| HISTORY:
The authority of public schools to test students for illegal drugs was broadened by the U.S. Supreme Court in June 2002 (Board of Education of Independent School District No. 92 of Pottawatomie County et al. v. Earls et al.). Previously, suspicionless (random) drug testing had been allowed only for student athletes (Vernonia School District v. Acton). Suspicionless routine and random drug tests are now allowed for all middle and high school students participating in competitive extracurricular activities. The court said the school district’s policy was a reasonable means of furthering its important interest in preventing and deterring drug use among its school children to protect their safety and health. The school district involved in the Supreme Court case applied the practice to only competitive extracurricular activities that were sanctioned by the state secondary schools activities association that included Future Farmers of America (FFA), Future Homemakers of America (FHA), band, choir, and cheerleading (Supreme Court of the United States, 2002).
DESCRIPTION OF ISSUE:
Illegal drug use among adolescents is increasing, causing a concern for both communities and school districts. In 2001 over 10% of youth age 12 to 17 were current drug users, an increase of over 1% from 2000 (SAMSHA, 2001). More than half of all students report using illegal drugs by the time they finish high school (Office of National Drug Control Policy, 2002). High-risk behaviors, including the use of illegal drugs that are established during youth are often extended into adulthood. Students are confronted with illegal drugs in a variety of places. Unfortunately one of these places is on school grounds. Over 28% of students nationwide had been offered, sold, or given an illegal drug on school property during the 12 months preceding the 2001 Youth Risk Behavior Survey (YRBS) (CDC, 2001). Metropolitan counties have a higher percentage of reported drug use by adolescents than rural non-metropolitan counties, ranging from 7.6% to 4.8% (SAMSHA, 2001).
Adolescents have reported using a variety of illegal substances. The 2001 YRBS data showed that over 42% of students nationwide had used marijuana during their lifetime. Prevalence of current marijuana use in states varied from about 9% to about 33%. Over 10% of students nationwide reported trying marijuana before age 13. Over 5% of students nationwide had used marijuana on school property more than once during the 30 days preceding the survey (CDC, 2001). Marijuana is not a benign drug, and its use poses risks for society as well as for the individual user. Several studies examined the risk of problematic outcomes for marijuana users including lower academic achievement, dropping out of school, unemployment, having a child out of wedlock, participating less in productive activities, having lower educational and occupational expectations, displaying later psychiatric disorders, and showing brain morphological changes on MRI (Jeynes, 2002; Wilson et al., 2000; Bray, Zarkin, Ringwalt, & Qi, 2000; Brook, et al., 2002; and Brooks, Adams, Balk, & Johnson, 2002).
While marijuana was the most widely used illegal drug, students also reported other drug use. Nationwide over 9% of students had used a form of cocaine and over 9% reported using methamphetamine during their lifetime. About 3% of students reported using heroin during their lifetime (CDC, 2001). Ecstasy (MDMA) use has tripled in the last two years (SAMSHA, 2001). Research shows individuals who make it through adolescence without using drugs are less likely to use them when they are older (Office of National Drug Control Policy, 2002).
RATIONALE:
The decision on whether or not to test students for illegal drugs is determined by individual communities and school district policy. To help assist school districts explore this issue, the Office of National Drug Control Policy has developed the resource titled, “What You Need to Know About Drug Testing in Schools.” The Office of Safe and Drug-Free Schools (OSDFS) through the United States Department of Education provides financial assistance for drug and violence prevention activities as well as for activities that promote the health and well-being of students. Schools and communities have many issues to consider when determining if they should adopt a policy for drug testing in their school district. The above resources will help provide guidance.
Some issues of particular concern to the school nurse in districts considering implementing suspicionless and/or random drug testing are:
- Who determines the need for testing?
- What substances will be tested?
- What is the threshold for the substances being tested?
- How will chain of custody be enforced to allow for use in any legal actions that may arise?
- Who does the testing? How and where will the specimen be obtained and made available for testing? (Will the school nurse be involved?)
- Who will provide training for staff performing the testing to assure that all legal requirements have been met? (What will be the role of the school nurse?)
- Who obtains parental permission to release the results of the testing to the school district?
- Where will permission be filed? (Will it be in the health file?)
- Where will testing results be filed and who may see the results of the screening? (Will these be in the health file or in another location in or out of the building?)
- What are the confidentiality provisions that are needed to meet federal and state requirements?
- What if the student is pregnant? (Depending on the substance this may have implications for placement of the infant following delivery)
- What services will the school system provide or not provide in the event of a positive test?
- What does drug testing tell or not tell about a student’s drug use?
- What provisions are in place for students whose prescription medication results in a positive test?
- How will the school health services team (school nurse, counselor, social worker, and/or psychologist) coordinate prevention, education, and referral activities in school?
- What do state laws say about issues surrounding drug testing of minors?
- What services should be in place for communities to deal effectively with students who test positive for drugs?
(Office of National Drug Control Policy, 2002; Schwab & Gelfman 2001).
The school nurse is in a position to assist the school district with decision-making regarding this issue. What is appropriate for students in one community may not be in another. School nurses have the expertise to assist with a community needs assessment and community education programs. School nurses may provide primary, secondary, and tertiary prevention services in substance use and abuse prevention and are knowledgeable about community-based referral resources and confidentiality. This is a complex issue going beyond simply performing suspicionless routine and random drug testing in schools.
CONCLUSION:
It is the position of the National Association of School Nurses that the school nurse, as student advocate and nursing expert, should be included in school district and community planning, implementation, and ongoing evaluation of any drug-testing program. A district-wide drug-testing program needs to be well planned by both the community and school district. Depending on local needs, not every community and school district will decide to implement such a program. Regardless of local decisions, it is in the best interests of students to be free from illegal drug use. This drug use impedes mental concentration for learning and interferes with growth and development. Suspicion of drug use by a student calls for appropriate referral, evaluation, and necessary treatment. Additionally, prevention programs are important; they provide students with the appropriate knowledge and skills to avoid use of illegal substances.
References/Resources:
American Academy of Pediatrics, Committee on Substance Abuse, Policy Statement (1996). Testing for drugs of abuse in children and adolescents (RE9628). Pediatrics, 98(2), 305-307. Retrieved April 16, 2003, from http://www.aap.org/policy/01495.html
Bray, J. W., Zarkin, G. A., Ringwalt, C., & Qi, J. (2000). The relationship between marijuana initiation and dropping out of high school. Health Economics, 9(1), 9-18.
Brook, D. W., Brook, J. S., Zhang, C., Cohen, P., & Whiteman, M. (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry, 59(11), 1039-1044.
Brooks, J. S., Adams, R. E., Balka, E. B., & Johnson, E. (2002). Early adolescent marijuana use: Risks for the transition to young adulthood. Psychological Medicine, 32(1), 79-91.
Centers for Disease Control and Prevention (CDC) (2001). Youth risk behavior surveillance—United States 2001. Retrieved April 21, 2003 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5104al.htm
Dowling-Sendor, B. (2002). ‘Reasonable’ drug testing. American School Board Journal, Sept., 76-80.
Jeynes, W. H. (2002). The relationship between the consumption of various drugs by adolescents and their academic achievement. American Journal of Drug and Alcohol Abuse, 28(1), 15-35.
Marcus, M. T. (2000). An interdisciplinary team model for substance abuse prevention in communities. Journal of Professional Nursing, 16(3), 158-168.
National Association of School Nurses (2001). Position statement. Coordinated school health program. Available at http://www.nasn.org/Default.aspx?tabid=213
National Association of School Nurses (2002). Issue brief. Privacy standards for student health records. Available at http://www.nasn.org/Default.aspx?tabid=277
National Association of School Nurses (2003). Issue brief. Substance use and abuse. Available at http://www.nasn.org/Default.aspx?tabid=282
Office of National Drug Control Policy. (2002, September). What you need to know about drug testing in schools. Retrieved April 11, 2003, from http://www.whitehousedrugpolicy.gov/publications/drug_testing/
Schwab, N., & Gelfman, M. (2001). Adolescent issues and rights of minors. In N. C. Schwab & M. H. B. Gelfman, Eds. Legal issues in school health services. North Branch, MN: Sunrise River Press.
Schwartz, R. H., Silber, T. J., Heyman, R. B., Sheridan, M. J., & Estabrook, D. M. (2003). Urine testing for drugs of abuse: a survey of suburban parent-adolescent dyads. Archives of Pediatric and Adolescent Medicine, 157(2), 158-161.
Substance Abuse and Mental Health Services Administration (SAMSHA) (2001). National household survey on drug abuse. Highlights. Retrieved April 18, 2003, from http://www.samhsa.gov/oas/nhsda/2klnhsda/vol1/highlights.htm
Supreme Court of the United States (2002). Board of Education of Independent School District No. 92 of Pottawatomie County et al. v. Earls et al, syllabus. Retrieved April 18, 2003, from http://a257.g.akamaitech.net/7/257/2422/27jun20021045/www.supremecourtus.gov/opinions/01pdf/01-332.pdf
Tuttle, J., Melnyk, B. M., & Loveland-Cherry, C. (2002). Adolescent drug and alcohol use. strategies for assessment, intervention, and prevention. Nursing Clinics of North America. 37(3), 443-460.
U. S. Department of Education (2003). Office of safe and drug-free schools (2003). Retrieved April 11, 2003, from http://www.ed.gov/offices/OSDFS/index.html
Wilson, W., Mathew, R., Turkington, T., Hawk, T., Coleman, R. E., & Provenzale, J. (2000). Brain morphological changes and early marijuana use: a magnetic resonance and positron emission tomography study. Journal of Addictive Diseases. 19(1), 1-22.
Adopted: June 2003 |