Special To The Globe And Mail

TROUBLED KIDS, BAD SCIENCE?

Home Drug-Test Kits Strain Bonds Of Trust Between Parent And Child

David had worked hard to get clean. He had a drug problem that included
cocaine, marijuana, hallucinogens and amphetamines but had entered a
treatment program at Toronto's Hospital for Sick Children. He commuted in
every weekday from his hometown -- going to school in the morning followed
by therapy in the afternoon.

But for some reason, his foster parents didn't believe he was sticking to
the program and David, who asked that his real name not be used, feared he
was about to be kicked out of an otherwise supportive family. He asked to
be given a drug test, so he would have proof.

The urine test, and a lengthy letter of explanation from the hospital,
confirmed that the teen was staying away from drugs and re-established the
trust that had disappeared from his foster home. He completed the program a
few weeks later and continued working toward a goal of complete abstinence
from even tobacco and alcohol.

But out of the hundreds of cases she's worked on, Dr. Karen Leslie says
David's is the only family that has been helped by drug testing -- and only
because he was so eager to participate.

"He would be the only kid I can think of where urine testing did provide
some significant positive impact on the treatment," says Dr. Leslie, a
staff physician at the Hospital for Sick Children. Whenever parents ask if
they can have their kids tested for drug use, she and her colleagues are
reluctant to even discuss it. Urine testing has no part in the hospital's
drug treatment program because it tends to erode trust, rather than build
it, she says.

But parents can now run the tests themselves, in the home. Earlier this
year, Toronto-based pharmaceutical company Novopharm introduced its KnowNOW
Multiple Drug Detection Test, a urine screening test aimed at parents who
want to check their kids for illegal drug use. Available at pharmacies
across Canada, it is the first drug test to be sold over the counter in
North America.

The test checks for six common categories of street drugs -- marijuana and
hashish, cocaine, heroin and other opiates, amphetamines, PCP and
methamphetamines such as Ecstasy. Each drug type is represented by a test
strip that is dipped in a urine sample. After five minutes, a section on
each of the strips will turn pink if no drug has been detected.

It's a simple procedure, similar to a home pregnancy test. But social
workers and drug experts warn that, with few exceptions, home testing can
cause more problems than it solves. Rather than gaining the peace of mind
suggested by the literature, parents are more likely to damage the
all-important communication and trust with their child -- setting off a
battle of wills and inflaming what is likely an already strained relationship.

"How is it going to help the kid get better?" asks Dr. Leslie. "Is it going
to make them more likely to say, 'Oh you're right. I should get treatment'?
Probably not. It's probably going to make them say, 'You're accusing me.' "

On those rare occasions in therapy when a urine test is called for, usually
for safety reasons, she says, it's a job best left to medical
professionals. "If you look at the recommendations for collecting a urine
sample, the ideal is that it's observed, and I don't think it's appropriate
at all for a parent to observe their adolescent peeing into a cup." And as
she explained to David and his foster parents, they don't necessarily prove
anything.

Health-care professionals worry that taking testing out of the lab or
hospital encourages a narrow or oversimplified attitude to drug treatment.

Joanne Shenfeld, a social worker at the Centre on Addiction and Mental
Health in Toronto, also has doubts. "I think if someone is struggling to
give up a drug addiction and is having some success and wants to prove
that, then testing can be a positive thing," she says. "But if people are
using it in a policing kind of way and it feels imposed, it might not be as
beneficial."

Novopharm, however, stands by its product despite the controversy. "All the
information that we give out, and the product itself, stresses
communication," says vice-president David Windross, pointing to the
voluminous literature available with the test. He insists that home tests
are not meant to replace the work of health-care professionals or formal
treatment, adding that parents can easily take questions or concerns to
their pharmacist or family doctor.

But emotional fallout or the absence of professional medical treatment are
just two of many potential problems. Although the technology has improved
considerably in recent years, urine screening is not 100-per-cent accurate
and there are many ways a test can be misused, misread or sabotaged.

"For every company that makes a drug test, there's a company that makes a
way to get around it," says Richard Garlick of the Canadian Centre for
Substance Abuse in Ottawa. Sure enough, a quick Web search turns up many
companies selling so-called detoxification drinks and other products, which
promise to mask the telltale chemical traces of drug use. One drink,
cheekily called "Urine Luck," is even endorsed by Tommy Chong, formerly of
the drug-addled comedy duo Cheech & Chong.

Other tips for foiling urine tests are just a mouse-click away. Drinking
coffee, cranberry juice, beer or spiking the sample with bleach, Drano, or
Visine are recommended. Even drinking a litre or two of water can flush out
one's system, so that only a high-end test in a lab could spot signs of drugs.

Mr. Garlick also warns that, faced with testing, kids who are taking drugs
might simply switch to different ones that would pose even greater risks to
their health. "It's a well-known phenomenon that whenever people feel drug
use can be detected, they move to more potent drugs -- drugs that are
harder to detect," he says.

LSD or "acid," for example, is hard to detect with any real accuracy --
even when using a sophisticated lab test. Likewise, signs of hard drugs
such as cocaine, heroin and amphetamines can clear out of the system in as
little as one or two days, unlike marijuana -- generally considered a soft
drug -- which can linger for days or even weeks.

Taking advantage of drug "clearance times" is a common means of dodging
tests. A parent wishing to strictly monitor his or her child's activities
could face the challenge of running a test every day -- an expensive habit,
considering that they cost $50 each and can't be reused.

Parents could also face legal obstacles if they try to force a child,
either physically or through intimidation, to take part in urine-testing.
It's a grey area -- there are no laws or precedents that relate
specifically to in-home testing -- but Canadian courts tend to favour the
rights, and privacy, of children over the authority of parents or even
medical professionals.

All this of course assumes that one administers the test properly and gets
an accurate reading. Dr. Zul Verjee, a clinical biochemist and
toxicologist, also at the Hospital for Sick Children, advises that even a
simple test can make mistakes. "There is always a tradeoff between
turnaround time and the accuracy of a test," he says. "The faster you want
it, [the greater the chance] you introduce areas where you are more prone
to false negatives and false positives."

Parents could encounter the common problem of cross-reactivity. Certain
foods and medications can cause a "false positive" on urine tests, the most
common example being a poppy-seed muffin, which, if eaten shortly before
taking a test, can cause someone to test positive for opiates.

Over-the-counter and prescription medications can also throw a wrench into
the works. Cold and allergy medications such as Nyquil and Sudafed can
cause a false positive reading for amphetamine use, as can asthma
medications like Bronkaid and Primatine. Painkillers such as Pamprin and
Advil have been known to cause positives for marijuana and cough syrups
such as Robotussin DM can turn up in tests as PCP. Novopharm provides lists
of substances that cross-react with its test, but toxicologists warn that
such lists aren't always exhaustive.

"Home tests are extremely sensitive," says Dr. Verjee, adding that even
someone who inhales second-hand marijuana smoke can test positive.

Too much hassle for too little help? Quite possibly. Health-care workers
say outside of those rare occasions when a child is willing, without being
coerced, to take part in a drug test, it's not likely to help the
situation. Parents are advised to stick with what they do best, talking
with their kids and, if need be, supporting them through treatment.

"It's a lot of work for families to get into treatment," says Dr. Leslie.
"So I worry about a urine test as something that a parent can do which
doesn't require them to do much else. Like get involved."

Mr. Garlick agrees, "These tests are a cop-out from being the best parent
you can be. They're a shortcut to being a parent just like drugs are a
shortcut to feeling good."

Step One: Talk About It

If collecting urine and running tests isn't the answer, what are parents
expected to do if they suspect their child might be using drugs?

Experts and parents in the know say maintaining trust and communication
between parent and child is the most important aspect of avoiding and, if
need be, dealing with drugs. Family traditions like meal times, shared
activities or designated "talk times" are good ways to promote regular and
open discussions.

If you fear your child is using drugs, ask. Don't be confrontational or
accusatory -- that will likely just put the child on the defensive and set
off a power struggle. If an argument breaks out and accusations start
flying, parent and child should both take a "time out" for an hour or so to
cool down.

Explain that you're worried, give reasons why (odd behaviour, poor health,
slipping grades) and ask if the child can explain what's going on. Even if
you think you have proof, always give the child a chance to explain.

Yes, you might get an evasive or dishonest answer ("It's not mine, I'm
holding it for a friend.") but the child will at least feel he or she has
been given a chance to be heard and treated fairly, which should promote
further communication.

And be honest about your own use, or non-use, of drugs, including tobacco
and alcohol. Be prepared for the old "You drink, you smoke up. Why can't
I?" argument. If children feel the parent is being dishonest, or setting
down a double standard, they'll be less likely to listen.