Since the June 1995 U. S. Supreme Court ruling in support of random interscholastic student athlete drug testing, more schools then ever before have begun either mandatory, reasonable suspicion or voluntary types of drug testing as they battle drug abuse by their students. By far most student drug testing programs consist of mandatory testing of only student athletes since the U.S. Supreme Court upheld this type of testing. Some schools have begun drug testing all co-curricular students or students wishing to drive to school. This latter action was challenged in Rush County, Indiana, and upheld by the District Court. When appealed to the U. S. Supreme Court they allowed the District Court ruling to stand.
Schools contemplating a drug testing program must first document their student athletes are using drugs to comply with the U.S. Supreme Court ruling. Likewise it is imperative that they rally community support for such a program in order for it to be a helpful tool used both my school officials and parents. Urine drug testing is the industry standard and recommended over hair or saliva testing which may not be defendable in court.
Student Drug Testing Options
Drug testing programs can be mandatory, as with interscholastic student athletes, voluntary as part of a student assistance program, or based on reasonable suspicion only. Random urine drug testing by far is the most deterrent to drug use by students since the students may be selected at any time for testing. This type program gives the students another reason to say “No!” However such a program requires more testing be done which elevates the total cost of the program. Voluntary programs do help those students caught breaking the rules by using drugs or alcohol, but has little impact on students using and not getting caught. Reasonable Suspicion programs are very effective at keeping drugs out of schools but have little deterrence to use by students in general.
Drugs to Screen for
A student drug testing program must screen for the appropriate illicit drugs and banned substances. Most schools have student codes of conduct and/or athletic codes of conduct that state illicit drugs are not to be used and most include tobacco as a banned substance. The substance abuse coordinator from your school should be able to tell you what drugs or substances your students are using and abusing. This list will probably include Pre-Game Drugs like tobacco (smoked and chewed), marijuana, pain medications (often used with parent knowledge) and anabolic steroids. After games, the Post-Game Drugs will include tobacco, marijuana, alcohol, LSD, and inhalants. There are several “club drugs” that students are starting to use including ecstacy, a methamphetamine known as MDMA, and ketamine, a veterinary anesthetic. Ecstacy has stimulation and hallucinogenic effects and often used at parties called Raves where students dance wildly and often dehydrate from elevated body temperatures. Unfortunately one dose of ecstacy causes permanent brain damage. During a Rave a student may take as many as 15 hits of Ecstacy. Current urine drug testing can discover Ecstacy but only when ordered as a special test and at considerable expense. There is not a screening test yet available for Ecstacy or Ketamine.
Currently most certified laboratories offer a standard Substance Abuse Panel -10 (SAP-10) which screen for the following ten drugs:
- Benzodiazepines (Valium®)
- Opiates (Codeine)
- Propoxyphene (Darvon®)
Many other chemical substances can be detected in the urine, and considering the drug use patterns of today’s youth, the following additional drug screens can be ordered:
- Anabolic Steroids
- Nicotine (Tobacco)
- MDMA (Ecstacy)
In the laboratory, the SAP-10 is automated and therefore less expensive to do. The other drugs must be tested for by different methods or at special locations, resulting in higher prices. The typical school will pay from $25 to $50 for each SAP-10 ordered, with urine alcohol costing $6 – $10 each, LSD $22-25 each, urine nicotine costs $10-12 each, and anabolic steroids costing $80-95 each. For this price, you should get MRO services as well (see Medical Review Officer section).
Since the drugs abused mostly by teenagers today consist of tobacco, marijuana, alcohol and LSD, a drug abuse intervention program must screen for these chemicals. Simply doing the industry standard of a SAP-10 is not enough. However, detection of alcohol in the urine is not very reliable since it is eliminated from the body very quickly. A drug screen for alcohol done on Tuesday is not likely to find alcohol that was consumed on Saturday night. LSD also leaves the body very quickly and is hard to catch. Therefore, schools often do weekend collection to deter the use of alcohol by their athletes.
A Certified Laboratory is a Must
There are many laboratories, both local and national, who advertise the ability to do urine drug testing. However, not every lab uses the same methods nor are they all certified by the Government. Therefore, it is imperative that only Government certified laboratories are used for any student drug testing program. This is the only way you can be assured that your results are accurate. If your policy will deny the privilege to participate in sports or other co-curricular activities when a positive test is found, your school will be in really hot water if your results are wrong. Any lab your medical vendor uses must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and should have a minimum of ten years of experience in toxicology testing and chair-of-custody procedures. Sport Safe Testing Service uses Quest Diagnostics, Inc. exclusive for testing due to their many years experience with athlete drug testing.
Analysis of Specimens
There are two levels of analysis that occur routinely with urine drug abuse screens. The sample is first subjected to an automated screening test that quickly looks for the presence of specified drugs or their metabolites. This initial testing uses a highly accurate immunoassay technique commonly called an EMIT®. All presumptive positive results should be confirmed by a Gas Chromatography/Mass Spectroscopy (GC/MS) confirmatory tests. This confirmation method provides a “molecular fingerprint” of the drug and/or metabolite, providing a high level of accuracy and specificity. The quantitative results, in nanograms per milliliter, are usually reported as well. Currently the GC/MS confirmatory test is the only acceptable industry standard for drug abuse screen confirmations. Thin layer chromatography, as sometimes offered by non-certified labs, is not acceptable.
The first words out of a teen’s mouth when told their urine showed marijuana is that they were in a car with someone who was smoking and therefore that is why their test came up positive. It is very true that detectable levels of both THC (active ingredient of marijuana) and nicotine can be found in those individuals having close exposure to the smoke of the burning tobacco or marijuana. The urine of young children whose parents smoke will have detectable nicotine. For this reason, a series of cutoff levels has been determined and proven scientifically so when a urine drug screen is positive, we know it is from use and not second-hand exposure. For THC the standard is 20-50 nanograms (ng) per milliliter in the screening test and 15 ng/ml by GC/MS. Nicotine has to be above 300 ng/ml to be called positive. When a drug screen is reported as positive, the actual quantitative levels are reported to the Medical Review Officer. This data is becoming more important in determining recent use verses natural decay of levels in the body. The levels for nicotine are less standardized and often take careful interpretation by the MRO.
Medical Review Officer
A Medical Review Officer (MRO) is a licensed physician who has additional training and certification in the area of drug testing. Specifically they have learned how drug testing is done, what affects the results, specifically medications and foods, and how individuals will try and adulterate the specimens to give false negative results. A physician can be certified by the Medical Review Officer Certification Council (MROCC) or the American Association of Medical Review Officers.
Any program of drug testing involving students should have a certified MRO to review all results and make a final certification as to being positive or negative. The MRO must be willing to phone parents when a positive result is found to verify if any medication has been prescribed. This is very important since medications like Tylenol® with codeine could be legally prescribed for a student following a tooth extraction and that student having a drug test would be positive for opiates. The MRO’s job is to verify if any medication has been prescribed for the student which could have resulted in the positive result. If the MRO receives from the prescribing physician or dentist documentation that a codeine containing medication was prescribed, the MRO will rule the test negative. However, if the parent happened to give the student one of his or her pills, and the student has no legal prescription for the medication, then the MRO must rule this test positive since a controlled drug was given and taken without the order of a licensed physician. (Believe it or not, athletes, with full knowledge of their parents, have taken pain medications prior to athletic competition to make their overused joints hurt less during that day’s events). Having an MRO adds significant credibility to any program and shares the burden of liability the school is placed under. For more information and contact Sport SafeTesting Service, Inc., 18 Grace Drive, Powell OH 43065 or call (614) 847-0847. Sample policies are available on our web site at www.sportsafe.com.
Correspondence concerning this article should be addressed to Dr. Joseph C. Franz, Medical Director, SPORT SAFE Testing Service, Inc., 18 Grace Drive, Powell, OH 43065. Phone/Fax:(614) 847-0874. Sample policies are available at www.sportsafe.com.