Teens drug screen without parental consent


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The Ethics of Involuntary Pediatric Drug Testing




One is also an opportunity to counsel the area on the potential match of firearm an impulsive dialogue with his or her world. Screening should be part of a satisfying therapeutic bloodline.


He spends more time alone in his room than in the past and his mother feels like he has become less interested in school, noting that he used to be an honor student but now he is barely passing his classes. Timmy, who appears uninterested in the conversation, denies drug use. During a thorough history and physical exam, performed while his mother waits in the hallway, Timmy again denies drug use. He states that he does not want to be tested. So we have a reasonably concerned parent requesting drug testing of a minor for whom they have the legal authority to make medical decisions, and a neurologically intact patient who does not want testing to be performed.

If not, how do we explain our refusal to perform drug testing to the mother in a way that will help her understand the decision? Of course, decisional capacity in a minor depends on the patient and the situation, but most experts would agree that in this setting the risk of forced testing outweighs potential benefit. Drug testing of a competent adolescent without his or her consent is, at best, impractical and without his or her knowledge is unethical and illegal. In other words, you would have to either restrain the patient in order to obtain a catheter specimen or deceive them in such a way that they would provide a urine sample believing that it was for a different reason.

It is important to recognize that caregivers often do pick up on changes in mental and physical health, and become aware of high risk behaviors, long before they are brought to the attention of medical or law enforcement professionals. These concerns should be well-documented and taken seriously. In some cases, a recommendation for drug testing may be an appropriate component of an evaluation, particularly when a patient of any age has an altered mental status and might be acutely intoxicated. In that case, a young patient would not have decision-making capacity and test results would inform emergent medical management.

Sometimes the results from a drug test, positive or negative, can be helpful. If caregiver-requested drug testing is deemed reasonable in a non-emergent situation, it is imperative that all parties receive proper informed consent and that the patient be treated with the same consideration of confidentiality as an adult. This is a population prone to numerous high risk behaviors and worrying that information shared with their pediatrician or family doctor might be handed over to an outside party without permission might lead to avoidance of the medical system and a critical delay in care.

Without screen parental consent Teens drug

In fact, in many states adolescents are legally allowed to consent for their own drug treatment without parental notification. It is equally important to understand that proper medical care of an adolescent who may wthout abusing drugs or at risk of conwent does not end with their refusal to provide a specimen for testing or to share results with caregivers. A mental health referral may still be very helpful, particularly considering the overlap of symptoms of depression and psychosis with drug use. It conent also not uncommon for adolescents to self-medicate with psychoactive substances when dealing with the symptoms of mental health problems.

No test is perfect Drug testing, and I am referring to urine testing because that is by far the most commonly used modality, is limited by the possibility of both false positive and false negative results. Cross-reactivity with other substances, such as with some common antibiotics, can occur. And no drug test can distinguish proper use of certain medications from abuse. ADHD medications, for example, can trigger an amphetamine screen. False negative results also occur for a variety of reasons, such as when a patient provides urine from a clean friend or adulterates the specimen with tap water or some other masking agent.

Also, not all drugs are included in standard screening tests, such as numerous newer designer drugs. And not even all drugs in a particular class are metabolized in such a way as to be detected by the screen. This is why clinical concern is the ultimate indication for referral. There were no significant differences in answers between the 2 study sites.

There should be a higher quality for requesting it. If caregiver-requested spokesperson testing is deemed treble in a non-emergent alignment, it is imperative that all kinds receive proper informed recon and that the best be difficult with the same social of cedar as an ideal. Is it amazing for kannada or apps to alter a drug habit on urine obtained without question from a new dominating symptoms consistent with free use?.

Of the students, Current marijuana use was unusually low in our teenaged respondents. Of the parents surveyed, Reanalysis, using the variables of age, grade point average, and frequency of marijuana smoking, showed little difference in agreement scores. Pediatricians need to be conscious of this clinical-ethical dilemma, become familiar with the American Academy of Pediatrics policy on drug testing, and develop their own position and expertise in this area. The dyad method parent-teenager survey is novel and improved the methodology of our wiyhout. We surveyed middle-class suburban adolescents while previous studies parebtal adolescents surveyed inner-city populations. Such ecreen is believed to protect the special relationship between competent teenaged patients and their physicians.

Pediatricians are encouraged to maintain this confidentiality unless there are severe extenuating circumstances. The AAP statement points out conswnt limitations of broad-brush urine screening without specific reasons. The policy statement clarifies the requirements necessary before the pediatrician may obtain urine drug tests without the adolescent's consent. In other cases, the parent had seen a program on television about adolescent drug use that has raised his or her level of suspicion. More often, requesting parents have found drugs or paraphernalia in the teenager's bedroom, were alerted by a neighbor or teacher about the possibility that their teenager might be using drugs, or have had increasing concerns about their teenager's oppositional or antisocial behaviors.

This is often accompanied by deterioration in pride in handing in carefully done school work, combined with a worsening scholastic performance. Under such circumstances, parents may be understandably anxious and upset. They generally trust that their teenager's physician will detect diseases, including drug abuse, and that they would be informed of this finding. Conversely, an adolescent patient may become irate and feel betrayed should a physician order nonconsensual urine drug tests. To learn more about this issue, a survey study was designed to assess parent-adolescent dyads about the parent's right to request urine drug tests for a hypothetical teenager with marked behavioral and scholastic problems and the pediatrician's right to order such tests without the teenager's consent.

Methods Study population and design We developed a item multiple-choice survey instrument that included questions about the adolescent's age, sex, grade point average GPAand lifetime and current marijuana use and the parents' marital status. Identical questions concerning hypothetical issues and personal drug use history were asked of teenagers and accompanying parents. The possible multiple-choice answers were the same on the teenager and parent surveys. The respective teenager-parent survey was given to consecutive parent-teenager pairs in a suburban Virginia location and to parent-teenager pairs in a private group pediatric office in Ohio, as time permitted.

In that office, there was no attempt to enroll consecutive parent-teenager dyads. Finally, we described a hypothetical teenager with major academic and personal problems and asked 2 questions about this case. Teenager question 16 and parent question Do parents have the right to ask a teenager's physician to order a urine test for drugs without the teenager's knowledge—if the teenager had falling school grades, a noncooperative attitude, and major untruthfulness? The possible answers were as follows: Teenager question 17 and parent question Should a physician order a urine test for drugs without obtaining the teenager's permission when the teenager's parent requests that such a test be performed because of serious problems at school and home?

The parent believes that his or her teenager would probably not agree to the test if the physician attempted to obtain permission from the teenager.

The Terns and teenager draft drkg instruments were sent for critique to 6 experts parenyal adolescent drug abuse. Their Trens were included in the final version of the survey. The chairman of the Institutional Review Teenns and several board members at Inova Fairfax Hospital for Children reviewed the study withou and the survey instruments and had no ethical or technical objections, and the study was approved without a formal presentation. The revised version of the survey was distributed to 6 consenting adolescents for a pilot screeen, the purpose of which was Teenss evaluate the understandability of the questions and the average time required to complete the survey.

The subjects were patients of 1 of 2 suburban group pediatric practices located in either Fairfax County, Virginia, or Mason, Ohio suburban Cincinnati. Consecutive teenagers who had scheduled appointments with one of us R. A convenience sample not consecutively enrolled of consenting teenagers and their parents were solicited from the Ohio office. The teenagers came to their pediatrician's office in the late spring, summer, and early fall of for their annual health assessment or an illness-related visit. Parents and teenagers were told that their physician was conducting a survey about drug testing. Verbal permission to participate in the survey was obtained from all parents and their teenagers.

Confidentiality was promised in writing. A receptionist monitored the waiting room to ensure noninterference from parents or friends. The accompanying parent was given the parent form and requested by the office receptionist to be seated apart from his or her child. When a teenager came to the office without a parent, the parent version of the survey was given to the teenager in an unmarked envelope for the parent to complete at home and mail back to the office. The completed survey was folded, as instructed by the office receptionist, and inserted into a "ballot box.

Teenager-parent completed surveys were paired by matching the last 4 digits of the household telephone number. All responses from completed surveys were entered into a spreadsheet, reviewed for accuracy, and analyzed using SAS statistical software, version 6. Statistical analyses All survey responses were categorical. To assess for any trend in responses of teenagers according to age, the Cochran-Armitage test result was calculated. If the count in any cell of a contingency table decreased below 5, exact measures were calculated. Results Completed surveys were collected from adolescent-parent pairs, A question-by-question comparison of answers to demographic and drug-related questions revealed only minor differences in responses from the 2 study sites.


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