Drug Testing in Schools

Howard Taras, M.D.Floralynn Einesman, J.D.

Jesse Brennan

United States of AmericaConstitution: 4th Amendment“The right of the people to be secure in

their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.”

U.S. Supreme Court: Schools can mandate drug screening if:

Student is enrolled in a school athletic program (e.g., school football team); 1995

- and -

Student is enrolled in any extra-curricular activity (e.g., chess club). 2002

Does drug testing at Does drug testing at school meet criteria for school meet criteria for a sound public health a sound public health

screen?screen?

6 basic principles of 6 basic principles of public health screeningpublic health screening

Public Health Principles Before Public Health Principles Before Starting a Screening ProgramStarting a Screening Program

1.1. DISEASE:DISEASE: ► Is the disease of adequate Is the disease of adequate severityseverity? ? ► Or Or prevalenceprevalence? ? ► What problems will occur by not What problems will occur by not

identifying health issue identifying health issue in that in that populationpopulation??

Public Health Principles Before Public Health Principles Before Starting a Screening ProgramStarting a Screening Program

2.2. An effective therapy An effective therapy or or intervention. intervention.

Public Health Principles Before Public Health Principles Before Starting a Screening ProgramStarting a Screening Program

3.3. Therapy availableTherapy available to all who to all who screen positive?screen positive?

4.4. Screen test: Screen test: Is it of acceptable: Is it of acceptable: “specificity”? “sensitivity”? “specificity”? “sensitivity”? “positive predictive value”?“positive predictive value”?

Public Health Principles Before Public Health Principles Before Starting a Screening ProgramStarting a Screening Program

5.5. Screening program is either: Screening program is either:

(a) (a) cost-effectivecost-effective or or

(b) a socially desirable expense(b) a socially desirable expense

Public Health Principles Before Public Health Principles Before Starting a Screening ProgramStarting a Screening Program

6.6. It’s being performed on the It’s being performed on the Target Target population:population:

For Schools: For Schools: Evidence that Evidence that schoolschool--basedbased testing is testing is most effectivemost effective locationlocation

If not a public health screen, then is it a If not a public health screen, then is it a deterrentdeterrent or an or an educational tooleducational tool??

__________________________________________________________________________

If so, we must demonstrate that testing If so, we must demonstrate that testing program: program:

(a)(a) is is effectiveeffective as educational or as educational or deterrent.deterrent.

(b)(b) does does not cause inadvertent harmnot cause inadvertent harm. .

Does research show drug Does research show drug screening to be a deterrent?screening to be a deterrent?

Very poor evidence: Very poor evidence: ►High School Principal Survey High School Principal Survey

(McKinney):(McKinney):►Yamaguchi R, et al. Yamaguchi R, et al. J School J School

HealthHealth. (2003). Vol 73; p-159 . (2003). Vol 73; p-159 ►Goldberg L, et al. Goldberg L, et al. J Adolesc HealthJ Adolesc Health

(2003) Vol 32; p-16(2003) Vol 32; p-16

Potential for Harm (not yet Potential for Harm (not yet proven) proven)

1.1. Testing may discourage Testing may discourage extracurricular activity.extracurricular activity.

2.2. Positive test may deteriorate an Positive test may deteriorate an unstable home situationunstable home situation

3.3. Adolescent developmental stage: Adolescent developmental stage: “estranged from their own body”“estranged from their own body”

4.4. Screening costs supplant proven Screening costs supplant proven educational curriculaeducational curricula

Potential for Harm (also Potential for Harm (also unproven) unproven)

5.5. Message that youth not Message that youth not trusted by adults. School trusted by adults. School climateclimate. .

• Poorer attitudes toward school among Poorer attitudes toward school among tested, versus non-tested tested, versus non-tested athletes/Goldbergathletes/Goldberg et al 2003 et al 2003

6.6. Students try to outsmart the Students try to outsmart the tests, use more dangerous tests, use more dangerous drugs?drugs?

• Use of ecstasy, inhalants, alcoholUse of ecstasy, inhalants, alcohol

Potential for Harm (also Potential for Harm (also unproven) unproven)

7. 7. False positive results damage False positive results damage relationships, until proven relationships, until proven negativenegative

8. 8. Counter-productive punitive Counter-productive punitive response to +’ve test? (e.g.: response to +’ve test? (e.g.: Are dismissal from sport; Are dismissal from sport; suspension) suspension)

Sample QuestionsSample Questions

The school’s drug testing program The school’s drug testing program makes it easier to say “no” to makes it easier to say “no” to drugs. drugs.

Drug-testing doesn’t work because Drug-testing doesn’t work because students know how to get around students know how to get around the test. the test.

True- 52%True- 52% FalseFalse

True- 24%True- 24% FalseFalse

““If a drug test proved I used If a drug test proved I used alcohol or drugs…”alcohol or drugs…”

… … my parents would be my parents would be angry. angry.

……my safety at home my safety at home would be at risk. would be at risk.

True-98%True-98% FalseFalse

TrueTrue-26%-26% FalseFalse

Sample QuestionsSample Questions

For Athletes:For Athletes:I thought about not joining a I thought about not joining a

school athletic activity because school athletic activity because I did not want to be drug-I did not want to be drug-tested. tested.

For Non-Athletes:For Non-Athletes:One of the reasons I did not join One of the reasons I did not join

a school activity is that I did a school activity is that I did not want to be drug-tested. not want to be drug-tested.

True – 4%True – 4% FalseFalse

True True -??-?? FalseFalse

What policies can Schools What policies can Schools adopt at this stage? adopt at this stage?

1.1. Allow drug testing with Allow drug testing with research research that detects that detects both potential harm and potential benefitboth potential harm and potential benefit

2.2. Identify Identify signs & symptomssigns & symptoms of illicit drug use of illicit drug use (eg, underachievement, truancy, behavior); (eg, underachievement, truancy, behavior);

3.3. Refer to medical clinics, rather than Refer to medical clinics, rather than discipline.discipline.

4.4. Drug prevention education; Select Drug prevention education; Select curricula curricula that have been proven to be effectivethat have been proven to be effective. .

Howard Taras, MDHoward Taras, MD

htaras@ucsd.eduhtaras@ucsd.edu1-619-681-06651-619-681-0665

San Diego, CaliforniaSan Diego, California