No Child Left Untested?

The White House Office of National Drug Control Policy announced last week that it will be holding four regional summits promoting random student drug testing in public middle and high schools. The controversial program, which has already been implemented in nearly 1,000 middle and high schools across the country, requires that kids submit to random drug testing if they want to participate in competitive extracurricular activities like athletics. The Department of Education offers grants to schools that want to develop or expand a drug-testing programs for children in grades 6-12, but decisions about whether to test and which drugs to test for are made on an individual school level. The testing is usually done by a school nurse with a urine sample taken on school premises. If there's a positive result, the sample is sent out for verification by a lab. Tests can also be done with blood or saliva. Samples are generally tested for cocaine, marijuana, ecstasy, opium-based substances, oxycontin and, in some cases, steroids.

The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President  Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:

NEWSWEEK: How does student drug testing work?

Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative.

Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.

Is there a standard model for schools to follow when implementing the random testing?

Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In  2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it.

Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.

Is anyone monitoring the schools to make sure they are doing it correctly?

Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information.

Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.

Kerns: 'No protocol on how schools have to do it exists so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives'

What are the penalties or repercussions for positive tests?

Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team.

Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.

Is there a risk that kids who test positive for drugs will be stigmatized?

Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior.

Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?

The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.

Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.

Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.

Should a program from the military be applied to kids?

Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.

Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.

What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?

Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."

Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.

Is mandatory drug testing a violation of a student's right to privacy?

Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves?

Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.