Testing for drugs of abuse in children and adolescents (Reprinted from Pediatrics, vol 98, pg 305-307, 1996)

The American Academy of Pediatrics (AAP) recognizes the abuse of psychoactive drugs as one of the greatest problems facing children and adolescents and condemns all such use. Diagnostic testing for drugs of abuse is frequently an integral part of the pediatrician's evaluation and management of those suspected of such use. ''Voluntary screening'' is the term applied to many mass nonsuspicion-based screening programs, yet such programs may not be truly voluntary, as there are often negative consequences for those who choose not to take part. Participation in such programs should not be a prerequisite to participation in school activities. Involuntary testing is not appropriate in adolescents with decisional capacity-even with parental consent-and should be performed only if there are strong medical or legal reasons to do so. The AAP reaffirms its position that the appropriate response to the suspicion of drug abuse in a young person is the referral to a qualified health-care professional for comprehensive evaluation. The widespread abuse of psychoactive drugs has resulted in an increase in laboratory testing to identify abusers. The significant health and social consequences of drug abuse are intensified in the pediatric population because of the added possibilities of longterm effects in a developing person. Furthermore, immature miners are often unable to make informed, autonomous decisions about their health care, creating an impediment to diagnosis and treatment.(1,2) This statement defines the position of the American Academy of Pediatrics (AAP) on laboratory testing for drugs of abuse. The abuse of psychoactive drugs among children, adolescents, and adults is an issue of national importance.(3) Concerns have focused not only on the physiologic and behavioral impact of drug abuse on the developing child and adolescent but also on the public health hazards that drug abusers pose to others.(4) This statement presents issues relevant to laboratory testing to identify drug users and does not discuss drug abuse in children and adolescents, which the academy strenuously opposes. Proposals for involuntary uring drug screening programs are also discussed. Testing for drugs of abuse in neonates, however, is discussed in another statement by the AAP.(5) Testing student athletes for performance-enhancing drugs not identified by routine urine toxicology tests, such as anabolic steroids and growth hormone, is not addressed.