1. Drug Testing in Schools Howard Taras, M.D. Floralynn Einesman, J.D. Jesse Brennan

2. United States of America Constitution: 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.

3. 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

4. Does drug testing at school meet criteria for a sound public health screen? 6 basic principles of public health screening

5. Public Health Principles Before Starting a Screening Program 1. DISEASE: Is the disease of adequate severity? Is the disease of adequate severity? Or prevalence? Or prevalence? What problems will occur by not identifying health issue in that population? What problems will occur by not identifying health issue in that population?

6. Public Health Principles Before Starting a Screening Program 2. An effective therapy or intervention.

7. Public Health Principles Before Starting a Screening Program 3. Therapy available to all who screen positive? 4. Screen test: Is it of acceptable: specificity? sensitivity? positive predictive value?

8. Public Health Principles Before Starting a Screening Program 5. Screening program is either: (a) cost-effective or (b) a socially desirable expense

9. Public Health Principles Before Starting a Screening Program 6. Its being performed on the Target population: For Schools: Evidence that school-based testing is most effective location

10. If not a public health screen, then is it a deterrent or an educational tool? _____________________________________ If so, we must demonstrate that testing program: (a) is effective as educational or deterrent. (b) does not cause inadvertent harm.

11. Does research show drug screening to be a deterrent? Very poor evidence: High School Principal Survey (McKinney): High School Principal Survey (McKinney): Yamaguchi R, et al. J School Health. (2003). Vol 73; p-159 Yamaguchi R, et al. J School Health. (2003). Vol 73; p-159 Goldberg L, et al. J Adolesc Health (2003) Vol 32; p-16 Goldberg L, et al. J Adolesc Health (2003) Vol 32; p-16

12. Potential for Harm (not yet proven) 1. Testing may discourage extracurricular activity. 2. Positive test may deteriorate an unstable home situation 3. Adolescent developmental stage: estranged from their own body 4. Screening costs supplant proven educational curricula

13. Potential for Harm (also unproven) 5. Message that youth not trusted by adults. School climate. Poorer attitudes toward school among tested, versus non-tested athletes/Goldberg et al 2003Poorer attitudes toward school among tested, versus non-tested athletes/Goldberg et al 2003 6. Students try to outsmart the tests, use more dangerous drugs? Use of ecstasy, inhalants, alcoholUse of ecstasy, inhalants, alcohol

14. Potential for Harm (also unproven) 7. False positive results damage relationships, until proven negative 8. Counter-productive punitive response to +ve test? (e.g.: Are dismissal from sport; suspension)

18. Sample Questions The schools drug testing program makes it easier to say no to drugs. Drug-testing doesnt work because students know how to get around the test. True- 52% False True- 24% False

19. If a drug test proved I used alcohol or drugs… … my parents would be angry. …my safety at home would be at risk. True-98% False True-26% False

20. Sample Questions For Athletes: I thought about not joining a school athletic activity because I did not want to be drug-tested. For Non-Athletes: One of the reasons I did not join a school activity is that I did not want to be drug-tested. True – 4% False True -?? False

21. What policies can Schools adopt at this stage? 1. Allow drug testing with research that detects both potential harm and potential benefit 2. Identify signs & symptoms of illicit drug use (eg, underachievement, truancy, behavior); 3. Refer to medical clinics, rather than discipline. 4. Drug prevention education; Select curricula that have been proven to be effective.

22. Howard Taras, MD htaras@ucsd.edu 1-619-681-0665 San Diego, California