Drug testing can be a helpful tool in determining substance use or mental health disorders in adolescents. To help pediatricians determine whether and when drug testing may be useful and how to best use this procedure when it appears necessary, the American Academy of Pediatrics recently released an updated guide. A summary of this guide for parents is available here.

The report gives a lot of clear and sensible advice (such as check the temperature of the urine sample immediately and if it is not between 95 and 100 degrees, it is not fresh urine – someone is trying to trick the tester), but the most important statement is in the parents' guide: "If your teen undergoes a drug test, it should be knowingly. The AAP opposes drug tests without a teen's knowledge and consent. "

Parents seem to think doctors are judges or police, but we are not.  To do our job as the adolescent's practitioner, we have to keep the teen's confidence.  I tell every teen that anything they say to me is confidential unless they tell me they are going to hurt themselves or other people.  I make the rules very clear.

When an adolescent starts to behave erratically, to hang out with a group that makes his parents uncomfortable and, most importantly, starts to fail in school, then discussing these concerns with the teen is reasonable.  The teen and you may come to a conclusion that drug testing is in the mutual interest of both of you, and then a sample of urine drawn under strict conditions to insure its legitimacy can be easily processed by the teen's medical practitioner.  But if the teen refuses to give a sample then the AAP suggests: "Parents may use logical consequences such as suspending driving privileges or grounding [the teen} if an indicated test is refused."

Although many materials can be tested for drugs (such as hair, breath, stool, and blood), urine is the one used almost exclusively because it can be obtained in a non-invasive manner and it's relatively inexpensive to process. Urine drug testing does have its problems.  Although marijuana stays in the body and in urine for many days, cocaine does not (For example, I know a mother that I saw in the hospital one time took cocaine two days before and yet her urine tested cocaine negative).  Since it is obtained in private, one can substituted another person's urine for one's own or put a little yellow dye in water and call it urine.  That is why checking the urine temperature among other quality control issues is so important.

What do you do if the drug test is positive and the teen does not want to change his or her habits? This is the hardest question.

If the teen is already in the judicial system, and we hope not, then random drug testing is a very successful method of preventing recidivism. Mark Kleiman, a pofessor of public policy at UCLA, and editor of Drug Policy Analysis, has shown that the efficacy of a deterrent threat in enforcing a rule depends in part on the probability that this punishment will be carried out. So judges who actually punish drug offenders with positive drug tests find that the offenders use drugs markedly less.

But in the home situation such consistency is difficult. The theory of "tough love" is correct, but the practice is difficult especially when the offenses are still annoying rather than serious.  The AAP suggests you and your child discuss all your concerns with your pediatrician.  Your doctor should talk to the teen in private.  If drug testing is considered appropriate, then the doctor can make sure the lab samples are collected and processed reliably and that false positives or negatives are accounted for, and that results are kept confidential.  Finally, the drug test is the entry to solving a problem not an ending.

A strong willingness to collaborate from parent, child and practitioner is the best chance of success in a teen's life and that is what we should all care about.

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