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APSAD Statement
Drug Testing Among School Students
In light of recent media on the use of drug testing among school students, the Australasian Professional Society on Alcohol and other Drugs (APSAD) would like to express reservations about this approach and highlight the existence of effective drug prevention programs specifically designed for schools. In the September issue of Drug and Alcohol Review we feature a systematic review of school-based prevention programs for alcohol and other drugs. This review of the evidence, conducted by Professor Teesson and colleagues at the National Drug and Alcohol Research Centre [1], concludes: “Existing school-based prevention programs have shown to be efficacious in the Australian context. …The findings challenge the commonly held view that school-based prevention programs are not effective.” This review of the evidence can be obtained from Wiley’s online library: In contrast, there are a number of issues surrounding the use of drug testing in schools that merit careful consideration. First and foremost, the evidence for the effectiveness of drug testing in schools is dubious: Evidence from the US, where drug testing has been adopted by a number of schools, indicates that schools that undertake drug testing do not have lower levels of drug use than those schools that do not test for drugs [2]. One study has found that drug testing students is associated with a very small reduction in the use of the specific drugs that are being tested for, but that testing did not reduce overall levels of drug and alcohol use [3]. Not only do they achieve little, these interventions are extremely costly: With such slim evidence that drug testing programs in schools are effective it is hard to justify their cost, which is likely to replace expenditure on more effective interventions to prevent drug use among students. For example, published figures claim that the cost of detecting only 11 students who tested positive for drugs in the US amounted to US$35,000 [4]. Drug testing does not ensure students are not using drugs: Drug testing procedures only detect drugs that have been taken within a given window period and this varies for different drugs. For example, stimulants can only be detected in urine for a couple of days, so weekend stimulant use is unlikely to show up in a drug test done at school. This means that there is no guarantee that children at a school are not using drugs; it only means that the drugs tested for were not in their urine at the time of the test. Drug tests are not 100% accurate: No test is 100% accurate. Whether through human error or the limitations of the testing procedure, there will always be some people who are falsely identified as using drugs, and others who are ‘missed’ by the testing procedure. The degree of accuracy depends on whether urine, saliva, hair or blood is tested, and this also differs for each drug type (e.g., urine is more accurate in testing for amphetamine than saliva). Inevitably some students will be labelled as drug users when they have not used any illegal drugs. Drug tests will identify students who are using prescribed medications: Perhaps most important, students who are prescribed dexamphetamine for Attention Deficit Hyperactivity Disorder, will be detected as using amphetamines, and presumed to be using illegal amphetamine, commonly known as ‘speed’. Drug tests cannot distinguish between the use of prescription dexamphetamine and the illegal form of the drug. Tests for amphetamines can also cross-react with a range prescribed medications (e.g., brompheniramine, bupropion, trazodone, chlorpromazine, promethazine and ranitidine) which could result in false-positive results of urine drug screens for amphetamines [5]. This issue is not specific to amphetamines, but the amphetamine-type drugs provide a good example. The ethics and effects of instituting testing need to be thought through: A testing program potentially changes relations between students and staff and the atmosphere of the school. Very likely, such a program will be regarded as an expression of lack of trust. The focus, as students talk it over, may shift from the substance of normative rules about behaviour at school to comparing notes on ways to evade or cheat the testing. Attention is needed to such issues as how student drug testing fits into the normative environment of school life. The consequences of testing positive for the student: Testing positive for an illicit drug will have a number of negative effects on the student, which have to be weighed up against any benefits for the school or its students more broadly. Drug testing can result in criminalizing school students, and it may affect their potential to engage successfully at school and reduce their subsequent vocational opportunities. Moreover, drug testing does nothing to help the student deal with their drug use or any issues that might be leading to their drug use. Essentially, drug testing may detect drug use, but it doesn’t treat it. Ethically, any testing would require planning for clinical follow-up: By way of example, random drug screening in schools failed 18 of the 19 Department of Health criteria for introducing new screening programs in the UK, and as highlighted by Professor Caan [6], a professor of public health in the UK, three failed criteria are especially pertinent to screening for school age drug use: (1) there should be an agreed policy on the further diagnostic investigation of people with a positive test result and on the choices available to them; (2) there should be an effective treatment or intervention for patients identified through early detection; and (3) clinical management of the condition and patient outcomes should be optimised by all healthcare providers before participation in a screening program. Drug testing must also respect privacy and confidentiality. Parents and children must receive accurate and detailed information on the drug testing procedures and policies, including the limitations of biological testing, and the course of action that will be taken should a child test positive for a drug. In conclusion, given the often invasive and costly nature of drug testing, limited evidence for its effectiveness, and its potentially negative ramifications, resources may be better invested in promoting resilience in young people so that they are at a lower risk of developing drug or alcohol problems as they mature into adulthood, and that they are equip with a broader set of life-skills that will give them the best chance of a bright future. [1] Teesson M, Newton NC, Barrett EL. Australian school-based prevention programs for alcohol and other drugs: A systematic review. Drug and Alcohol Review DOI: 10.1111/j.1465-3362.2012.00420.x Available at: [2] Ryoko Y, Johnston LD, O’Malley. Relationship between student illicit drug use and school drug-testing policies. Journal of School Health 2003;73:159-64 [3] James-Burdumy S, Goesling B, Deke J, Einspruch E. The effectiveness of mandatory-random student drug testing: a cluster randomized trial. Journal of Adolescent Health. 2012;50:172-178. [5] Cody JT, “Precursor medications as a source of methamphetamine and/or amphetamine positive drug testing results,” Journal of Occupational and Environmental Medicine 44 (2002): 435–50. [6] Gerada C, Gilvarry E. Random drug testing in schools. British Journal of General Practice. 2005;55:499-501. [6] Caan W. Random drug testing in schools fails screening criteria. British Medical Journal. 2004;328:641.


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Isabelle Gaboury, PhD Liste totale des publications Documents revus et publiés (* Travaux d’étudiants ou de résidents supervisés ou co-supervisés) Fitzpatrick EM, Olds J, Gaboury I , McCrae R, Schramm D, Durieux-Smith A. Cochlear Implants Int . 2012 Feb;13(1):5-15. Menon K, Ward RE, Gaboury I , Thomas M, Joffe A, Burns K, Cook D» Intensive Care Med . 2012 Jan;38(1):

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