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:

• Amphetamines
• Barbiturates
• Benzodiazepines (Valium®)
• Cocaine
• Marijuana
• Methadone
• Methaqualone
• Opiates (Codeine)
• Phencyclidine
• 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:

• Alcohol
• Anabolic Steroids
• LSD
• 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.

Second-Hand Exposure

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.

1. USADA’s Relationship with the United States Olympic committee (“USOC”)USADA is an independent legal entity not subject to the control of the USOC. The USOC has contracted with USADA to conduct drug testing and results management for participants in the Olympic movement within the United States and to provide educational information to those participants. For the purposes of transmittal of information by USADA, the USOC is USADA’s client/ However, the USOC has authorized USADA to transmit information simultaneously to the relevant National governing Body (“NGB”), International Federation (“IF”) the World Anti-Doping Agency (“WADA”) and involved athlete.

1. Athletes Subject to Testing USADAThe USOC and NGBs have authorized USADA to test the following athletes:
   1. Any athlete who is a member of a NGB;
   2. Any athlete participating at a competition sanctioned by the USOC or a NGB;
   3. Any foreign athlete who would otherwise be subject to testing by USADA, the USOC or NGB; or
   4. Any other athlete who has given his/her consent to testing by USADA.
   5. Any athlete who has been named by the USOC or an NGB or is competing in a qualifying event to represent the USOC or NGB is in international competition.

USADA will not allow the testing process to be used to harass any athlete. In selecting athletes for testing, USADA will focus primarily on athletes who are participating or have the potential to participate, in international competition.

1. Choice of Rules In conducting drug testing and results management under this protocol, USADA will look to the following sources of rules:

1. The selection and collection procedures set forth in paragraphs 4, 5, & 6

herein shall apply to all testing done by USADA unless different procedures are agreed to between USADA and the party requesting the test for a particular event.

• All test performed by USADA shall be analyzed by IOC-accredited laboratories. In analyzing samples for USADA, those laboratories shall follow the standards established by the IOC.
• Tests performed by USADA shall be analyzed for the categories of prohibited and restricted substances set forth in the rules of the applicable IF unless agreed otherwise between USADA and the party ordering the test.
• USADA shall be responsible for results management of all tests performed by it and all other tests for which the applicable IF rules require the initial adjudication forth in paragraph 9 herein, unless otherwise referred by USADA to a foreign sports organization having jurisdiction over the athlete.

1. Selection of Athletes to be Tested In-Competition
   USADA shall have the authority to determine which athlete will be selected for testing in all competitions tested by USADA. In making this determination, USADA will normally follow NGB or IF selection procedures and will include at a minimum the selection formulas or requests for target selection on particular athletes which are proposed by the USOC or a particular NGB. USADA retains the right to test any athlete that it chooses, with or without cause or explanation.

1. Selection of Athletes to be Tested Out-of-Competition USADA shall have the authority to determine which athlete will be selected for testing out-of-competition testing by USADA. In making this determination, USADA will carefully consider selection formulas or requests for target selection on particular athletes which are proposed by the USOC or a particular NGB. USADA retains the right to test any athlete that it chooses, with or without cause or explanation.
   Each NGB will provide USADA with a regularly updated list of athletes to have included in No Advance Notice or other out-of competition testing. With respect to each athlete on such list and such additional athletes as may be designated by USADA, the NGB will provide USADA with the information as set forth on the athlete location form attached as Annex A. Thereafter it shall be the responsibility of each individual athlete to provide USADA with updated information as to his or her whereabouts.

1. Sample Collection Sample collection by USADA will substantially conform to the standards set forth by the IOC and the World Anti-Doping Agency.

1. Laboratory Analysis All samples collected by USADA will be sent for analysis only to IOC-accredited laboratories.

1. Notification USADA will provide the following notification will respect to each laboratory report received by USADA:

1. Upon receipt of a negative laboratory report, USADA will promptly forward that result to the athlete, the USOC and the applicable NGB.
2. Upon receipt of a positive laboratory A report or a report indicating an elevated testosterone, epitestosterone ratio or epitestosterone concentration, USADA will promptly notify the applicable NGB and athlete at the address on the Doping Control Notifications/Signature Form and shall advise the athlete of the date on which the laboratory will conduct the B sample analysis. The athlete may attend the B sample analysis accompanied by a representative at his or her own expense. Prior to the B sample opening, USADA shall provide to the athlete the A sample laboratory documentation set forth on Annex B. A sample shall not be considered positive until after the B sample analysis confirms the A sample analysis.
3. Upon receipt of the laboratory’s B sample report, USADA shall promptly notify the USOC, the applicable NGB and the athlete. USADA shall then provide to the athlete the B sample documentation package set forth on Annex C. The laboratory shall not be required to produce any documentation in addition to Annexes B and C unless ordered to do so by an arbitrator(s) during adjudication, in which case it shall be produced at the athlete’s expense.
4. In special circumstances where USADA is conducting testing for an IF, regional or continental sports organization or other Olympic movement sporting body, other than the USOC or an NGB, the notification described in this section shall be made exclusively to that sporting body, the athlete, and , if applicable, to the USOC and NGB.
1. Results Management Whenever USADA receives a laboratory report confirming positive test, elevated testosterone or epitestosterone ration or epitestosterone concentration, or when USADA has other reason to believe that a doping violation has occurred, such as admitted doping, address that case through the following results management procedures:
   1. USADA ANTI-DOPING REVIEW BOARD
      The USADA Anti-Doping Review Board (“Review Board”) is a group of experts independent of USADA with medical, technical and legal knowledge of anti-doping matters. The Review Board members shall be appointed for two year terms by the USADA Board of Directors. The Review Board shall review all B sample test results reported by the laborator7y as analytically positive or elevated in accordance with i below. Such review shall be undertaken by between three and five Review Board members appointed in each case by USADA’s Chief Executive Officer and composed of at least one technical, one medical and one legal expert.

   Upon USADA’s receipt of a laboratory report identifying an analytically positive or elevated B test result, the following steps shall be taken:

   1. USADA’s Chief Executive Officer shall appoint a Review Board as provided in Section (a) above.
   2. The athlete shall be promptly notified of the date by which the athlete shall submit any written materials, through USADA, to the Review Board for its consideration. The athlete shall also be provided the name and telephone number of the Athlete Ombudsman.
   3. The Review Board shall be provided the laboratory documentation and any additional information which USADA deems appropriate. Copies of this information shall be provided simultaneously to the athlete and the athlete shall be entitled to file a response with the Review Board.
   4. The Review Board shall be entitled to request additional information from either USADA or the athlete.
   5. Notwithstanding the forgoing, the process before the Review Board shall not be considered a “hearing.” The Review Board shall only consider written submittals. Submittals to the Review Board shall not be used in any further hearing or preceding without the consent of the party making the submittal. The Review Board’s recommendations shall not be admissible in any further hearing or proceeding.
   6. The Review Board shall consider the written information submitted to it and shall, by majority vote, make a recommendation to USADA with a copy to the athlete whether
      or not there is sufficient evidence of doping to proceed to a hearing.
   7. USADA shall also forward the Review Board’s recommendation to the USOC, the applicable NGB and IF and WADA.
   1. ADJUDICATION
      1. Following receipt of the Review Board Recommendations, USADA shall notify the athlete in writing whether USADA considers the matter closed or alternatively what specific charges or alleged violations will be adjudicated and what sanction, consistent with IF rules, USADA is adjudicated and what sanction, consistent with IF rules, USADA is seeking the have imposed (an other possible sanctions which could be imposed under the applicable IF rules). The notice shall also include a copy of the USADA Protocol for Olympics Sport Testing and the modifications to AAA Commercial Rules. Within ten (10) days following such notice, the athlete must notify USADA if he or she desires a hearing to contest the sanction sought by USADA. If the sanction is to contested, then it shall be communicated by USADA to the USOC, the applicable NGB and If and WADA and thereafter imposed by the NGB. If the sanction is contested by the athlete, then a hearing shall be conducted pursuant to the procedure set forth below.
      2. The hearing will take place before the American Arbitration Association (“AAA”) using a single arbitrator (or a three arbitrator panel if demanded by either of the parties) selected from a pool of the North American Court of Arbitration for Sports (“CAS”) Arbitrators who shall also be AAA Arbitrators. The hearing will take place in the U.S., be administered by Decentralized Office of CAS in the Americas (the “Administrator”), and the conducted under modified AAA Commercial Rules attached as Annex D. The parties will be USADA and the athlete. USADA shall also invite the applicable IF to participate either as a party or as an observer. For their information only, notice of the hearing date shall also be sent to the USOC, the applicable NGB and WADA.
      3. Either the athlete or the IF(whether a party or not) shall be entitled to appeal the AAA arbitrator(s) decision to CAS. A CAS appeal shall be filed with the Administrator and the CAS hearing will automatically take place in the U.S. Otherwise the regular CAS appellate rules apply. The decision of CAS shall be final and binding on all parties and shall to be subject to further review or appeal.
      4. The athlete, within ten (10) days following the Notice described in section (i) above, shall be entitled, at his or her option, to elect to bypass the hearing described in section (ii) above and proceed directly to a single final hearing before CAS conducted in the United States. The CAS decision shall be final and binding on all parties and shall not be subject to further review or appeal.
      5. In all hearings conducted pursuant to this procedure the applicable IF’s categories of prohibited substance, definition of doping and sanctions shall be applied. In the event an IF’s rules are silent on a issue, the rules set for the in the Olympic Movement Anti-Doping Code shall apply. Notwithstanding the foregoing; (a) The IOC laboratories used by USADA shall be presumed to have conducted testing and custodial procedures in accordance to prevailing and acceptable standards a of scientific practice. This presumption can be rebutted by evidence to the contrary, but the accredited laboratory shall have no onus in the first instance to show that it conducted the procedures other than in accordance with its standard practices conforming to any applicable IOC requirements; (b) minor irregularities in sample collection, sample testing or other procedures set forth herein which cannot reasonablely be considered to have effected the results of an otherwise valid test or collection shall have no effect on such results; and (c) if contested, USADA shall have the burden of establishing the integrity of the sample collection process, the chain of custody of the sample, the accuracy of laboratory test results by clear and convincing evidence unless the rules of the applicable IF set a higher standard.
      6. All administrative costs of the USADA review and adjudication process will be borne by USADA except the CAS appeal fee which will be refunded to eh athlete by USADA should the athlete prevail on appeal.
      7. The results of all hearings shall be communicated by USADA to the athlete, the USOC, the applicable NGB and If and WADA. The NGB shall impose any sanction resulting from the adjudication process. The NGB shall not impose any sanctions until after the athlete has had the opportunity for a hearing pursuant to section 9(b)ii or 9(b)iv.
2. Ownership and Use of Samples All samples collected by USADA shall be the property of USADA. USADA may authorize the use of negative samples for research; however, in such event all markings on the sample which identify the ample as coming from a particular athlete shall be obliterated.
3. Confidentially Except for the notifications to the USOC, NGB, IF, WADA (or other sporting body ordering the test) as otherwise provided in this protocol, USADA shall not publicly disclose an athlete’s positive test result or other alleged doping violation until after the athlete has been found to have committed a doping violation in a hearing conducted under either article 9(b)(ii) or 9(b)(iv) above. USADA may release aggregate statistics of testing and adjudication results.
4. Expedited Procedures USADA may shorten any time period set fourth in these procedures where doing so is reasonable necessary to resolve an athlete’s eligibility before a protected competition.