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Monday, March 5, 2007
Home and school drug testing flawed, pediatricians say
Drug testing of adolescents at home or in school is unreliable and lacks scientific proof of effectiveness, the American Academy of Pediatrics says in its journal Pediatrics today. Simple conversations with a school counselor are more effective and cost far less, according to the study.
In 1996 the AAP published a policy statement opposing testing adolescents for drugs without their consent. Since then two US Supreme Court decisions have upheld random testing, first for student athletes and then for any student participating in extracurricular activities. At the same time, drug-testing companies have begun marketing kits to parents for use at home. The current policy addendum was written in response to these two trends.
"Testing can be a very powerful tool when it is used properly in a clinical population," Dr. John R. Knight, associate professor of pediatrics at Harvard Medical School and director of the Center for Adolescent Substance Abuse Research at Children's Hospital Boston, said in an interview. He is the lead author of the article. "It's just a really bad screening test."
There is little proof that drug testing in schools works, he said, citing two studies whose results conflict. Testing is complicated, it produces errors, its results can be hard to interpret and the Internet is awash in ways to defeat it.
"It's almost like an arms race," Knight said. "We think up new tests and kids who are using drugs think up new ways to beat the new tests."
The tests also miss ecstasy, inhalants such as glue and paint thinners and prescription drugs such as oxycodone, as well as alcohol, he said.
Where drug tests do work is in programs where young people are committed to recovering from drug abuse and agree to monitoring, he said. For the larger population of students, talking to a doctor or school nurse works better, published data has shown, he said.
"I am in favor of screening teens for drug and alcohol abuse and I know how it can be done cheaper and more effectively," he said. "Have a health care provider ask the young person, with a confidential questionnaire or a simple oral test, and most of the time they give you an honest answer."
Schools can do the same kind of screening, instead of taking samples for lab tests, Knight said he told the president's Office of National Drug Control policy in November. Using charges for tests by Quest Laboratories, he calculated that a school with 1,000 students that tested half of them once each year, yielding 30 percent positive results, would spend $142,000 on tests and $58,000 to administer the program.
Screening all the students with confidential questionnaires and follow-up counseling would cost about $50,000 per year for one school-based counselor, he estimated. The government could better spend its money on treatment or prevention programs, he said.
"We should be taking the money they're dangling in front of the schools willing to do the testing and we should be putting it into treatment for young people," he said.