Key Researchers


Key Results: Drug Testing of Adolescents in Schools

Citations Listed in Key Results

  • A relatively small number of schools have random drug testing programs; this number appeared to be increasing in the early 2000s.
    According to data from the Monitoring the Future Study, approximately 18% of schools reported any type of drug testing program in 1998-2001; the majority of these involved testing for cause. Over the course of the study significant upward trends were noted in the development of suspicionless drug testing for athletes and students participating in extracurricular activities (Yamaguchi et al., 2003). A nationally representative sample of randomly selected school districts found that 14% of school districts reported that at least one of their high schools conducted random drug testing in the 2004-2005 school year. Over 93% of these programs included athletes, 65% included students who participate in extracurricular activities, and 28% included all students (Ringwalt et al., 2008). No comparable surveys have been published since that time, though the availability of federal funding to support new school-based drug testing programs makes it likely that the number of school drug testing programs has continued to rise (ONDCP, 2007).
  • A large cross-sectional study found no difference in the rates of marijuana or other illicit drug use by students in schools with drug testing programs versus those without.
    These findings question the efficacy of school drug testing programs; however, the cross-sectional design precludes conclusions about causation. In this study, the penetration of the policy (i.e., the amount of testing per student) was not determined and many students in "drug testing schools" were not actually subject to drug testing. Furthermore, the author notes that it is possible that schools with higher levels of drug use may be more likely to institute drug testing programs, and the levels of drug use observed at these schools actually represents a decrease (Yamaguchi et al., 2003).
  • A small case-control pilot study of random drug testing of athletes found a significant decrease in past 30 day illicit drug use by athletes attending an experimental school with a drug testing program compared to athletes attending a control school. Goldberg et al. also found that athletes in the experimental school expressed more attitudes associated with increased drug use, suggesting that students exposed to drug testing may have higher risk of future drug use than peers in the control school.
    Rates of new initiation of drug use were not different between the schools, suggesting that the drug testing program had minimal or no preventative impact. This study included two schools - a self selected intervention school and a control school that was matched in size and demographics. The study found that, compared to control, athletes attending the experimental school expressed more attitudes associated with increased drug use, believed there were fewer benefits to drug testing, and believed that testing was ineffective (Goldberg et al., 2003).
  • The results of the only randomized controlled trial of school drug testing published to date were inconclusive, showing decreased past year drug use at two time points but not at three others, and no reduction in past month drug use. As in the pilot study, athletes exposed to drug testing expressed more attitudes associated with increased drug use than those in control schools.
    The Student Athlete Testing Using Random Notification (SATURN) study, also conducted by Goldberg et al. was a two-year prospective randomized controlled trial of five intervention high schools with drug and alcohol testing programs for student athletes and six control schools. No difference was found in past one month drug use at any of the follow-up periods, but there were lower rates of past year illicit drug use at two of five measurement points. Drug testing was associated with attitudinal changes which have been associated with increased risk of future substance use. Based on these findings the authors concluded, "More research is needed before [drug testing] is considered an effective deterrent for school-based athletes" (Goldberg et al., 2007).
  • A majority (74.1%) of students surveyed in a rural school district that was about to begin a random drug testing program believed that random drug testing would be effective in reducing drug use in their school, and 45% thought that random drug testing at school was a "good idea."
    In this study students who reported more drug use had lower expectations of policy effectiveness, suggesting that experienced students may believe that they can beat a drug test. The authors noted that this study may not be broadly generalizable since it included only students from a single rural school district. It should also be noted that this survey was conducted prior to implementing a drug testing program, which may be significant because both SATURN studies (summarized above) demonstrated that students who participated in drug testing programs developed negative attitudes over time and believed drug testing was less effective (Evans et al., 2006).
  • A survey of middle and high school students in the rural northwestern area of the United States found that middle school students were more likely to endorse drug testing than were high school students, who were more likely to believe that drug testing violated their privacy.
    In general, students who participate in after-school activities and who do not use drugs view drug testing more favorably, suggesting that teens who use drugs believe drug testing to be relatively ineffective (Russell et al., 2005).
  • Drug tests are susceptible to misinterpretation.
    Although seemingly straightforward, the process of obtaining reliable and valid test results from drug screening of human tissue samples is deceptively complex. Both screening and confirmatory test results are affected by a number of factors, including the chemical of interest, the screen or test methodology used, the frequency and amount of the substance ingested, and the timing of last use. Additionally, individuals may be highly motivated to avoid detection of their substance use through various tampering methods (Jaffee et al., 2008). A variety of adulterants may be used to interfere with drug testing and some of these substances may be difficult to detect in a urine sample (Jaffee et al., 2007). As with other laboratory tests, drug test results should be interpreted in the context of the medical history, which may pose significant logistical difficulty when screening large populations. One adolescent substance abuse program found that 21% of all confirmed positive drug tests resulted from appropriate use of prescription or over-the-counter medications, including a few (6%) of the opioid positive and most (91%) of the amphetamine positive tests, nearly all of these latter resulting from prescription amphetamine use to treat attention-deficit hyperactivity disorder (ADHD). Two-thirds of oxycodone use was detected only by confirmatory gas chromatography/mass spectrometry (GC/MS) testing, and would have been missed by standard enzyme-based screening panels (Levy et al., 2007).

    These results suggest the following important considerations: (1) To be effective, urine drug test samples must be collected using methods that decrease opportunities for adulteration, but such methods also may be embarrassing or pose privacy issues; (2) Drug testing without the benefit of an individual’s medication history may expose students to the risk of false positive results (i.e., a positive drug test resulting from prescribed medication use) and false accusations of drug use, or may reveal confidential medication use. It may be illegal to demand knowledge of medication intake; (3) Drug testing programs that rely on less expensive screening techniques without confirmatory testing expose adolescents to the risk of false positive drug tests resulting from proper use of prescriptions, over-the-counter medications or food products; and (4) Drug testing programs that use standard drug testing panels may result in negative drug tests in the context of illicit drug use if students are using drugs that are not included in the panel, potentially resulting in false reassurance, delayed detection of drug use, decreased belief in effectiveness, and reduced deterrent effect.

    Websites posted by drug testing kit manufacturers and distributors often encourage parents to establish random drug testing policies at home in order to prevent their children from using drugs. A Robert Wood Johnson Foundation Substance Abuse Policy Research Program (SAPRP) sponsored content review of eight of these websites found that the information regarding which substances are detectable was confusing, claims of home drug testing benefits were unsubstantiated, and the limitations and potential risks of these products were omitted (Levy et al., 2004). In a follow-up study sponsored by SAPRP, Levy et al. found that even primary care physicians who have greater training in the use of laboratory testing than do most parents are not fully aware of the limitations of drug testing and often omit recommended procedures for collecting and validating urine drug test specimens (Levey et al., 2006).
  • Students may put themselves at risk by attempting to defeat a drug test.
    Ingestion of miscellaneous substances has been recommended on the Internet as a way to circumvent drug testing. For example, the Rocky Mountain Poison and Drug Control Center reported that 11% of callers reporting niacin (vitamin B6) exposure specified altering drug test results as the cause of the ingestion, and another 27% who reported intentional, non-medical, non-suicidal use of niacin were categorized as possibly ingesting niacin for this reason. A large variety of other substances with potential toxicities have also been recommended for this purpose on "pro-drug" websites (CDC, 2007). Students may also attempt to defeat drug testing by switching to substances such as inhalants that are difficult to detect by standard testing methods but pose great health risk. None of these unintended consequences have been systematically studied, and the magnitude of the risk is unknown.
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