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Drug Testing for Teens

Nurses need to know the pros and cons of testing teenagers for illicit drug use so they can educate and advise worried parents.

Nurses working in many areas of care may encounter parents who believe their child may be using drugs.

It could be in the ED when the child is brought in on an unrelated issue, in the school setting, in a primary care office, or any number of places.

Parents may turn to nurses for advice as nurses are a trusted profession, and parents may feel they can confide in the nurse without consequence.

For this reason nurses must be informed about drug use among teens, and about the pros and cons of testing teens for drug use.  

It's only natural for parents to worry about the safety of their children. They want to know that their kids are OK. As a result, some see drug testing as a no-nonsense solution to the nagging questions and as a possible deterrent to drug abuse.  

Parents want the truth, but teenagers aren't likely to be honest. Teens Today research from SADD and Liberty Mutual Group shows that while 95% of parents say they trust their teens in making decisions about drugs, only 28% of teens report being completely honest with parents on the issue.

Teenagers often take elaborate steps to conceal their drug use. While drug testing may appear as a simple solution, the problem is far more complex.

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How Common is Drug Use Among Teens?

According to the 2012 Monitoring the Future Study conducted by the University of Michigan, drug use among high school seniors is prevalent.
  • 36.4% confess to using marijuana/hashish
  • 11.3% confess to using synthetic marijuana (Spice or K2)
  • 4.8% confess to using hallucinogens
  • 4.4% confess to using MDMA (Ectasy)
  • 2.7% confess to using cocaine (any form)
This study identifies a few trends:
  • Synthetic marijuana is a major concern.
  • Nonmedical use of prescription and OTC medicines remain a significant part of the teen drug problem. 
  • More students are smoking marijuana (22.9%) than cigarettes (17.1%).
Fortunately, adolescents in grades 6-12 say parents are their biggest influence not to use drugs. Teens who report open and honest communication with their parents are more likely to avoid drugs, to try to live up to their parents' expectations, and to say that their parents' methods of keeping them away from drugs are effective.

However, many parents still feel that "scare tactics" and the threat of a drug test is an effective approach, especially with the widespread availability of home drug testing kits.

Is Testing Kids the Answer?

The National Institute on Drug Abuse recommends that drug testing should never be done as a standalone response to a drug problem.

Why is there hesitancy?

1. Drugs are only detectable in urine for a short period of time, and this varies from drug to drug. Catching occasional drug use isn't always possible or can be misleading.

2. While testing can possibly identify a drug problem, the real issue is how to treat the drug abuse. Grounding a teenager for smoking pot addresses the disobedience - but not any addiction.

3. False positives can mislead parents. Poppy seeds, cold medications and even antibiotics in high doses can cause false-positive results on certain tests. This flaw may lead parents to falsely accuse innocent teens of illegal drug use. It also becomes a convenient way for a teenager with a drug problem to profess that it was the "poppy seeds" and not drug use.

4. Home kits can be difficult to navigate. Parents have to know the difference between similar-sounding drug types, such as opiates and opioids. Get the wrong kit, and the results could be meaningless.

Five Ways Teens Try to Fool Drug Tests

As testing becomes more widespread, teenagers become more adept at cheating the test. It doesn't take long for a teenager to Google possible ways to circumvent the drug test.

Tampering.
Salt, bleach, vinegar, detergent or drain cleaner will ruin a urine specimen. These substances can be smuggled into the bathroom and used to alter the urine test, making the presence of illegal substances undetectable.

Why it doesn't work in a lab test: Toxicologists use tests to catch these cheats.

Water loading. The most common way teens will try to foil a drug test is by drinking a ridiculous amount of fluids before providing urine. The goal is to water down drugs so they can't be detected.

Why it doesn't work in a lab test:
Testing facilities check urine for dilution and deem overly watery samples "unfit for testing."

Switching drugs. Teens bent on fooling drug tests will switch from their drug of choice to an undetectable substance that's considerably more hazardous, such as inhalants.

Why it doesn't work: It's a dangerous "solution," which poses alternate problems that can make the drug abuse even easier to identify.

Taking vitamins. Some teens got the idea that extreme doses of certain vitamins could erase any trace of illicit drug use.

Why it doesn't work: Taking vitamins to fool a drug test is an urban myth, and it can be dangerous.

Swapping urine samples. Teens will try to pass off foreign samples as their own. They may use a friend's clean urine, synthetic pee, or even freeze-dried urine purchased online.

Why it doesn't work in lab test:
The biggest tip-off is temperature. Labs are good at spotting fake samples.

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When Teens Resist

Instead of bothering with a home kit, determined parents might bring their son or daughter to a family medical practice, asking for a test.

This scenario raises three important ethical questions, which every healthcare facility should be mindful of before proceeding with or denying a drug test.

1. Can young people truly give their informed consent to be tested?

The American Academy of Pediatrics is opposed to involuntary diagnostic testing. Although minors are under the care of their parents, some legal and moral rights still extend past the rights of parents. Yes, drug abuse can be a matter of life and death, but lab testing isn't the only method for diagnosing a problem.

2. Does the testing impinge negatively on the physician-patient relationship?

Patient confidentiality is a fundamental right. If a patient sees the nurse or doctor as an agent of the parents, they have no reason to believe sensitive information is private or credible. No matter how well intentioned, complying with parents' wishes may damage the provider-patient trust. This breach of trust can lead to more problems.

3. How will you respond when a young person tests positive for illegal drugs?
What will you say to the patient? What will you say to the parents? Do you have referrals for a teen drug rehab center?

Nurses should be ready for these moments, acting as a calm voice of reason to the ease concerns of a family dealing with drug abuse. If a child fails a drug test, it should lead to early intervention and treatment, not merely punitive measures.

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Does a Test Obligate Rehab?

Parents want to know that their children are OK. But more than that: they want their children to receive help if they have a drug problem.

Testing positive for drug use doesn't obligate a teenager to admit that he or she has a problem. A test can't shove them down the path to recovery. If anything, a drug test should be part of a larger conversation about healthy choices and getting the necessary help.

Sometimes the best "drug test" is simply talking with the teenager in a non-threatening way.

Nurses have an opportunity to listen and asking the right questions. Patients may open up if they feel they are in a caring environment, which is an important step in overcoming drug addiction.

Johnny Patout is a licensed clinical social worker and CEO of New Beginnings Recovery Center. Lafayette, La.



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