SCHOOLS URGED INTO DIVISIVE DRUG CRACKDOWN

FOR its supporters, random drug testing sends out an important
message to schoolchildren. "It provides them with a suit of armour
against peer pressure, enabling them to say no to drugs," says John
P. Walters, director of the White House Office of National Drug
Control Policy (ONDCP). Since 2002, when the Supreme Court ruled that
schools could drug-test middle and high-school students participating
in extracurricular activities, the US has seen a rapid increase in
such testing.

However, scientists have repeatedly called into question the
effectiveness of such tests. Last month the American Academy of
Pediatrics (AAP) reaffirmed its position that drug testing should not
be widely implemented without additional evaluation of its safety and
efficacy. It also recommended making drug treatment services more
readily available for teens (Pediatrics, DOI: 10.1542/peds.2006-2278).

In spite of the criticisms, proponents are already pushing ahead with
plans to expand testing in schools. On 24 April, school
administrators from across the south-west US will gather in Las
Vegas, Nevada, to hear ONDCP representatives speak in the fourth in a
series of drug policy "summits" this year. Speakers will explain how
schools can join the nearly 1000 that have already started random
testing, and compete for a slice of $1.6 million in federal support
for such programmes.

Schools in other countries have been watching with interest, and some
have already followed suit. In 2005, The Abbey School in Faversham,
UK, began taking mouth swabs from random pupils to test for all
classes of drugs. Exam results have since improved significantly,
claims the UK's Department for Education and Skills. The DfES is
considering further pilot schemes, and is recruiting schools to take
part in trials of random tests. Meanwhile, in August 2006, South
Australia member of parliament Ann Bressington proposed mandatory
biannual drug testing of all the state's school students over the age of 14.

The ONDCP and others in favour of testing claim that a number of
studies have shown it works. These include a survey in which 80 per
cent of high-school principals in Indiana reported an increase in
drug use after the cessation of a state-wide testing programme in
2000; a study by the US Department of Defense which found that drug
use among military personnel decreased from 27 per cent to less than
1 per cent in the 25 years following the introduction of random drug
tests; and research by Oregon Health & Science University in Portland
which found that drug use was 14 per cent lower in a school that used
random drug testing compared with one that didn't - although it only
compared these two schools.

"I think that what is being presented is seductive," says Sharon
Levy, director of the Adolescent Substance Abuse Program at
Children's Hospital Boston. However, she believes the ONDCP
overstates the effectiveness of drug testing, and she is not alone. A
2005 survey of 359 US physicians specialising in paediatric,
adolescent and family medicine, found that 80 per cent disagreed or
strongly disagreed with the ONDCP's recommendation that all
adolescent students be tested for drugs. John Knight, also of
Children's Hospital Boston, says there are only two peer-reviewed
articles. "One showed essentially no correlation between testing and
drug use rates, the other showed a slight decline," he says.

The AAP points to the largest federally funded study on school drug
testing so far, conducted by the University of Michigan. It surveyed
more than 76,000 students and found virtually no difference in
marijuana use between schools that tested and ones that did not.
Based on this and other studies, an independent review by the UK's
Joseph Rowntree Foundation concluded in 2005 that the evidence in
favour of drug testing was "remarkably thin", and that it may be
"potentially damaging" to efforts to tackle drug abuse.

What's more, such tests can flag kids who are "clean" and miss
genuine users. A study led by Levy and published this month in
Pediatrics (DOI: 01.1542/peds.2006-2278) examined recent drug tests
of teenagers being treated for substance abuse. Of 710 drug tests
performed, 85 gave incorrect results, either because the urine sample
was too dilute to interpret properly, or because the test picked up
prescription medicines. Meanwhile, routine tests failed to detect the
painkiller oxycodone in nearly two-thirds of cases.

"Drug tests can be very difficult to understand and interpret," says
Levy. "There are lots of circumstances under which a kid could be
using drugs and not test positive or have a positive test when they
are not using drugs."

While the rules for federally funded testing say positive results
must be checked by an approved lab, no such rules exist for the
approximately 500 schools that are testing without federal grants.
"Confirmatory testing adds a lot of cost. I don't think most schools
are doing it." Levy says.

Bertha Madras, deputy director for demand reduction at the ONDCP,
says she is confident the tests do work and can have a major impact
in discouraging drug use. She claims the Michigan study is flawed
because it lumps together random tests with testing suspected users.
The Department of Education is conducting a three-year study to
assess the programme's effectiveness, and starting last year, US
schools receiving federal support must report their results.

Until these results are in, Levy says it is unwise to recruit more
schools into the scheme. "Until we better understand the costs,
risks, and benefits of these tests, we really can't make a rational
decision about using them in this way," she says.