Children who are prenatally exposed to illicit substances are commonly identified through toxicologic screening of their mothers. Toxicologic screening does not distinguish between maternal use and abuse. However, children are identified as “prenatally exposed,” and the decisions that follow are often the result of conclusions that are based on laboratory findings. The purpose of this article is to examine methods used to identify pregnant and parenting women as users of illicit drugs, policies and practices that are barriers for those who need treatment, and the need for expanded services and interagency support for these women and their children.