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American Academy of Pediatrics Recommends Against School and Home-Based Drug Testing of Adolescents

The American Academy of Pediatrics (AAP) has recently issued new guidelines recommending against drug testing of adolescents in schools and at home until more research is conducted. The AAP believes that adolescents should not be drug tested without their knowledge and consent, and that more research is needed on both safety and efficacy before school-based testing programs are implemented. The AAP also suggests that more adolescent-specific substance abuse treatment resources are needed so that testing will result in early rehabilitation rather than only punitive measures. These guidelines update a policy statement issued in 1996 and reaffirmed in 2006, which opposed involuntary testing of adolescents for drugs of abuse and also stated that laboratory testing for drugs under any circumstances is improper unless the patient and clinician can be assured that the test procedure is valid and reliable and that patient confidentiality is ensured. Since a 1995 US Supreme Court ruling that random drug testing of high school athletes is constitutional, national interest in school-based drug testing has increased. In June 2002, the US Supreme Court ruled that public schools can perform random drug tests on all middle and high school students participating in extracurricular activities. Shortly thereafter, the President's Office of National Drug Control Policy published a guidebook encouraging schools to incorporate drug-testing policies for all students. The AAP Committee on Substance Abuse reviewed available data on drug testing of adolescents and concluded that much has been written about the advantages and disadvantages of testing adolescents for drugs, but relatively little has been published in the peer-reviewed scientific literature. A comparison of two schools, only one of which implemented a mandatory drug-testing program for student athletes, showed that the use of illicit drugs was significantly lower among athletes who were drug tested, but that these athletes also experienced an increase in known risk factors for drug use, including an increase in normative views of use, belief in lower risk for use, and poorer attitudes toward the school. In a larger observational study, there was no association between school-based drug testing and students' reports of drug use, and drug testing was not significantly associated with reduction in the use of marijuana or any other illicit drug among students in any grade studied. However, the AAP committee notes that a single observational study is insufficient to establish causation or lack of causation. The AAP issued this addendum to the 1996 policy statement to assist pediatricians who are asked by parents of their adolescent patients about home drug testing because products that test for alcohol and drugs in urine, saliva, and hair are marketed directly to parents and made available at retail outlets and on the Internet. These revised guidelines should also assist pediatricians involved in school health who may be asked to help implement school-based drug-testing programs. Key recommendations in the updated guidelines are as follows: - Both the safety and efficacy of school- and home-based drug testing of adolescents should undergo rigorous scientific study. - School- and home-based drug testing should not be implemented before safety and efficacy are established and adequate substance abuse evaluation and treatment services are available. - Rather than rely on school-based drug screening or home drug-testing products, parents who are concerned that their child may be using drugs or alcohol should consult their child's primary care clinician or other healthcare professional. - Healthcare professionals who obtain drug tests or assist others in interpreting the results of drug tests should be knowledgeable about the relevant technical aspects and limitations of the procedures. - Potential benefits of school- and home-based drug testing are increased number of adolescents who are screened for use of drugs of abuse and the potential for providing early intervention and treatment services to more adolescents diagnosed with substance abuse and/or dependence. "Proponents of drug testing also claim that the existence of a school- or home-based drug-testing program will help adolescents refuse drugs and provide legitimate reasons to resist peer pressure to use drugs, although these claims are not yet proven," the authors write. "On the negative side, drugThe American Academy of Pediatrics (AAP) has recently issued guidelines recommending against at-home and school-based drug testing of adolescents until more research is conducted. The AAP believes that adolescents should not be drug tested without their knowledge and consent, and that more research is needed on both safety and efficacy before school-based testing programs are implemented. The AAP also suggests that more adolescent-specific substance abuse treatment resources are needed so that testing will result in early rehabilitation rather than only punitive measures. These guidelines update a policy statement issued in 1996 and reaffirmed in 2006, which opposed involuntary testing of adolescents for drugs of abuse and also stated that laboratory testing for drugs under any circumstances is improper unless the patient and clinician can be assured that the test procedure is valid and reliable and that patient confidentiality is ensured. Since a 1995 US Supreme Court ruling that random drug testing of high school athletes is constitutional, national interest in school-based drug testing has increased. In June 2002, the US Supreme Court ruled that public schools can perform random drug tests on all middle and high school students participating in extracurricular activities. Shortly thereafter, the President's Office of National Drug Control Policy published a guidebook encouraging schools to incorporate drug-testing policies for all students. The AAP Committee on Substance Abuse reviewed available data on drug testing of adolescents and concluded that much has been written about the advantages and disadvantages of testing adolescents for drugs, but relatively little has been published in the peer-reviewed scientific literature. A comparison of two schools, only one of which implemented a mandatory drug-testing program for student athletes, showed that the use of illicit drugs was significantly lower among athletes who were drug tested, but that these athletes also experienced an increase in known risk factors for drug use, including an increase in normative views of use, belief in lower risk for use, and poorer attitudes toward the school. In a larger observational study, there was no association between school-based drug testing and students' reports of drug use, and drug testing was not significantly associated with reduction in the use of marijuana or any other illicit drug among students in any grade studied. However, the AAP committee notes that a single observational study is insufficient to establish causation or lack of causation. The AAP issued this addendum to the 1996 policy statement to assist pediatricians who are asked by parents of their adolescent patients about home drug testing because products that test for alcohol and drugs in urine, saliva, and hair are marketed directly to parents and made available at retail outlets and on the Internet. These revised guidelines should also assist pediatricians involved in school health who may be asked to help implement school-based drug-testing programs. Key recommendations in the updated guidelines are as follows: - Both the safety and efficacy of school- and home-based drug testing of adolescents should undergo rigorous scientific study. - School- and home-based drug testing should not be implemented before safety and efficacy are established and adequate substance abuse evaluation and treatment services are available. - Rather than rely on school-based drug screening or home drug-testing products, parents who are concerned that their child may be using drugs or alcohol should consult their child's primary care clinician or other healthcare professional. - Healthcare professionals who obtain drug tests or assist others in interpreting the results of drug tests should be knowledgeable about the relevant technical aspects and limitations of the procedures. - Potential benefits of school- and home-based drug testing are increased number of adolescents who are screened for use of drugs of abuse and the potential for providing early intervention and treatment services to more adolescents diagnosed with substance abuse and/or dependence. The revised statement notes that adult substance abuse treatment programs may be inappropriate and ineffective for adolescents and that many communities lack substance abuse treatment services dedicated specifically to adolescents. "A key issue at the heart of the drug-testing dilemma is the lack of developmentally appropriate adolescent substance abuse and mental health treatment," the authors conclude. "Adequate resources for assessment andThe American Academy of Pediatrics (AAP) has recently issued new guidelines recommending against drug testing of adolescents in school and at home until more research is conducted. The AAP believes that adolescents should not be drug tested without their knowledge and consent, and that more research is needed on both safety and efficacy before school-based testing programs are implemented. The AAP also suggests that more adolescent-specific substance abuse treatment resources are needed so that testing will result in early rehabilitation rather than only punitive measures. These guidelines update a policy statement issued in 1996 and reaffirmed in 2006, which opposed involuntary testing of adolescents for drugs of abuse and also stated that laboratory testing for drugs under any circumstances is improper unless the patient and clinician can be assured that the test procedure is valid and reliable and that patient confidentiality is ensured. Since a 1995 US Supreme Court ruling that random drug testing of high school athletes is constitutional, national interest in school-based drug testing has increased. In June 2002, the US Supreme Court ruled that public schools can perform random drug tests on all middle and high school students participating in extracurricular activities. Shortly thereafter, the President's Office of National Drug Control Policy published a guidebook encouraging schools to incorporate drug-testing policies for all students. However, the AAP Committee on Substance Abuse reviewed available data on drug testing of adolescents and concluded that much has been written about the advantages and disadvantages of testing adolescents for drugs, but relatively little has been published in the peer-reviewed scientific literature. A comparison of two schools, only one of which implemented a mandatory drug-testing program for student athletes, showed that the use of illicit drugs was significantly lower among athletes who were drug tested, but that these athletes also experienced an increase in known risk factors for drug use, including an increase in normative views of use, belief in lower risk for use, and poorer attitudes toward the school. In a larger observational study, there was no association between school-based drug testing and students' reports of drug use, and drug testing was not significantly associated with reduction in the use of marijuana or any other illicit drug among students in any grade studied. However, the AAP committee notes that a single observational study is insufficient to establish causation or lack of causation. The AAP issued this addendum to the 1996 policy statement to assist pediatricians who are asked by parents of their adolescent patients about home drug testing because products that test for alcohol and drugs in urine, saliva, and hair are marketed directly to parents and made available at retail outlets and on the Internet. These revised guidelines should also assist pediatricians involved in school health who may be asked to help implement school-based drug-testing programs. Key recommendations in the updated guidelines are as follows: Both the safety and efficacy of school- and home-based drug testing of adolescents should undergo rigorous scientific study. School- and home-based drug testing should not be implemented before safety and efficacy are established and adequate substance abuse evaluation and treatment services are available. Rather than rely on school-based drug screening or home drug-testing products, parents who are concerned that their child may be using drugs or alcohol should consult their child's primary care clinician or other healthcare professional. Healthcare professionals who obtain drug tests or assist others in interpreting the results of drug tests should be knowledgeable about the relevant technical aspects and limitations of the procedures. Potential benefits of school- and home-based drug testing are increased number of adolescents who are screened for use of drugs of abuse and the potential for providing early intervention and treatment services to more adolescents diagnosed with substance abuse and/or dependence. "Proponents of drug testing also claim that the existence of a school- or home-based drug-testing program will help adolescents refuse drugs and provide legitimate reasons to resist peer pressure to use drugs, although these claims are not yet proven," the authors write. "On the negative side, drug testing poses substantial risks — in particular, the risk of harming the parent-child and school-child relationships by creating an environment of resentment, distrust, and suspicion." The revised statement notes that adult substance abuse treatment programs may beThe American Academy of Pediatrics (AAP) has recently issued new guidelines recommending against drug testing of adolescents in schools and at home, until more research is conducted. The AAP believes that adolescents should not be drug tested without their knowledge and consent. The AAP also suggests that more adolescent-specific substance abuse treatment resources are needed so that testing will result in early rehabilitation rather than only punitive measures. These guidelines update a policy statement issued in 1996 and reaffirmed in 2006, which opposed involuntary testing of adolescents for drugs of abuse and also stated that laboratory testing for drugs under any circumstances is improper unless the patient and clinician can be assured that the test procedure is valid and reliable and that patient confidentiality is ensured. Since a 1995 US Supreme Court ruling that random drug testing of high school athletes is constitutional, national interest in school-based drug testing has increased. In June 2002, the US Supreme Court ruled that public schools can perform random drug tests on all middle and high school students participating in extracurricular activities. Shortly thereafter, the President's Office of National Drug Control Policy published a guidebook encouraging schools to incorporate drug-testing policies for all students. However, the AAP Committee on Substance Abuse reviewed available data on drug testing of adolescents and concluded that much has been written about the advantages and disadvantages of testing adolescents for drugs, but relatively little has been published in the peer-reviewed scientific literature. A comparison of two schools, only one of which implemented a mandatory drug-testing program for student athletes, showed that the use of illicit drugs was significantly lower among athletes who were drug tested, but that these athletes also experienced an increase in known risk factors for drug use, including an increase in normative views of use, belief in lower risk for use, and poorer attitudes toward the school. In a larger observational study, there was no association between school-based drug testing and students' reports of drug use, and drug testing was not significantly associated with reduction in the use of marijuana or any other illicit drug among students in any grade studied. However, the AAP committee notes that a single observational study is insufficient to establish causation or lack of causation. The AAP issued this addendum to the 1996 policy statement to assist pediatricians who are asked by parents of their adolescent patients about home drug testing because products that test for alcohol and drugs in urine, saliva, and hair are marketed directly to parents and made available at retail outlets and on the Internet. These revised guidelines should also assist pediatricians involved in school health who may be asked to help implement school-based drug-testing programs. Key recommendations in the updated guidelines are as follows: - Both the safety and efficacy of school- and home-based drug testing of adolescents should undergo rigorous scientific study. - School- and home-based drug testing should not be implemented before safety and efficacy are established and adequate substance abuse evaluation and treatment services are available. - Rather than rely on school-based drug screening or home drug-testing products, parents who are concerned that their child may be using drugs or alcohol should consult their child's primary care clinician or other healthcare professional. - Healthcare professionals who obtain drug tests or assist others in interpreting the results of drug tests should be knowledgeable about the relevant technical aspects and limitations of the procedures. - Potential benefits of school- and home-based drug testing are increased number of adolescents who are screened for use of drugs of abuse and the potential for providing early intervention and treatment services to more adolescents diagnosed with substance abuse and/or dependence. "Proponents of drug testing also claim that the existence of a school- or home-based drug-testing program will help adolescents refuse drugs and provide legitimate reasons to resist peer pressure to use drugs, although these claims are not yet proven," the authors write. "On the negative side, drug testing poses substantial risks — in particular, the risk of harming the parent-child and school-child relationshipsThe American Academy of Pediatrics (AAP) has recently issued guidelines recommending against at-home and school-based drug testing of adolescents until more research is conducted. In an addendum statement published in the March issue of Pediatrics, the AAP suggests that more adolescent-specific substance abuse treatment resources are needed so that testing will result in early rehabilitation rather than only punitive measures. The AAP Committee on Substance Abuse reviewed available data on drug testing of adolescents and concluded that much has been written about the advantages and disadvantages of testing adolescents for drugs, but relatively little has been published in the peer-reviewed scientific literature. A comparison of two schools, only one of which implemented a mandatory drug-testing program for student athletes, showed that the use of illicit drugs was significantly lower among athletes who were drug tested, but that these athletes also experienced an increase in known risk factors for drug use, including an increase in normative views of use, belief in lower risk for use, and poorer attitudes toward the school. In a larger observational study, there was no association between school-based drug testing and students' reports of drug use, and drug testing was not significantly associated with reduction in the use of marijuana or any other illicit drug among students in any grade studied. However, the AAP committee notes that a single observational study is insufficient to establish causation or lack of causation. The AAP issued this addendum to the 1996 policy statement to assist pediatricians who are asked by parents of their adolescent patients about home drug testing because products that test for alcohol and drugs in urine, saliva, and hair are marketed directly to parents and made available at retail outlets and on the Internet. These revised guidelines should also assist pediatricians involved in school health who may be asked to help implement school-based drug-testing programs. Key recommendations in the updated guidelines are as follows: - Both the safety and efficacy of school- and home-based drug testing of adolescents should undergo rigorous scientific study. - School- and home-based drug testing should not be implemented before safety and efficacy are established and adequate substance abuse evaluation and treatment services are available. - Rather than rely on school-based drug screening or home drug-testing products, parents who are concerned that their child may be using drugs or alcohol should consult their child's primary care clinician or other healthcare professional. - Healthcare professionals who obtain drug tests or assist others in interpreting the results of drug tests should be knowledgeable about the relevant technical aspects and limitations of the procedures. - Potential benefits of school- and home-based drug testing are increased number of adolescents who are screened for use of drugs of abuse and the potential for providing early intervention and treatment services to more adolescents diagnosed with substance abuse and/or dependence. "Proponents of drug testing also claim that the existence of a school- or home-based drug-testing program will help adolescents refuse drugs and provide legitimate reasons to resist peer pressure to use drugs, although these claims are not yet proven," the authors write. "On the negative side, drug testing poses substantial risks — in particular, the risk of harming the parent-child and school-child relationships by creating an environment of resentment, distrust, and suspicion." The revised statement notes that adult substance abuse treatment programs may be inappropriate and ineffective for adolescents and that many communities lack substance abuse treatment services dedicated specifically to adolescents. "A key issue at the heart of the drug-testing dilemma is the lack of developmentally appropriate adolescent substance abuse and mental health treatment," the authors conclude. "Adequate resources for assessment and treatment must be available to students who have positive test results.... Federal support for school-based drug testing should include an allocation of resources that will facilitate greater access to adolescent substance abuse treatment." In conclusion, the AAP recommends against drug testing of adolescents in schools and at home until more research is conducted. The focus should be on providing adequate substance abuse evaluation and treatment services to adolescents who are diagnosed with substance abuse and/or dependence. Healthcare professionals should be knowledgeable about the relevant technical aspects and limitations of drug testing procedures, and parents who are concerned that their child may be using drugs or alcohol should consult their child's primary care clinician or other healthcare professional.


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