Many hospitals test newborn babies for exposure to drugs of abuse. Although this sounds fairly straightforward, in practice it has been difficult to standardize testing protocols, let alone keep up with substance use trends. Compared with other areas of laboratory medicine, drug testing is also associated with unique social and legal ramifications, specimen collection processes, and result reporting decisions. In this interview, Dr. Gwen McMillin describes current academic perspectives on these issues, and where she sees the field heading.