Random drug testing in schools fails screening criteria
http://www.100md.com
《英国医生杂志》
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
Blair T. Yes, I back random drug-testing in our schools. News of the World 2004 Feb 22: 10-11.
Department of Health. Second Report of the UK National Screening Committee. London: DoH, 2000.
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.
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
Blair T. Yes, I back random drug-testing in our schools. News of the World 2004 Feb 22: 10-11.
Department of Health. Second Report of the UK National Screening Committee. London: DoH, 2000.
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.