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Voluntary drug testing for high school students.

Voluntary drug testing for high school students

Would any normal teenager willingly participate in a voluntary drug testing program based at school? The answer was a resounding yes when our laboratory plunged into a venture that quickly exceeded our high original hopes.

Voluntary drug testing is a relatively new approach to combating the problem of substance abuse in high schools. We found it fairly easy to develop a successful program by combining the talents and resources of our laboratorians with the enthusiasm and assistance of school personnel.

* First contact. In 1986, the principal and vice principal of a local high school who had begun to develop a voluntary drug testing program for athletic teams approached our lab. The school, having developed the concept for the program, was looking for a licensed laboratory to perform the testing. After some consultation, we decided that we could do the job at minimal cost while providing an excellent service for our community. As medical director of the lab, I took the reins.

During the next year we planned the program. I met with hospital administration and gained their approval to sponsor it. At the same time, the principal and vice principal got the go-ahead from their school board.

* Why sports teams? Support programs thrive on word of mouth. We--the clinical laboratory and the school--wanted students to appreciate the program and to encourage their friends to participate. Targeting boys' and girls' sports programs helped facilitate such involvement. This tactic has worked in several ways.

First is the high visibility of school sports. If members of the football, basketball, baseball, and other teams are actively enrolled and supportive, other students will follow suit.

The second advantage of starting with athletes was a chance to gain the involvement of the coaches. Their encouragement of students to participate was instrumental as the program began and has continued to be so ever since.

The coaches were glad to cooperate. Many had known one or more promising young athletes lost to the devastating effects of drug abuse. In addition, the coaches were familiar with the tragic stories of substance abuse in many amateur and professional sports.

A third reason to begin with student athletes is the prevailing attitude of that group. They want credit for every tackle and home run they achieve. What they don't want is to have their achievements tainted by suspicion of drug use.

*Pep rally. Our primary focus is on deterrence, not detection: to prevent teenagers from experimenting with drugs rather than to point a finger at those who have tried them. We take pride in the voluntary and confidential nature of our program. No student is required to participate, yet participation has been strong--and growing--from the beginning.

We start off each year with a bang. At a special pep rally, usually held just before the debut of fall athletics, we introduce the program. To build it up, we involve the drill team, the local press, and even local celebrities. After the rally, we discuss the program with students, parents, coaches, teachers, administrators, and anyone else who is interested.

We have made it easy to sign up. A simple application form asks for the student's name, address, and telephone number. At the bottom, the student and one or both parents sign their consent to have the testing done. The coaches hand out some applications before our big meeting. Other students receive theirs at the event. The forms are mailed to the chemical dependency unit at the hospital and then passed to me.

* At the lab. Testing is performed once a week. I schedule it on different days so that students never know exactly on what day specimens will be collected. Because weekends present the biggest risk for substance abuse, we often do the testing on Monday mornings.

The students to be tested are determined by a weekly lottery. The procedure is straightforward. I keep all the applications in a folder under lock and key. On each collection day, I pull about five forms out of the file. I notify the school administration of the names drawn that morning.

After a student has been tested, his or her name goes into a second pool. My weekly drawing includes at least one name from the second pool so that those who have already been tested won't let down their guard.

* To the school. The school calls the parents to confirm their approval. The students are usually notified during the first class of the day that their names have come up. An administrator immediately escorts the student to the school nurse's office to provide a urine specimen in a private setting. We collect the specimen early in the day to get as close to a fasting specimen as possible. Voiding is not observed.

No student is required to provide a specimen. We make this policy clear to the students and their parents from the beginning. I do, however, notify by letter any parent whose son or daughter has chosen not to follow through with the test. This situation has occurred only once or twice in the 4-1/2 years of our program.

At the end of the collection period, urine specimens are locked in a transport cooler. A school administrator takes them directly from the nurse's office at the school to our laboratory.

* Back to the lab. All testing is performed at the hospital along with our regular work. We use enzyme-multiplied immunoassay technique (EMIT) screening procedures, which test for marijuana, cocaine, barbiturates, opiates, phencyclidine (PCP, or "angel dust"), amphetamines, and benzodiazepines. We also do a special screen for alcohol. The counselor from the chemical dependency unit sends a letter of congratulation to parents of students whose test results are negative.

When a test result is positive, we send the specimen to a reference laboratory for confirmation by gas chromatography mass spectrometry (GC/MS). Only 1% of the tests at each school have been positive each year.

I review all positive test results with a counselor from our hospital's chemical dependency unit. The counselor then notifies the parents by telephone that a positive result has been found, although the substance identified is not named at this time. They set a date for a meeting at the hospital that will include the student, one or both parents, and the counselor to discuss the specifics of the test.

At the meeting, the parents and student are told what substance or substances the tests have uncovered. The counselor suggests subsequent arrangements for treatment or follow-up. It is up to the parents to proceed from there.

We take care to assure that the program is carefully controlled, voluntary, and confidential. The hospital retains all consent forms and sign-up sheets. No records are kept at the school, nor is the coach or school informed of test results. Therefore, the school can take no disciplinary action related to a positive test. The entire matter is placed in the hands of the family.

We have not received a single complaint about our project from students or parents. One student, who raised the issue of invasion of privacy, was reassured when I explained that the program was voluntary. If anything, parents tend to be overzealous. Some would like their teenagers to be tested every week. Parents have even asked me to "fix" the lottery so that their children's names would be drawn next. I declined to tamper with the system.

* Our gift. Our expenses are minimal. We keep costs low by using our regular equipment in the lab (see Figure I for a breakdown of cost per test). Or lab staff performs the students' tests along with their regular work. Our clerical staff takes care of the paperwork. Our entire staff is proud of the program and glad to be a part of it. The hospital administration is willing to shoulder most of the expense as a community service and a public relations effort.

Presently our hospital sponsors this program at three schools, ranging in enrollment from 700 to 2,000. The first year we sponsored one school. The second year, another joined the ranks. Some schools participate on alternate years.

Because we absorb most of the costs, we have been able to include only the sports teams so far. Community groups provide additional financial support. As the program grows to include more schools, we plan to sponsor fund-raisers, apply for Federal and state grants, and approach local businesses for donations. To encourage people to develop programs similar to ours, I give lectures in neighboring communities.

* Influence. The enthusiasm of students is vital to the program's success. When the vast majority of a group such as the football team agree to sign up, they help create an atmosphere in which drug experimentation is discouraged. Many participants have told us that the program offers an excuse not to experiment. Widespread participation also serves as notice that no one in the group uses or intends to use drugs.

Students who receive negative test results are proud to have "passed." Some display the report on their lockers. The spirit of the program is infectious. Its existence creates peer pressure to stay clean and sends the message that it isn't cool to use drugs.

* Lifeboat. We anticipated that students who were already using drugs wouldn't sign up for our program. To our surprise, however, some students on drugs have enrolled in the program as a way of asking for help. Others, encouraged by friends who were enrolled in our program, have called us directly, seeking assistance.

All such calls are transferred to the counselor, who give advice over the phone about area treatment programs. In this way, the program complements rather than competing with other school-sponsored anti-drug efforts.

* Center of attention. Our program was put squarely in the public eye during the first year of its existence because of two special factors. First, we concluded the pioneer program in the Los Angeles area. Second, one of the participating schools was highlighted by local and national news media because of its football team.

Each member of the team had made a badge with a red circle and slash--the international symbol for "no"--over a drawing of a syringe and pills. The team wore them on their jerseys during the city championship game. A national news-oriented television network later interviewed a member of the team, who mentioned the badge and our program. The reporter then interviewed me.

Many high schools around the country have asked us how to set up a program like ours. I do my best to assist them.

* In the works. We hope to add steroid testing to our program. Because this is an expensive test, we would have to raise money by holding fund-raisers in conjunction with the school. Since steroid tests are not on our menu, we would use a reference lab for primary and secondary testing.

Eventually we would like to expand the program beyond sports teams and make it available to the entire school. To do this, we will have to seek more volunteers and more money.

* Labs' role. Drug use is consistently identified as one of the top problems in the nation's schools. Clearly, drugs threaten families and the lives of children. Laboratorians can take a step toward resolving this problem by taking an active role in giving school-age children an excuse not to experiment. By using our expertise and resources in a urine drug testing program, laboratorians may help prevent a future overdose victim from having to be treated in one of our emergency rooms.

The author is medical director of the laboratory at San Pedro Peninsual Hospital, San Pedro, Calif.
COPYRIGHT 1991 Nelson Publishing
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Author:Ellis, Richard R.
Publication:Medical Laboratory Observer
Date:Mar 1, 1991
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