Little package of just poppy seeds. And they were so crunchy..." (Susan Horton, 03:02)

Poppy seeds are known to contain trace amounts of codeine, which can trigger false positives in urine drug screens.

• Impact on Her Family:
  • "I felt very emotional and I was alone... they had a singular piece of evidence that I had taken something and it was wrong." (Susan Horton, 05:02)

Grace and Michael Smith's Similar Struggle

Parallel to Susan's story is that of Grace and Michael Smith from Pennsylvania. Grace, a lawyer diagnosed with Attention Deficit Disorder (ADD) and prescribed Vyvanse, an amphetamine-based medication, tests positive for methamphetamine—another flaw in the drug testing process.

• Initial Hospital Interaction:
  • "Well, your urine tests show that you were positive for methamphetamine." (Grace Smith, 09:40)

Grace presents her medical records to clarify that her prescription medication is the cause of the positive result. However, the hospital staff dismisses this explanation, leading to immediate CPS intervention.

• Confrontation and Separation:
  • "They couldn't have lived with themselves if they hadn't tried. Just to make sure that this wouldn't happen again. You gotta try." (Grace Smith, 33:58)

Despite providing evidence of her legitimate medication use, Grace and Michael face the bureaucratic and emotional turmoil of having their newborn child temporarily removed.

Expert Insights: The Science Behind False Positives

The episode features an interview with Dr. Gwen Miller, a medical director specializing in drug test analysis. Dr. Miller elucidates the technical shortcomings of standard urine drug tests:

• Common Causes of False Positives:

  • "Some common cold medications will trigger positive results... Labetalol metabolites are triggering the test into thinking that fentanyl or methamphetamine are present." (Dr. Gwen Miller, 14:21)
  • "Vyvanse, the medication for attention deficit disorders, also looks like methamphetamine." (Dr. Gwen Miller, 14:21)

• Limitations of Preliminary Tests:

  • Dr. Miller emphasizes that preliminary tests, often used for their cost-effectiveness and non-invasiveness, lack the specificity to accurately identify illicit substances, leading to high false-positive rates—"Close to 50% for many drug classes." (Dr. Gwen Miller, 14:21)

• Need for Confirmatory Testing:

  • She advocates for a second, more definitive test conducted by toxicologists to verify initial results, a step that is not routinely mandated or standardized across hospitals.

Systemic Flaws and Policy Shortcomings

The podcast highlights significant policy and procedural deficiencies within the healthcare and child welfare systems:

• Lack of Standardized Confirmatory Testing:

  • "There should be a second step, and that's a more definitive test where a toxicologist looks at the molecules in that sample to determine whether or not they are the illicit substance that the screen identified." (Dr. Gwen Miller, 14:21)

• Overreliance on Preliminary Results:

  • Hospitals, driven by legal liabilities and the opioid epidemic's urgency, often bypass confirmatory tests, acting on initial screenings despite their inaccuracies.

• Inconsistent State Policies:

  • The episode reveals that while federal law mandates reporting substance exposure, most states extend this requirement without necessitating follow-up confirmations, exacerbating the issue of false positives.

• Impact on Child Welfare Decisions:

  • "Federal law requires states to identify babies that are... exposed to substances and refer them to child welfare authorities." (Narration, 14:21)

Emotional and Personal Toll

Both Susan Horton and Grace and Michael Smith endure profound emotional distress due to these systemic failures:

• Susan Horton's Fear and Determination:

  • "This is just how P tests work... But really, that type of testing is not mandated." (Narration, 14:21)
  • After enduring CPS intervention, Susan faces the daunting task of proving her innocence in court, battling both legal hurdles and personal doubts.

• Grace and Michael Smith's Resolution:

  • The Smiths invest significant resources into legal battles, including a hair follicle test to establish the illegitimacy of the methamphetamine result. Their persistence leads to the eventual dismissal of the case, but not without enduring financial and emotional strain.
  • "We could not have lived with ourselves if we hadn't tried. Just to make sure that this wouldn't happen again." (Grace Smith, 33:58)

Potential Solutions and Calls for Reform

The episode underscores the urgent need for reform in drug testing protocols and CPS procedures:

• Implementation of Mandatory Confirmatory Testing:

  • Aligning with practices established during employee drug screenings, pregnant women should be granted the right to a second, precise test to confirm any preliminary positive results.

• Standardization Across Healthcare Facilities:

  • Developing unified guidelines that mandate confirmatory tests can help prevent wrongful CPS interventions based on inaccurate drug screening results.

• Education and Training for Medical and CPS Personnel:

  • Enhancing awareness about the common causes of false positives among healthcare providers and CPS workers can reduce bias and improve decision-making processes.

Conclusion: The Human Cost of Systemic Failures

"False Positive" poignantly illustrates how flawed drug testing systems and rigid bureaucratic policies can inflict unnecessary pain and trauma on innocent families. Through the harrowing experiences of Susan Horton and Grace and Michael Smith, the episode calls for compassionate reform and greater accuracy in medical testing to safeguard the well-being of both parents and children.

Notable Quotes:

• "I was just sitting there having to swallow my pride and going like, this person is about to make a decision based on, like, my kids." — Grace Smith (25:17)

• "I have no clue what else it could be." — Susan Horton (03:02)

• "Close to 50% for many drug classes." — Dr. Gwen Miller (14:21)

Attributions:

• Reporter: Shoshana Walter
• Producer: Marianne McCune
• Edited by: Jenny Casas
• Additional Contributors: Manuel Torres, Nina Martin, Kate Howard, Jim Briggs, Fernando Arruda, Claire Mullen, Nikki Frick, Kim Frida, Leda Walker

For further information and to listen to the full episode, visit Criminal's Official Website or the Vox Media Podcast Network.