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School- and home-based drug testing is not enough to prevent adolescent substance abuse, and more research needs to be done before such testing can be recommended, according to a policy statement from the American Academy of Pediatrics (AAP). The statement, appearing in the March issue of Pediatrics, comes at a time when companies are marketing home-based drug products directly to parents and the U.S. Supreme Court is recommending random drug testing of students participating in extracurricular activities. The President's Office of National Drug Control Policy has gone even further and recommended mandatory drug testing of all students in school.
Reviewing the available scientific literature, the lead authors of the AAP policy statement, John R. Knight, MD, of Children's Hospital Boston and Cynthia J. Mears, DO, of Children's Memorial Hospital in Chicago, note that school- and home-based drug testing does not appear to reduce substance use and carries risks as well as benefits, undermining parent-child and school-child relationships and creating distrust.
"Mandatory laboratory testing is not the best way to detect and treat illicit drug use in adolescents," says Knight, who directs the Center for Adolescent Substance Abuse Research at Children's Hospital Boston. Drug testing is a complicated and costly procedure that is subject to error, and results can be difficult to interpret, the statement notes. In urine testing, specimen collection either has to be observed directly or through a federally approved protocol involving documentation, temperature testing and controls to prevent tampering. School staff members would need special training in proper collection procedures, while most parents cannot do direct observation and do not have the means to implement the federal collection protocol. Other alternatives -- saliva, oral swab and hair testing -- are easier to conduct, but are less reliable. Oral testing detects only a limited number of illicit drugs, while the accuracy of hair tests has not been established and racial differences may unfairly cause more positive hair tests in students from minority groups.
Drug testing is also getting easier to defeat. Information on ways to beat tests is readily available to adolescents over the Internet. In addition, standard drug tests do not detect the drugs most frequently used by adolescents, like alcohol, ecstasy (3,4 methylenedioxymethamphetamine), and inhalants.
"School and home based drug testing might encourage some adolescents to abuse alcohol which is associated with more youth deaths than any drug," says Knight. "They may also change from drugs with less morbidity, like marijuana, to those that are not detected by current tests but pose greater danger, like inhalants or prescription medications."
The AAP statement also cites concern over the lack of adolescent substance abuse and mental health treatment programs available for those with positive test results.
"Successful rehabilitation of adolescent substance abusers relies on proper assessment and a prescribed treatment plan, not just punitive measures," says Knight. "Many communities do not have programs established which are essential in the prevention of later abuse." To facilitate greater access to adolescent substance abuse treatment programs, the AAP recommends funding for such programs be included in federal support for school-based testing.
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