- Drug Testing in Adolescents
- Good Ethics Starts with Good Facts
- Suggested Course of Action
- Drug Testing at Home: Parent’s Guide to Drug Testing Teens
- Is Your Teen Using Drugs?
- When to Drug Test Your Teen
- Where to Get a Home Drug Test
- Administering a Home Drug Test for Teens
- What to Do If Your Teen’s Drug Test is Positive
- Should You Drug Test Your Child?
- Drug testing your child: the challenges
- Is testing an invasion of my kid’s privacy?
- What type of test is best?
- Are you willing to observe?
- What about other types of tests?
- Why it’s best to leave drug screening to the professionals
- The Pros and Cons of Home Drug Tests For Teenagers
- So, what are the pros and cons of home drug tests?
- What’s the Best Way to Give a Drug Test?
- If the drug test Is positive, what then?
Drug Testing in Adolescents
Adam has been under the pediatric care of Dr. Nichols for the last 7 years, since his family moved to town. He has been an average student and plays football and baseball. He has had no major health problems to date and is, to all appearances, a healthy 15-year-old. He has 2 younger siblings and very involved parents, Beth and David.
Dr. Nichols saw that Adam was on the clinic schedule with a 2 PM appointment; the chief complaint listed was simply «concerns.» She quickly checked his chart. He was last seen 9 months ago for a sports physical and everything was normal. Her notes say that he was «a little more quiet than usual, but talked about baseball when asked.»
As Adam was escorted into an exam room with his parents, he appeared sullen and replied in one-word answers to the nurse's jovial greeting and questions. His parents appeared anxious.
Dr. Nichols greeted both Adam and his parents and asked what brought them in. Adam stared at the floor. His parents shifted uncomfortably in their chairs, and then David replied, «We'd a drug test on Adam.»
The parents explained that Adam, previously a cheerful and garrulous boy, had become more withdrawn and sullen the past few months. Since he started high school his circle of friends had changed, and they feared he was hanging out with a «bad crowd.
» In the past his grades had been Bs, but had now dropped to mostly Cs. Both parents were convinced that Adam was doing drugs and were desperate to get him help. They begged Dr.
Nichols to perform a drug test so that they would have proof he was doing drugs and could get some help.
Dr. Nichols asked Adam, «How do you feel about what you have just heard?» He replied: «I'm not on drugs. I don't want the test.»
«Well, how about a basic check-up?» Dr. Nichols asked. With Adam's permission, Dr. Nichols performed a physical on Adam and everything, including the neurologic exam, was normal.
Dr. Nichols asked the parents what made them think that Adam was doing drugs. They explained that the change in friends had them very concerned. They stated that sometimes he came home from nights out with his friends and looked «a little strange.
» One of the friends that Adam occasionally spent time with was older and recently had a major car accident. Beth and David feared it was drug- or alcohol-related.
They explained that Adam spent a lot of time in his room when he was home, whereas he used to spend more time interacting with the family.
The situation had come to a head the previous weekend after Adam arrived home from a night out with friends.
The next morning his mother went to do his laundry and thought that his clothes smelled strange, possibly marijuana.
His parents asked Adam about this, and he denied using the drug but explained that some of his friends did use it and that was probably what made his clothes smell bad.
Dr. Nichols knows that changes in behavior, grades, and friends are all suggestive of possible drug use. She also knows that Adam's behavior and exam do not suggest that he is currently on drugs. What should she do?
Adam's parents have appropriately identified changes in his behavior, grades, and friends that might indicate drug use, and they appear to be motivated to help him rather than to punish him. Despite their apparently good intentions, however, their request to test Adam for drugs without his consent raises ethical issues involving competence, consent, confidentiality, and paternalism.
The American Academy of Pediatrics (AAP) policy statement on testing for drugs in adolescents states: «Involuntary testing is not appropriate in adolescents with decisional capacity—even with parental consent—and should be performed only if there are strong medical or legal reasons to do so» .
Definitions of decisional capacity, or competence, vary widely . The AAP policy states that competency «refers to the patient's ability to understand the relationship between the use of a drug, its consequences, and testing» .
This definition, most, relies on overall cognitive functioning and developmental status, as opposed to age.
Age is a poor proxy for the determination of competence, since there is such variability in the age at which one achieves the ability for abstract reasoning. The acquisition of abstract reasoning occurs gradually and in some cases never occurs. Therefore, it is necessary to make this determination on a case-by-case basis .
We assume that Adam would meet most standards for competence.
If Adam is competent then his consent is required .
An acutely intoxicated individual might not have decisional capacity, and in that case a urine drug test could be conducted without consent as part of the medical evaluation.
But there is no reason to suspect Adam is intoxicated at this time, and, even if he were, there does not appear to be an emergency, so consideration of testing could be delayed until he regained capacity.
Confidential health care is commonly offered to adolescents because of their cognitive development but also because of the prevalence of high-risk behaviors in teenagers. Adolescents are less ly to seek care if they perceive that health care services are not confidential .
An exception might occur if there were an imminent threat of serious harm to the patient or others, but that does not seem to be present at the time of Adam's visit. Statutory requirements for breaching confidentiality, such as reporting of suspected child abuse or contagious diseases, would also be exceptions.
If there were a compelling argument for breaching the presumption of confidentiality, the adolescent should have the opportunity to assist in how the parents are to be informed .
As the AAP policy on consent states, reasonable efforts should be made to include the pediatric patient in health care decisions . As with adults, there are situations when it may be necessary to violate a patient's autonomy, either because he is not competent or there is a substantial risk of harm to self or others .
As Silber suggested, «Paternalism can be justified when the evil prevented is greater than the wrong caused by the violation of the moral rule and, more importantly, if it can be universally justified under relevantly similar circumstances always to treat persons in this way» . Few competent adults would support a paternalistic policy of involuntary testing in this situation.
Good Ethics Starts with Good Facts
Good ethics starts with good facts, and there are a number of important considerations about the specifics of this case. First, a urine drug test in this setting could be falsely negative.
The specimen might be obtained too late after the most recent drug exposure, or the quantitative threshold for a positive test could be higher than the patient's drug level.
Furthermore, several psychoactive drugs (eg, «ecstasy,» inhalants, «designer drugs») are not tested in standard urine drug screens . Therefore, a negative test would not eliminate concerns regarding the possibility of a substance abuse problem.
A positive screening test would provide laboratory confirmation of the recent use of some psychoactive drugs, but would not distinguish the frequency, pattern, or extent of drug use . In this sense, a urine drug test is only a small part of a substance abuse assessment and often is not required at all.
Even a positive test will be helpful only if it leads to a successful intervention. How well do treatment programs work, and, more importantly, how well do they work when the adolescent is participating involuntarily?
Treatment programs for adolescent substance abuse vary in their modality, setting, and level of care, and the selection of a program is usually tailored to the severity of the adolescent substance abuse disorder .
Although many of these programs have been associated with some short-term and long-term reductions in substance use, there are still significant rates of relapse and noncompletion . No studies to our knowledge assess the effectiveness of treatment programs when the adolescent is participating involuntarily.
The prevailing wisdom, however, is that involuntary participation is less ly to be effective than voluntary participation.
Suggested Course of Action
If Adam is incompetent or is acutely impaired at the time of the evaluation, then a drug test without his consent could be justified as part of a diagnostic evaluation essential to protecting his health. But Adam does not appear to be acutely intoxicated and is presumably competent.
Violation of his autonomy could be justified if he appeared to be at risk of imminent harm and the violation had a reasonable chance of success in addressing his problems. However, we do not have evidence of ly benefit, particularly if he were forced to be tested and undergo treatment against his will.
The lihood of benefit is an empirical question, and data are inadequate to make a confident judgment of success. The default position is «First, do no harm» and respect the fundamental obligations of obtaining consent and respecting confidentiality.
The burden is on the health care professional to overcome this presumption, and there does not seem to be a compelling argument to do so in this case.
Furthermore, such a violation could jeopardize the patient-physician relationship and may deter Adam from seeking appropriate health care services in the future, resulting in further harm to his interests.
In summary, a positive urine drug test will have uncertain benefits, and a negative test would not provide reassurance that Adam is not using drugs. Because we are not able to appropriately justify the violation of Adam's autonomy, a urine drug test should not be performed on him without his consent.
That said, Dr. Nichols still has an obligation and other opportunities to help Adam. After a discussion with Adam and his parents, she should offer a confidential interview with Adam.
The goals would be to obtain a meaningful history of drug use and to identify his attitude toward drug use, the use patterns of his friends, risk factors for future drug use, the presence of co-morbid conditions, and the presence of other risky behaviors .
Depending on the results of this interview, Dr. Nichols should encourage him to share this information with his parents, with her help as a facilitator. Regardless of a disclosure by Adam, he should be encouraged to talk with his parents more extensively about his friends, state of mind, and attitudes about drug use.
Since Adam's history is indicative of possible drug use, Dr. Nichols should consider referral to a qualified mental health professional to determine the need for further diagnostic evaluation or treatment .
It is in Adam's interest to elucidate the cause of his recent behavior changes, as well as to take reasonable steps to assure his parents that he is addressing their concerns.
American Academy of Pediatrics Committee on Substance Abuse. Testing for drugs of abuse in children and adolescents. Pediatrics. 1996;98(2 Pt 1):305-307.
- Roth LH, Meisel A, Lidz CW. Tests of competency to consent to treatment. Am J Psychiatry. 1977;134(3):279-284.
- Weddle M, Kokotailo P. Adolescent substance abuse. Confidentiality and consent. Pediatr Clin North Am. 2002;49(2):301-315.
Committee on Bioethics, American Academy of Pediatrics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. 1995;95(2):314-317.
- Silber TJ. Justified paternalism in adolescent health care. Cases of anorexia nervosa and substance abuse. J Adolesc Health Care. 1989;10(6):449-453.
- Casavant MJ. Urine drug screening in adolescents. Pediatr Clin North Am. 2002;49(2):317-327.
- Jaffe SL. Treatment and relapse prevention for adolescent substance abuse. Pediatr Clin North Am. 2002;49(2):345-352.
Bukstein O, and the Work Group on Quality Issues. American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with substance use disorders. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry. 1997;36(10 suppl):s140-156.
American Academy of Pediatrics. Committee on Substance Abuse. Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention and management of substance abuse. Pediatrics. 1998;101(1 Pt 1):125-128.
Indications for management and referral of patients involved in substance abuse. American Academy of Pediatrics. Committee on Substance Abuse. Pediatrics. 2000;106(1 Pt 1):143-148.
Virtual Mentor. 2005;7(3):208-212.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
Drug Testing at Home: Parent’s Guide to Drug Testing Teens
You may find that drug testing is necessary when you suspect someone close to you is using drugs.
Many times those who find it necessary to drug test someone close to them are parents who have a teenager they suspect may be using drugs.
There are several types of home drug tests that can be used to find out if your teenager is using drugs, and learning how to administer these tests can be the difference between finding out if your teenager is using drugs or not.
Is Your Teen Using Drugs?
Many parents wonder if their teen may be using substances. Regardless of your background or status, your teen may be exposed to peers who use drugs, and you could be completely unaware of it. There are warning signs that should trigger you to suspect that your teenager is using drugs and examine this possibility more closely.
Some warning signs of teen substance abuse include:
- Poor performance at school
- Deceptive behavior
- Acting strange or differently
- Being more tired or sleepy than normal
- Being more hyper than normal
- Smelling alcohol or drugs
- Increased forgetfulness
- Decreases in personal hygiene
- Frequently being late or forgetting obligations
If your teen is exhibiting any of these warning signs, then you may consider using a home drug test to find out if your teenager is using drugs.
When to Drug Test Your Teen
If you are considering testing your teen for drugs, know that some experts view doing so as potentially damaging to your relationship with your teenager. Drug testing your teen may be the right decision, but you should carefully weigh the negative consequences with the benefits.
If you do notice signs of drug use in your teen and decide to perform an at-home drug test, then the timing for this test should be random and unexpected. Doing a home drug test right after you have indicated you are suspicious may give your teen time to prepare.
Teens that use drugs and are expecting a drug test may try to clear a drug from their system or try to find a way to get around the test.
If your teen is showing symptoms of drug use, it may also be a good time to test them, as it will still ly be detectable if it is causing symptoms.
Where to Get a Home Drug Test
You can get a home drug test kit from a variety of sources. The type of kit needed will also determine its availability. If marijuana is all you need to test for, you can typically get a marijuana test kit at most convenience stores.
However, parents will typically want to test for a broader range of drugs. Most pharmacies sell drug test kits that will test for substances that are commonly abused, and you can also purchase home drug test kits online.
Just keep in mind that you should only purchase these tests from a reputable online source. Testing for alcohol may require a separate test.
Administering a Home Drug Test for Teens
When using an at-home drug test, it is vital to ensure that you have an accurate sample. Teens who have used drugs may try to supply you with something besides urine, or urine that is not their own or not fresh.
Teens may do this by hiding someone else’s urine in a bag in their pants and then pretend to urinate while emptying the bag into a cup.
There are multiple ways to fake giving a true sample while not actually providing the sample yourself.
Each urine drug test is different, depending on the manufacturer, but there are certain components that are typically consistent. Once you have the sample, you will typically apply the sample to a collection site in the test.
The test will have to develop for a certain length of time that depends on the test purchased. Most tests will have two lines for each substance being tested. One line is a control line that should always be present and which tests that the test is actually working and valid.
The second line is the test line, and if the test line is present, even faintly, it means the test for that drug is negative. If there is no line, it means the test is positive.
Each test may vary, and you should carefully read the instructions on how to administer the test and interpret its results before you use it.
- Understanding the Detection Window: When you drug test your teen, you should carefully read the instructions to determine how long the drugs can be detected. Often, drugs can only be detected for 1–10 days in the urine, depending on the drug and test.
- Overlooking Frequently Abused Substances: Your home drug test may be accurate, but will only test for common drugs used by teens. Some substances may not show up on a drug test. Often alcohol will be used, but it is not tested for in a normal home drug test. Related: Does alcohol show up on a drug test
- False Negatives: A false negative while using a home urine drug test is uncommon, but can occur if your teen has diluted the sample. You should read the instructions of the test you purchase to find the exact false-negative rates for your particular drug test.
- False Positives: False positive drug tests are rare, but can occur. You should read the instruction manual that comes with your drug test to find substances or conditions that can lead to false positives. For example, energy drinks may cause false positives in some drug test kits.
What to Do If Your Teen’s Drug Test is Positive
If you are using a home drug test for your teen and you get a positive result, then it is very ly that your teen is using a dangerous, potentially addictive substance.
Continued substance use can lead your teen to try stronger, more dangerous drugs and raise the risk that they will join the tens of thousands of people who die each year from a drug overdose.
Even if your teen does not overdose, they will be more ly to suffer from addiction throughout life if they use substances in their youth, as well as from the negative health and social effects that substance abuse can cause.
Immediate intervention is necessary, and you should take your teen to see an addiction specialist to find out if treatments or teen drug rehab may be necessary. By intervening quickly, you will be able to help your teen have the best chance of recovery that they can.
If you have a teen that suffers from addiction, professional help will provide them with their best chance of recovery. The Recovery Village has a strong record of helping teens who are starting to or have already developed addictions. Reach out to one of our understanding team members to learn about options to help your teen start on their path to recovery today.
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Should You Drug Test Your Child?
As a parent searching for answers, you may be considering drug testing with the expectation that it will discourage your child from experimenting with drugs, hopefully preventing a world of hurt down the road.
If you suspect your child is already using substances, you may assume that testing will discourage experimental use before it escalates into serious use or addiction.
However, many experts recommend against drug testing our kids unless it is done by a medical professional, and only when it is truly warranted.
Drug testing your child: the challenges
Timing is tricky because various drugs react very differently. For example, marijuana leaves the system slowly and may result in positive tests for several days or even a month, depending on the amount and frequency of use. On the other hand, cocaine, heroin and meth generally clear the system very quickly, usually in one to three days.
With that in mind, should you test once a week or more often? On Monday mornings? The day after a party or social event? Random tests provide the element of surprise, but they also present the possibility that your timing will be off and your child will test negative, even if they have used during the past few days.
Is testing an invasion of my kid’s privacy?
The American Academy of Pediatrics advises that testing can be an invasive breach of trust that may damage the relationship between parent and child. If not done correctly, you may be viewed as a police officer rather than a parent, which does little to promote a healthy, trusting relationship. Regaining lost trust with a son or daughter who feels betrayed is never easy.
In general, it’s risky to test your child without a really good reason. A kid who has no intention of experimenting with drugs or alcohol will understandably resent the lack of trust indicated by testing without clear justification.
What type of test is best?
There isn’t a single test that will detect all substances, and a kit from your neighborhood pharmacy might test negative for one drug while totally missing others. No test casts a wide enough net to catch every possible drug.
Most standard urine and saliva kits test for marijuana, cocaine, opiates, amphetamines and PCP, while more sophisticated at-home tests will also detect barbiturates, benzodiazepines, methadone and certain prescription painkillers. Specialized, more expensive tests are necessary if you suspect your child is using LSD, mushrooms or inhalants.
Are you willing to observe?
It’s almost certain that your teen will resent you watching closely as she fills the bottle, but, if so motivated, many kids know ways of getting around a urine test.
For example, bleach or other substances are often used to adulterate drug tests, and purchased or “borrowed” urine is frequently used to escape detection. Kids are aware that a variety of options are available online, at any neighborhood head shop, or even at many all-night convenience stores.
Also, claims of “I don’t need to pee right now” or “I can’t go with you watching,” are ly to result in heated arguments between parent and child.
What about other types of tests?
Hair testing sounds a viable, non-invasive alternative to urine testing, but hair samples won’t detect use in the last week to 10 days and may be skewed by rate of hair growth, hygiene or use of cosmetics, dyes or bleaches. Hair testing generally isn’t an option for occasional or recent drug use, but is generally used for heavy use that has occurred over an extended time. The long window of detection makes hair tests impractical for parents.
Similarly, saliva tests are easy and less invasive than urine tests, and many detect drugs before the substances are detectable in urine.
The problem is that a savvy young adult may find ways of generating more saliva to dilute the test, and smoking cigarettes may also skew the results.
In order for saliva tests to be effective, you’ll need to ensure your child is supervised for 30 minutes prior to sampling.
Why it’s best to leave drug screening to the professionals
Dr. Sharon Levy, Director, Adolescent Substance Use and Addiction Program at Boston Children’s Hospital, recommends against home drug testing. In Dr.
Levy’s words, “I am not at all convinced that drug testing is useful as a preventive tool; it is a terrible tool for identifying use (since most teen and young adult drug use is sporadic, which is very unly to be picked up by a random test), and it is certainly not a stand-alone treatment for a substance use disorder.”
Further, some kids will switch using one substance for another in an attempt to avoid a positive drug screen. For example, some teens who enjoy smoking marijuana will switch to a synthetic form K2 or Spice to beat a marijuana drug screen, often with disastrous outcomes.
“If you suspect your child has a substance use problem or disorder, my suggestion would be to drop the drug kit and to speak with a health professional,” recommends Dr. Levy.
The Pros and Cons of Home Drug Tests For Teenagers
Teenagers. Even ones who don’t get into trouble can raise their parents’ blood pressure to the level of an ER visit. But what about the ones who are skirting the line, maybe taking illegal drugs, in danger of getting in trouble with the law? What's a parent to do?
For those who think their children are abusing drugs, there is the option of readily available in-home drug screens. They have become much less expensive in recent years. A marijuana screen may cost as little as $1.
There is a lot of controversy over resorting to drug screening. But having worked for nearly 11 years in Multisystemic Therapy (MST), I see drug tests as a huge parenting “win.” Knowledge is power.
If you believe there is a problem, you can act.
First, let's address some questions.
- What are the benefits of in-home drug screens? The negatives?
- If you become concerned about potential drug use and decide to give your child a test, what’s the best way to do it?
- How should you respond to a positive drug screen?
- Once you confirm your child has been using drugs, what are your next steps?
So, what are the pros and cons of home drug tests?
The issue of parents giving drug tests has become a polarizing one with mental-health providers on both sides of the fence.
The American Academy of Pediatrics released this statement in 2007: “Drug testing poses substantial risks—in particular, the risk of harming the parent-child relationship by creating an environment of resentment, distrust, and suspicion.” Many other providers disagree, including most MST clinicians.
Parenting consultant Karen Alonge blogged in 2008, “Random drug testing can be a fantastic deterrent to peer pressure. ‘No way, my parents could test me anytime’ is a pretty strong reason to ‘Just Say No’ that other kids easily understand.”
There are merits in both statements. Yes, drug testing at home poses risks. It might lead to a heated argument. Your child could get angry and feel you don’t trust him. He could become skilled at “fooling” the test or start using something for which you don’t test.
On the other hand, you might learn of a problem before it grows into something bigger and more dangerous. You could prevent future legal charges.
Most importantly, this has the potential of creating an opportunity to insert yourself more fully into the life of your teenager, learn about her struggles, get to know her friends and offer a higher level of accountability.
What’s the Best Way to Give a Drug Test?
First, develop a game plan. How will you explain what your child might see as a gross invasion of privacy and lack of trust? It’s not going to be easy. Find some support, have your partner practice the conversation with you, and do it together.
Or, if you’re a single parent, have a friend come over whom your child will trust. Do it in a non-confrontational way by explaining your concerns and discussing what will happen if the test comes back positive or negative.
Decide on incentives for clean drug screens and consequences if the test comes back positive.
Next, find a way to increase your chances of getting accurate results. Teenagers are sometimes smart and creative in “playing” a drug test. Some caregivers choose to have the same-sex parent or relative observe as the youth takes the test. Others have turned off the water or put tape across the sink, making it easier to see if the water has been turned on.
Be prepared for refusal. If your child will not take the test, decide what you will do next. Many parents have been successful by treating refusal as a positive screen and giving the same consequences until the teenager complies with submitting to the test.
If you have concerns that you might not be able to handle conflicts that arise, speak to a mental-healthcare provider before you screen or consider having the test performed by your primary-care physician. Lastly, offer contingencies.
Take away a privilege that is important to your child, allowing him or her to earn it back when the drug screen comes back negative.
If the drug test Is positive, what then?
If your fears are confirmed and your child has been using drugs, there are some important questions to ask yourself as a parent. First, do you need outside help? If your child is already in treatment, speak with his or her mental-healthcare provider. If not, turn to your primary-care physician.
He or she can give a follow-up test to ensure that your child is not using substances that you did not test for and make referrals for more support, as needed. Second, learn as much as you can about when and where your child is using drugs.
Who are his friends? Where does he spend time when he is not at home? Consider having a friend or neighbor help you keep tabs on your child or enroll him in a positive activity to take up any unstructured time, reducing the opportunity for drug use.
You might want to sweep your home for drugs, as suggested by the Partnership for a Drug Free America. “Search for drugs and drug paraphernalia.
If you want to collect concrete evidence of your child’s drug use before your intervention, here are some good places to look: dresser drawers, desk drawers, backpacks, the glove compartment of the car, the back of closets, corners of bed sheets, under the mattress or bed, small boxes, books/book cases, make up cases, over-the-counter medicine bottles, and empty candy wrappers.”
If you do locate drugs, decide how you want to dispose of them. Some parents flush them down the toilet or throw them away. Others have found that you can anonymously surrender them to law enforcement, but it will be important to check to see how this is handled in your community.
Teenage substance use is a complex problem. But, it is a problem that parents should be empowered to help solve. Be encouraged that you can influence your teenagers to make positive changes.
Our children need us to stay informed and involved—and identify the problem.
Inexpensive and easily accessible drug screens will in some small measure, put parents back in the driver’s seat and allow us to take action to protect our children.
If you are looking for an effective treatment for teen drug misuse, download this whitepaper: MST is a Proven Treatment for Substance-abusing Teens.