Drug testing of adolescents in general medical clinics, in school and at home: physician attitudes and practices.
OBJECTIVE
To determine (1) whether physicians agree with recommendations for home and school drug screening, (2) under what circumstances physicians recommend urine drug tests for adolescents, and (3) how physicians manage adolescent patients with positive results. Few clinical practice guidelines have been published on urine drug testing of adolescents, and it is not known when physicians recommend this procedure or how they manage positive results.


METHODS
Multi-modal survey of a nationally representative sample of physicians conducted April-July 2004. We computed simple frequencies and used backwards selection logistical regression to determine if there were differences in agreement or practices among physicians from different specialties (pediatrics, family medicine, adolescent medicine) or by demographic factors (physician age, gender, practice type or location).


RESULTS
A total of 359 physicians (43% after eliminating ineligibles) completed the survey. Thirty-eight percent would recommend a drug test if were required to return to school, 41% if a parent was concerned, and 46% based on history (without a parent's concern). Forty-eight percent of physicians would share a positive drug test result with parents. A large majority (83%) disagreed with high school drug testing programs.


CONCLUSIONS
There is little consensus among physicians regarding the indications for drug testing in the general medical clinic. However, most disagree with school drug testing programs. There is little consistency among physicians in how to proceed when a urine drug test is positive. Professional organizations should consider publishing clinical practice guidelines in order to assist physicians in using this procedure effectively.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA. sharon.levy@tch.harvard.edu
Sharon
S
Levy
Sion K
SK
Harris
Lon
L
Sherritt
Michelle
M
Angulo
John R
JR
Knight
D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000368:Aged; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D012572:School Health Services; D015813:Substance Abuse Detection; D016482:Urinalysis