Recommendations Updated for Child, Adolescent Drug Testing

Recommendations Updated for Child, Adolescent Drug Testing

Medscape:  Recommendations Updated for Child, Adolescent Drug Testing

Marcia Frellick

May 26, 2014

Drug testing is often used in children and adolescents but is invasive and can yield limited information, and results are easily misinterpreted, according to a clinical report from the American Academy of Pediatrics (AAP). The report, published online May 26 in Pediatrics, provides guidance on the use of drug testing for pediatricians and other clinicians.

“Pediatricians are on the front lines for deterring, delaying, detecting, and diminishing the use of drugs by children. It is imperative that all pediatricians understand and are ready to use the tools and strategies effective for these endeavors,” write Sharon Levy, MD, MPH, Lorena M. Siqueira, MD, MSPH, and the Committee on Substance Abuse for the AAP.

The AAP and other national organizations advise against involuntary drug testing. However, the committee does note situations when testing is appropriate, including:

  • Truly emergent situations; for instance, after an accident, suicide attempt, or unexplained seizure that renders the patient incapable of informed consent.

  • Assessment of behavior problems including fatigue, excessive moodiness, failure in school, or when a parent or another adult suspects drug use may be a factor.

  • As part of a therapy program for substance abuse that has rewards and consequences based on the outcome of the test.

    The AAP does not endorse home drug testing because there is limited evidence that it reduces drug use, it has significant potential for parents to misinterpret the tests, and it has strong potential for damage to the parent–child relationship.

    Urine tests are the most common testing methods in primary care and are well-standardized, but they are invasive (although less invasive than blood testing) and highly susceptible to tampering.

    Urine testing is most reliable when collection is observed, Less-invasive collection involves banning coats or bags from the collection room, which is specially equipped without running water, soap, or other chemicals. Toilet water should be tinted.

    The clinician should document the specimen’s appearance and color and record the temperature within 4 minutes of collection. Specimen temperature should range from 90°F to 100°F.

    Guidelines for other testing methods:

    • Saliva and sweat testing provide information similar to blood testing but are less invasive and do not require extensive training to collect samples. Saliva tests can detect recent drug use (ie, within 24 to 48 hours) before a urine test may detect it, and a saliva sample has less chance of contamination.

    • Blood tests are most useful for detecting alcohol and other drug use within the last 2 to 12 hours. They are most reliable when correlated with the patient’s level of impairment and morbidity in the emergency situation. They are more expensive because training for collection is costly.

    • Hair testing detects use over an extended time, but not for the previous 7 to 10 days. Hair needs to be cut as close to the scalp as possible, as the first 3 cm is used for testing. Collection is easily observed, and samples are not easily tampered with, although hair products can affect drug concentrations.

      The committee also offered these general guidelines for testing:

      • Discuss who will receive results with adolescents and their parents before ordering a drug test.

      • Reach a consensus with responsible adult regarding action plan for both negative and positive results before conducting testing.

      • In all cases, the need for information must be balanced with protecting dignity. Alternatives include forgoing a drug test and basing decisions on history and physical examination alone.

      • Testing can have a high potential for false-positives. A patient taking amphetamine and dextroamphetamine for attention-deficit/hyperactivity disorder will have a positive result for amphetamines, which could be misinterpreted as substance abuse. To interpret correctly, a physician must get a complete medical history with details on prescribed medications.

      Pediatrics. Published online May 26, 2014.



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