Drug Testing in Schools and Workplaces: Policy implications and considerations of

punitive, deterrence and/or prevention measures

Ann M RocheNational Centre for Education and Training on Addiction

Flinders University

Second Annual Conference of the International Society for the Study of Drug Policy

3-4 April, 2008Lisbon, Portugal

Full report:

Drug Testing in Schools:

Evidence, impacts and alternatives.Ann Roche, Ken Pidd, Petra Bywood, Vinita Duraisingam, Tania

Steenson, Toby Freeman, Roger Nicholas

We attempted to synthesise a diverse array of complex, conflicting and sensitive information in a balanced manner.

Comprehensive coverage of relevant issues

1. available data on drug use by school-aged children and, in particular, high-risk groups

2. evidence of the effectiveness of biometric and psychometric tests

3. evidence on the effectiveness of tests to deter or reduce drugs and any associated potential adverse outcomes

4. 5. cost implications of the implementation of various forms of testing

6. ethical, legal and practical implications of testing school-aged children

7. incorporated the views and perspectives of professionals, parents and community members through a submissions process and an online survey

8. addressed the range of alternative strategies available to tackle drug use among school-aged children and the evidence base of effectiveness.

A Public Health ModelThe public health model applied in the present review involved:

• assessing the epidemiology of a targeted problem (i.e. patterns and prevalence of use)

• identifying risk and protective factors associated with the development of the problem

• applying interventions known to reduce these risk factors and enhance protective factors that buffer against the effects of risk

• monitoring the impact of these interventions on the incidence and prevalence of the targeted disease and disorder

(Hawkins, Catalano & Arthur, 2002).

Aims/rationale for drug testing

• Drug testing is sometimes viewed as an appealing strategy to deal with drug use among school-age children as it is assumed to: – deter initiation of drug use and encourage cessation– detect users in order to refer them to

treatment/counselling– reduce drug-related harm by improving young

people’s physical and psychological wellbeing, reduce truancy and behavioural problems, and improve educational outcomes.

What drug testing does not purport to do

• provide a measure of intoxication or impairment• determine the quantity, frequency or context of

drug use• distinguish between experimental, occasional or

one-off users and those with problematic drug use

• distinguish between similar metabolites found in over-the-counter or legally prescribed medications and illicit drugs.

1.

Approaches to drug detection and screening

There are a number of different approaches that can be employed to address the use of drugs in a school environment.

These include: 1. biometric measures of drug use (e.g. biological

assays of urine, saliva, sweat, hair)2. psychometric measures of drug use (e.g. self- report survey, questionnaires or interviews)3. devices for detection of drugs or drug

paraphernalia (e.g. sniffer dogs, search of lockers or belongings).

Assumptions underlying drug testing

Assumption #1 Criminological theory and

the power of surveillance

Surveillance is used as a tool for social control. If their behaviour is open to scrutiny, young people will avoid deviant acts

(Foucault, 1980).

LimitationsSurveillance alone is inadequate unless accompanied by: Social consensus about what defines deviant

behaviourDrug testing will reduce drug use only if young people believe they will experience stigma or negative consequences of their drug use if discovered. Individuals with pro-drug attitudes and little respect for societal norms are less likely to reduce drug use and may view a positive drug test as status.

Capacity to apply negative sanctions or punishmentWithout a negative sanction (e.g. exclusion, punishment from parents), drug testing is unlikely to deter future use. For example, athletes may view exclusion from competition as undesirable, but schoolchildren may welcome exclusion from classes.

Capacity to handle concealment (e.g. masking)Individuals may use masking agents, avoid providing a sample (e.g,. absence from school if they expect to be tested), or switch to less detectable, and potentially more harmful, drugs or alcohol.

Assumptions underlying drug testing cnt.

Assumption #2 Early identification and intervention

• Identification of drug use at an early stage may reduce the likelihood of developing into a drug ‘problem’.

LimitationsTeenage drug use does not lead inevitably to problematic drug use.

While screening is sensible for health issues that predictably lead to deterioration (e.g. cancers), this is not so for teenage drug use. The relevance of early identification applies only to a very small number of students

Assumptions underlying drug testing cnt.

Assumption #3Capacity to bolster resistance to

drugs

Drug testing programs give students a reason to say ‘No’ when they

encounter drug use.

LimitationsRoutes to drug use differ.

Not all young people are pressured by their peers to start using drugs. Young people may also select their friends on the basis of similar interests, including drug-using behaviour.

Prevalence of Drug Use Declining

• Between 1996 and 2005 there was a significant decrease in cannabis use by 12-17 year olds (the most commonly used illicit drug among this age group) .

• (e.g. lifetime use for 12-15 year olds in 1996 28% adn 13% in 2005. Among 16-17 year olds 52% vs 31%).

Effectiveness of tests

• Sensitivity (>90%)

• Specificity (>90%)

• Accuracy (>95%)

• Standard tests would result in a minimum of 10% false positives

Cost

Urine

• Universal $302Mil• Random sample $91mil• Targeted groups $47.9mil• For cause $11.7mil

Saliva

• Universal $355Mil• Random sample $110mil• Targeted groups $58mil• For cause $15.9mil

Effectiveness in Deterrence

• Little evidence to support it

• Eg., Yamaguchi´s study of 323 schools and 94,000 students

Potential Adverse Consequences

• Breakdown in parent- child and/or school-child relationship

• stigamisation• Increase in school exclusions

or truancies• Reduced participation in

healthy extracurricular activities

• Diversion to other substances not tested for, or less detectable

• Unwarranted invasion of privacy

• Breach of confidentiality

• False sense of a drug-free environment

• Lack of developmentally appropriate adolescent treatment/interventions after testing positive

• School time and resruoces used on drug testing, incl. Opportunity costs

• Ambiguous role for schools• Penalities for drug use

imposed on schools

MORE ADVOCACYTHAN

EVIDENCE

Ethical and Legal Issues

• Duty of care

• Right to bodily inviolability

• Right of the child

• Drug testing as a deterrence strategy

• Similarities and difference with Workplaces and workplace testing

Ethical Perspectives

• Principalist Theory of Ethics

Employs values such as:

o Respect for personso Justiceo Beneficence

• Consequentialist Ethics

Justifications based on consequences, not principles

1.

4 major motivations underlying the development of drug use problems

1. To escape developmental distress. 2. To self-manage body and spirit. 3. To conform to social norms. 4. To create individual identity.

Drug use problems are not wholly influenced by individual choices.

They are also shaped by a range of macro-economic factors, including the economic, social and physical environment.

“Trying to shift the whole responsibility on to the user is clearly an inadequate response. This blames the victim, rather than addressing the complexities of the social circumstances that generate drug use. Effective drug policy must therefore be supported by the broad framework of social and economic policy”

(Wilkinson and Marmot (2003;p.25).

Alternative, evidence-based roles for schools

1. Support and foster connectedness between school and students

2. Provide targeted early and brief interventions

3. Õffer family strengthening interventions

Copy of the report is available from:

• www.nceta.flinders.edu.au

• www.ancd.org.au