Pubdate: Tue, 17 Jul 2001
Source: Globe and Mail (Canada)
Copyright: 2001, The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Details: http://www.mapinc.org/media/168
Section: Pg R6
Author: Sean Davidson

Special To The Globe And Mail

TROUBLED KIDS, BAD SCIENCE?

Home Drug-Test Kits Strain Bonds Of Trust Between Parent And Child

David had worked hard to get clean. He had a drug problem that included 
cocaine, marijuana, hallucinogens and amphetamines but had entered a 
treatment program at Toronto's Hospital for Sick Children. He commuted in 
every weekday from his hometown -- going to school in the morning followed 
by therapy in the afternoon.

But for some reason, his foster parents didn't believe he was sticking to 
the program and David, who asked that his real name not be used, feared he 
was about to be kicked out of an otherwise supportive family. He asked to 
be given a drug test, so he would have proof.

The urine test, and a lengthy letter of explanation from the hospital, 
confirmed that the teen was staying away from drugs and re-established the 
trust that had disappeared from his foster home. He completed the program a 
few weeks later and continued working toward a goal of complete abstinence 
from even tobacco and alcohol.

But out of the hundreds of cases she's worked on, Dr. Karen Leslie says 
David's is the only family that has been helped by drug testing -- and only 
because he was so eager to participate.

"He would be the only kid I can think of where urine testing did provide 
some significant positive impact on the treatment," says Dr. Leslie, a 
staff physician at the Hospital for Sick Children. Whenever parents ask if 
they can have their kids tested for drug use, she and her colleagues are 
reluctant to even discuss it. Urine testing has no part in the hospital's 
drug treatment program because it tends to erode trust, rather than build 
it, she says.

But parents can now run the tests themselves, in the home. Earlier this 
year, Toronto-based pharmaceutical company Novopharm introduced its KnowNOW 
Multiple Drug Detection Test, a urine screening test aimed at parents who 
want to check their kids for illegal drug use. Available at pharmacies 
across Canada, it is the first drug test to be sold over the counter in 
North America.

The test checks for six common categories of street drugs -- marijuana and 
hashish, cocaine, heroin and other opiates, amphetamines, PCP and 
methamphetamines such as Ecstasy. Each drug type is represented by a test 
strip that is dipped in a urine sample. After five minutes, a section on 
each of the strips will turn pink if no drug has been detected.

It's a simple procedure, similar to a home pregnancy test. But social 
workers and drug experts warn that, with few exceptions, home testing can 
cause more problems than it solves. Rather than gaining the peace of mind 
suggested by the literature, parents are more likely to damage the 
all-important communication and trust with their child -- setting off a 
battle of wills and inflaming what is likely an already strained relationship.

"How is it going to help the kid get better?" asks Dr. Leslie. "Is it going 
to make them more likely to say, 'Oh you're right. I should get treatment'? 
Probably not. It's probably going to make them say, 'You're accusing me.' "

On those rare occasions in therapy when a urine test is called for, usually 
for safety reasons, she says, it's a job best left to medical 
professionals. "If you look at the recommendations for collecting a urine 
sample, the ideal is that it's observed, and I don't think it's appropriate 
at all for a parent to observe their adolescent peeing into a cup." And as 
she explained to David and his foster parents, they don't necessarily prove 
anything.

Health-care professionals worry that taking testing out of the lab or 
hospital encourages a narrow or oversimplified attitude to drug treatment.

Joanne Shenfeld, a social worker at the Centre on Addiction and Mental 
Health in Toronto, also has doubts. "I think if someone is struggling to 
give up a drug addiction and is having some success and wants to prove 
that, then testing can be a positive thing," she says. "But if people are 
using it in a policing kind of way and it feels imposed, it might not be as 
beneficial."

Novopharm, however, stands by its product despite the controversy. "All the 
information that we give out, and the product itself, stresses 
communication," says vice-president David Windross, pointing to the 
voluminous literature available with the test. He insists that home tests 
are not meant to replace the work of health-care professionals or formal 
treatment, adding that parents can easily take questions or concerns to 
their pharmacist or family doctor.

But emotional fallout or the absence of professional medical treatment are 
just two of many potential problems. Although the technology has improved 
considerably in recent years, urine screening is not 100-per-cent accurate 
and there are many ways a test can be misused, misread or sabotaged.

"For every company that makes a drug test, there's a company that makes a 
way to get around it," says Richard Garlick of the Canadian Centre for 
Substance Abuse in Ottawa. Sure enough, a quick Web search turns up many 
companies selling so-called detoxification drinks and other products, which 
promise to mask the telltale chemical traces of drug use. One drink, 
cheekily called "Urine Luck," is even endorsed by Tommy Chong, formerly of 
the drug-addled comedy duo Cheech & Chong.

Other tips for foiling urine tests are just a mouse-click away. Drinking 
coffee, cranberry juice, beer or spiking the sample with bleach, Drano, or 
Visine are recommended. Even drinking a litre or two of water can flush out 
one's system, so that only a high-end test in a lab could spot signs of drugs.

Mr. Garlick also warns that, faced with testing, kids who are taking drugs 
might simply switch to different ones that would pose even greater risks to 
their health. "It's a well-known phenomenon that whenever people feel drug 
use can be detected, they move to more potent drugs -- drugs that are 
harder to detect," he says.

LSD or "acid," for example, is hard to detect with any real accuracy -- 
even when using a sophisticated lab test. Likewise, signs of hard drugs 
such as cocaine, heroin and amphetamines can clear out of the system in as 
little as one or two days, unlike marijuana -- generally considered a soft 
drug -- which can linger for days or even weeks.

Taking advantage of drug "clearance times" is a common means of dodging 
tests. A parent wishing to strictly monitor his or her child's activities 
could face the challenge of running a test every day -- an expensive habit, 
considering that they cost $50 each and can't be reused.

Parents could also face legal obstacles if they try to force a child, 
either physically or through intimidation, to take part in urine-testing. 
It's a grey area -- there are no laws or precedents that relate 
specifically to in-home testing -- but Canadian courts tend to favour the 
rights, and privacy, of children over the authority of parents or even 
medical professionals.

All this of course assumes that one administers the test properly and gets 
an accurate reading. Dr. Zul Verjee, a clinical biochemist and 
toxicologist, also at the Hospital for Sick Children, advises that even a 
simple test can make mistakes. "There is always a tradeoff between 
turnaround time and the accuracy of a test," he says. "The faster you want 
it, [the greater the chance] you introduce areas where you are more prone 
to false negatives and false positives."

Parents could encounter the common problem of cross-reactivity. Certain 
foods and medications can cause a "false positive" on urine tests, the most 
common example being a poppy-seed muffin, which, if eaten shortly before 
taking a test, can cause someone to test positive for opiates.

Over-the-counter and prescription medications can also throw a wrench into 
the works. Cold and allergy medications such as Nyquil and Sudafed can 
cause a false positive reading for amphetamine use, as can asthma 
medications like Bronkaid and Primatine. Painkillers such as Pamprin and 
Advil have been known to cause positives for marijuana and cough syrups 
such as Robotussin DM can turn up in tests as PCP. Novopharm provides lists 
of substances that cross-react with its test, but toxicologists warn that 
such lists aren't always exhaustive.

"Home tests are extremely sensitive," says Dr. Verjee, adding that even 
someone who inhales second-hand marijuana smoke can test positive.

Too much hassle for too little help? Quite possibly. Health-care workers 
say outside of those rare occasions when a child is willing, without being 
coerced, to take part in a drug test, it's not likely to help the 
situation. Parents are advised to stick with what they do best, talking 
with their kids and, if need be, supporting them through treatment.

"It's a lot of work for families to get into treatment," says Dr. Leslie. 
"So I worry about a urine test as something that a parent can do which 
doesn't require them to do much else. Like get involved."

Mr. Garlick agrees, "These tests are a cop-out from being the best parent 
you can be. They're a shortcut to being a parent just like drugs are a 
shortcut to feeling good."

Step One: Talk About It

If collecting urine and running tests isn't the answer, what are parents 
expected to do if they suspect their child might be using drugs?

Experts and parents in the know say maintaining trust and communication 
between parent and child is the most important aspect of avoiding and, if 
need be, dealing with drugs. Family traditions like meal times, shared 
activities or designated "talk times" are good ways to promote regular and 
open discussions.

If you fear your child is using drugs, ask. Don't be confrontational or 
accusatory -- that will likely just put the child on the defensive and set 
off a power struggle. If an argument breaks out and accusations start 
flying, parent and child should both take a "time out" for an hour or so to 
cool down.

Explain that you're worried, give reasons why (odd behaviour, poor health, 
slipping grades) and ask if the child can explain what's going on. Even if 
you think you have proof, always give the child a chance to explain.

Yes, you might get an evasive or dishonest answer ("It's not mine, I'm 
holding it for a friend.") but the child will at least feel he or she has 
been given a chance to be heard and treated fairly, which should promote 
further communication.

And be honest about your own use, or non-use, of drugs, including tobacco 
and alcohol. Be prepared for the old "You drink, you smoke up. Why can't 
I?" argument. If children feel the parent is being dishonest, or setting 
down a double standard, they'll be less likely to listen.
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MAP posted-by: Beth