RANDOM DRUG TESTING IN SCHOOLS FAILS SCREENING CRITERIA

EDITOR--Last month the prime minister, Tony Blair, lent his weight to
random drug testing in schools in an interview for a downmarket newspaper.1
He proposed a national programme be implemented soon, adhering to
unspecified central directives.

The Department of Health has 19 criteria for introducing new screening
programmes.2 At least 18 of these 19 criteria are not met for widespread,
wide spectrum drug urine analysis in schools. The remaining criterion is
that the condition is an important health problem.

Drug use in young people is indeed associated with many health risks,3 but
a single, positive urine test, for any illicit drug, is probably not
meaningful in a clinical sense. Each schoolchild's context of use (family
history, social and emotional development) is crucial to interpreting any
supposed "drug career." Use by a homeless pregnant teenage runaway from
local authority care with a history of deliberate self harm and high risk
sex work to pay for her drugs may be very different from a single
experimental use at home with adults during a family party.

Three failed criteria are especially pertinent to screening for school age
drug use:

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.

There should be an effective treatment or intervention for patients
identified through early detection.

Clinical management of the condition and patient outcomes should be
optimised by all healthcare providers before participation in a screening
programme.

In three years of experience of school health provision for alcohol and
drug problems and their related referral networks I do not know of one
school that could satisfy these criteria, especially the underpinning
policy of promoting informed choice for children and families.2

Woody Caan, professor of public health

Department of Public and Family Health, APU, Chelmsford, Essex CM1 1SQ
a.w.caan@apu.ac.uk

Competing interests: WC was chair of the School Health Research Group,
2001-3; he has been a member of the Society for the Study of Addiction
since 1988.

References

1. Blair T. Yes, I back random drug-testing in our schools. News of the
World 2004 Feb 22: 10-11.

2. Department of Health. Second Report of the UK National Screening
Committee. London: DoH, 2000.

3. Caan W. Adolescent drug use and health. Problems other than dependence.
In: Caan W, de Belleroche J, eds. Drink, drugs and dependence. From science
to clinical practice. London: Routledge, 2002: 145-70.