Drug testing is often used as part of an assessment for substance use in children and adolescents. However, the indications for drug testing and guidance on how to use this procedure effectively are not clear. The complexity and invasiveness of the procedure and limitations to the information derived from drug testing all affect its utility. The objective of this clinical report is to provide guidance to pediatricians and other clinicians on the efficacy and efficient use of drug testing on the basis of a review of the nascent scientific literature, policy guidelines, and published clinical recommendations. Pediatrics 2014;133:e1798-e1807
INTRODUCTIONThe recreational use of drugs is an underrecognized cause of mortality and morbidity in children and adolescents. It is, in fact, a public health priority. 1 Although annual surveys of drug use by children and adolescents may show fluctuation, the underlying rates remain high. 2 Numerous adverse consequences accompany use, not the least of which is the increased risk of dependence among those who began smoking, drinking, and using drugs before 18 years of age. 3,4 Furthermore, most adults with substance use disorders initiated use during childhood or adolescence. 5 Pediatricians are on the front lines for deterring, delaying, detecting, and diminishing the use of drugs by children. It is imperative that all pediatricians understand and are ready to use the tools and strategies effective for these endeavors.Drug testing has been recommended in a variety of settings and clinical situations to avert substance use, to identify use as part of an assessment, or as part of treatment of individuals with substance use disorders. To date, there is little consensus among physicians regarding the indications for drug testing and little guidance on how to use this procedure effectively for any indication. 6 The federal government has issued extensive guidance on the use of urine drug testing with federal and other employees, 7 although this guidance is not applicable for all situations and age groups. Experts have called for further evidencebased studies to guide best practices with adolescents. 8 The complexity and invasiveness of the procedure and limitations to the information derived from drug testing all affect its utility. The objective of this clinical report is to provide guidance on the efficacy and efficient use of drug testing on the basis of a review of the nascent scientific literature, policy guidelines, and published clinical recommendations.