The role of youth drug testing

testing.JPG (22829 bytes)Why Testing May be Useful

Even though you may have good

rapport with your young patient, there may still be reasons why he or she is unwilling to

reveal substance abuse to you.  As noted, denial that substance abuse is a

problem is common.  In the early stages of involvement, the child is likely

to believe “I can handle it” and may resent adult intrusion.  Later, when

use has become compulsive, lying is common to protect access to the drug.  Young

people also fear the consequences if parents find out about their use and frequently

protect themselves by denying any involvement with alcohol and other drugs.

In one study of clinical diagnosis, based on emergency room visits, two-thirds

of the patients for whom the E.R. visit was drug abuse-related would have been

misdiagnosed without laboratory testing.  An added complication of street

drugs is that the user may not be sure, or may have been misinformed,

about the drug he or she has taken.

What Testing Does

Urine toxicology screening provides an objective means of detecting use of a

wide range of abused substances at reasonable cost.  It may help assess the

extent of drug involvement both on the basis of the drugs detected and by contrasting

the objective findings with the patient’s self report.  Follow-up testing

after treatment is a useful means of verifying that use is probably not occurring.  

While negative findings provide no absolute assurance that drugs are not being used (some

drugs cannot be readily detected or can only be detected for a brief period of after use),

they do establish that drug use has not occurred within the sensitivity of the testing

protocol.

Substances that Can be Tested

The drugs for which urine is commonly screened include: amphetamines, cannabinoids,

cocaine, opiates and phencyclidine.  Multiple screening is usually desirable since it

is more cost effective and since seriously involved youth may be using more than one drug.

Confirmation Techniques

More specialized and expensive techniques — such as gas liquid chromatography (GLC)

and high pressure liquid chromatography (HPLC) — are available when it is important to

confirm the presence of a drug by an alternative means, to very specifically

identify the exact drug that is being abused, or to measure more precisely the amount

present.

Discussing the Findings with Patient and

Parent

Should the interview and/or the laboratory testing give evidence of drug use, the

nature and extent of the child’s involvement must be explored. If other

behavioral signs of drug involvement are present, the test results provide objective

confirmation that drug abuse is a central problem.

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