Sports Medicine: Drug Testing - LEGAL ISSUES: Options should be explored before starting student drug-testing program

IAA Magazine, Volume 24, No. 1, Fall 1997

By Joseph C. Franz, M.D.

Since the June 1995 U. S. Supreme Court ruling in support of random interscholastic student-athlete drug testing, many school boards have put drug-testing policies into place. Once the news media reports that a school district is considering drug testing of its athletes, a feeding frenzy starts with many local labs offering to do the actual testing. A word of caution is in order when starting down the road of student-athlete drug testing: Several areas need to be considered carefully, such as whether to use only a certified laboratory and how best to use a Medical Review Officer (MRO).

As the principal author of the first drug-testing policy approved for a high school in Ohio, I spent six months doing research. Besides being a team physician, additional training allowed me to be certified as an MRO, a service I perform for several large corporations in Ohio. It was this expertise that gave a new perspective on our policy. This article will offer some key points that must be considered in order to develop a sound policy with the least risk of legal challenge.

Student Drug-Testing Options

Drug-testing programs can be mandatory, as with interscholastic student-athletes, or voluntary as part of a student-assistance program. Random urine drug testing of a public school interscholastic athlete is legal
as determined by the United States Supreme Court in the case of Vernonia School District 47J (Oregon) v. Wayne and Judy Acton. This decision was handed down on June 26, 1995, and since then a handful of schools across the country have instituted similar policies for their interscholastic athletes in hopes of deterring drug use by this group of students. Other schools have instituted voluntary programs as a way to toughen up their student-assistance programs.

Both options have many pros and cons as listed below. For any drug testing program to work, it must be directed by a well-written policy approved by the school's governing body. A voluntary program has less liability since the search and seizure questions do not come into play; however, it has some disadvantages as well. The biggest factor any school is likely to consider is the cost of the program. The cost of a mandatory program is high because more drug screens are performed, but the results are far superior.

Voluntary Drug Testing

Usually, voluntary drug testing is part of a cocurricular student-assistance program activated when students are caught using illicit drugs or banned substances like tobacco. Students elect to participate in drug testing to decrease their punishment. Policy determines frequency of tests, and the school usually decides when testing occurs and pays for the first level of testing.

PROS

• Less costly
  
• Easier to administer
  
• Since voluntary, less likely for legal challenges
  
• Can target testing around known illicit use
  
• Collections can be done on campus or off

CONS

• Less of a deterrent to drug abuse Only takes action when problems are found


• Students are good at not getting caught


• Takes more school staff time to keep track of when tests need to be done and to transport students to get
  collections done

Costs: If each student is drug tested three times a year, at $50 per 13 tests, total program costs for five students per year would be approximately $7,500. Number of tests performed is about 150.

Information provided by:
Sport Safe Testing Service, Inc.
Joseph C. Franz, M.D.
7570 Steitz Road
Powell, OH 43065
(614) 881-4180


Mandatory Drug Testing

Applies only to student interscholastic athletes and is legal by U.S. Supreme Court ruling of Vernonia School District 47J vs. Acton (6/26/95). Programs usually consist of team testing at beginning of each season, then weekly random testing of up to 10% of in-season athletes. School usually pays for total program.

PROS

• Greater deterrence to drug use


• Another reason to say "No"


• More students are tested


• Testing can be tailored to look at drug-use trends


• Cannot be punitive; purpose is to help

CONS

• More costly


• Harder to administer


• Pool of eligible students must be updated weekly


• Selection of students to test must be randomized


• Students have to prove they are innocent


• Collections usually done at school and require student leaving class


Costs: For a school with 700 athletes who were all tested initially each season, then from 3% to 10% tested weekly for 35 weeks of competition, the school can expect to pay from $54,000 to $88,000 annually. Actual number of tests performed ranges from 965 to 1,583. Costs will vary based on actual cost of laboratory tests.

Drugs to Screen

A student drug-testing program must screen for the appropriate illicit drugs and banned substances. Most schools have student codes of conduct and/or athletic codes of conduct stating that illicit drugs are not to be used, and most include tobacco as a banned substance.

A school's substance-abuse coordinator should be able to tell the athletic director what drugs or substances students are using and abusing. This list probably will include pregame drugs like tobacco (smoked and chewed), marijuana, pain medications (often used with parent knowledge) and anabolic steroids. After games, the postgame drugs will include tobacco, marijuana, alcohol, LSD and inhalants. Currently, most certified laboratories offer a standard Substance Abuse Panel -- 10 (SAP- 10) which screens for the following 10 drugs:

Amphetamines
Barbiturates
Benzodiazepines (Valium®)
Cocaine
Marijuana
Methadone
Methaqualone
Opiates (Codeine)
Phencyclidine
Propoxyphene (Darvon®)

Many other chemical substances can be detected in the urine, and considering the drug-use patterns of today's youth, the following additional drug screens can be ordered:

Alcohol
Anabolic Steroids
LSD
Nicotine (Tobacco)

In the laboratory, the SAP-10 is automated and, therefore, less expensive to complete. The other four drugs must be tested for by different methods or at special locations, resulting in higher prices. The typical school will pay from $25 to $50 for each SAP-10 ordered, with urine alcohol costing $6 - $10 each, LSD $22-25 each, urine nicotine $10-12 each, and anabolic steroids $80-95 each. A new test for LSD is being developed which will reduce this cost to about $10 each. For this price, MRO services should be provided as well (see Medical Review Officer section).

Since the drugs abused most by teenagers today consist of tobacco, marijuana, alcohol and LSD, a drug abuse intervention program must screen for these chemicals. Simply doing the industry standard of a SAP-10 is not enough. However, detection of alcohol in the urine is not very reliable since it leaves very quickly. A drug screen for alcohol done on Tuesday is not likely to find alcohol that was consumed on Saturday night. LSD also leaves the body very quickly and is hard to catch.

A Certified Laboratory is a Must

There are many laboratories, both local and national, that advertise the ability to do urine drug testing. However, not every lab uses the same methods nor are they all certified by the government. Therefore, it is imperative that only government-certified laboratories are used for any student drug-testing program. This is the only way one can be assured that the results are accurate.

If a school's policy denies the privilege to participate in sports or other cocurricular activities when a positive test is found, the school will be in hot water if the results are wrong. Any lab used by a school's medical vendor must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and should have a minimum of 10 years of experience in toxicology testing and chair-of-custody procedures.

There are two levels of analysis that occur routinely with urine drug abuse screens. The sample is first subjected to an automated screening test that quickly looks for the presence of specified drugs or their metabolites. This initial testing uses a highly accurate immunoassay technique commonly called an EMITO. All presumptive positive results should be confirmed by a Gas Chromatography-Mass Spectroscopy (GC-MS) confirmatory tests. This confirmation method provides a "molecular fingerprint" of the drug and/or metabolite, providing a high level of accuracy and specificity. The quantitative results, in nanograms per milliliter, are usually reported as well.

Currently, the GC/MS confirmatory test is the only acceptable industry standard for drug-abuse screen confirmations. Thin-layer chromatography, as sometimes offered by non-certified labs, is not acceptable.

Second-hand Exposure

The first words out of a teen's mouth when told their urine showed marijuana is that they were in a car with someone who was smoking and, therefore, that is why their test came up positive. It is very true that detectable levels of both THC (active ingredient of marijuana) and nicotine can be found in those individuals having close exposure to the smoke of the burning tobacco substance. The urine of young children who live in a family where parents smoke will have detectable nicotine. For this reason, a series of cutoff levels has been determined and proven scientifically so when a urine drug screen is positive, we know it is from use and not second-hand exposure.

For THC the standard is 50 nanograms (ng) per milliliter in the screening test and 15 ng/mi by GC/MS. For nicotine, the measured metabolite, Cotinine, has to be above 500 ng/ml to be called positive. When a drug screen is reported as positive, the actual quantitative levels are reported to the MRO. This data is becoming more important in determining recent use vs. natural decay of levels in the body. The levels for nicotine (Cotinine) are less standardized and often take careful interpretation by the MRO.

Medical Review Officer

An MRO is a licensed physician who has additional training and certification in the area of drug testing. Specifically, they have learned how drug testing is done, what affects the results, specifically medications and foods, and how individuals will try and adulterate the specimens to give false negative results. A physician can be certified by the Medical Review Officer Certification Council (MROCC) or the American Association of Medical Review Officers (AAMRO).

Any program of drug testing involving students should have a certified MRO review all results and make a final certification as to being positive or negative. The MRO must be willing to phone parents when a positive result is found to verify if any medication has been prescribed. This is very important since medications like Tylenol with codeine could be prescribed legally for a student following a tooth extraction and that student having a drug test would be positive for opiates.

The MRO's job is to verify if any medication has been prescribed for the student which could have resulted in the positive result. If the MRO receives from the prescribing physician or dentist documentation that a medication containing codeine was prescribed, the MRO will rule the test

negative. However, if the parent happened to give the student any medication, and the student has no legal prescription for the medication, then the MRO must rule this test positive since a controlled drug was given and taken without the order of a licensed physician. (Believe it or not, athletes, with full knowledge of their parents, have taken pain medications prior to athletic competition to make their overused joints hurt less during that day's events). Having an MRO adds significant credibility to any program and shares the burden of liability with the school.

Other Factors to Consider

As more and more schools put programs of student drug testing into action, we will learn how to do it differently and how to do it better. If one elects for a voluntary program as part of a student-assistance program, look closely at the time it will take to administer the program. Maybe the school's medical vendor can do more of the work so faculty and staff can dedicate their time to the educating of students rather than taking them to the lab for drug tests.

A school's policy should have teeth, but it should be designed to help students as well. If the program is only designed to punish students, making it hard for them to continue in the activities they love, they may deal with the anger by using more drugs. Try to use their love for sports and other cocurricular activities as the reason they stay off drugs.

For more information and sample policies, contact Sport Safe Testing Service, Inc., 7570 Steitz Road, Powell, Ohio 43065 or call (614) 881-4180 to order the Consultation Package.

Joseph C. Franz, M.D., is the medical director of Sport Safe Testing Service, Inc., in Powell, Ohio. A certified MRO, Franz also is a volunteer physician with the Olentangy School District in Ohio.