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Drug Testing Without Patient Consent?

It's acceptable to perform drug testing in an adolescent without the patient's consent in cases of altered mental status such as intoxication or overdose or as an adjunct in the evaluation of the victim of trauma or violence, Dr. Baren said.

It's also acceptable when it's necessary to make an appropriate disposition that's clearly going to benefit the patient. "Some physicians ask, 'Why do rehab facilities require us to do the drug testing when the patients is not currently showing signs of drug or alcohol intoxication?' Because it's in the patient's best interest to get to that facility," Dr.Baren said. "We all know it's a crunch in terms of available beds for treating mental health disorders."

It's also okay to perform drug testing when the patient gives you permission. "Many teens want help, and they know this is going to be a way to get it," said Dr.Baren.

Before ordering a urine drug screen, consider this question: Will the test provide any information on the pattern of abuse, the amount of dependence, or the impairment the patients has from drug use?

"The answer is almost uniformly going to be no," Dr. Baren said. "A positive screen only tells you that there's been use, but it doesn't really tell you where that patient falls on that continuum. A negative screen doesn't rule out use."

The American Academy of Pediatrics' Committee on Substance Abuse does not object to diagnostic testing for the purpose of drug abuse treatment, but it recommends that testing be approached with informed consent. The committee said that involuntary testing is only justified when there is risk of serious harm and when knowing the specific drug would avert that harm.

Involuntary drug testing should never be done "on demand" by parents or guardians, Dr. Baren said. Instead, address the issues that provoked such a request.

Physicians may disclose results of the drug screen with the patient's permission, or if they determine that there is significant potential harm to the patient and that disclosure is likely to facilitate appropriate treatment.

Consent for substance abuse treatment varies by state law, Dr. Baren said, Most states allow a minor to consent to their own drug and alcohol abuse treatment at any age; but some have a minimum age, and others require parental notification. Federally funded programs prohibit parental notification unless the minor lacks the capacity to provide consent or would be harmed without it.
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Title Annotation:Across Specialities
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jul 1, 2008
Previous Article:Psychosocial assessment is key for teens in emergency departments.
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