Sunday, January 16, 2011

Drug Testing Pot Smoking Adolescents

If you think your teen is smoking marijuana they probably are. Otherwise they might have a brain tumor. I once did the thousands of dollars work up with complete psychiatric assessment, neurological exam, CTScan and EEG, blood work, and such because the kid's grades were poor and teachers wondered why he was so feral with no memory and no concentration.
Teen and parents insisted he didn't smoke marijuana. I was afraid I was missing some sort of brain eating virus. The kid was that stupid and irritable. Worse than an average teen ager by many points. I was upset that I must be missing something and expressed my defeat to my secretary. She told me his parents were the town drug dealers.
It did a urine test and it came back positive. Mostly marijuana isn't that obvious. It's associated with poor grades, irritability and arrogance. The way to pick it up is by a simple urine drug screen.
Today I'm a medical review officer for government and transportation and such. Refusal to pee is a positive test. That was the agreement between government, unions and Americans with disabilities. If you're not smoking marijuana you're glad to pee because it will be clean. It's a matter of pride for people like me. I'm happy to show you my urine doesn't have drugs. It's not a civil liberties thing. If I'm acting dumb it's a lot cheaper test than doing an MRI. It's the place to begin with teens.

Any family doctor can order a urine drug screen. To make it random the teen has to do it without notice within 24 hours. Marijuania will test positive in urine for weeks to months. It's not like cocaine which clears in days to weeks. The drugs we look for in addition to marijuana are cocaine, opiates, amphetamines, benzodiazepines and hallucinogens. The simple cheap dipstick test has cannabis, cocaine, amphetamines, pcp and benzodiazepines. More extensive broader tests have more but truthfully I'm rarely concerned about more than the above. These are all the gateway drugs and if people are doing designers they may be picked up but they're probably doing the 'fav 4" (cannabis, cocaine, amphetamine, opiates.)

There are occasional false positives, the urine tests positive and the teen isn't doing drugs. But we sort this out by having the young adult be seen by an addiction specialist. Addiction specialists have a Canadian Society of Addiction Medicine (CSAM) Certificate or an American Society of Addiction Medicine Certificate (ASAM) or an International Society of Addiction Medicine Certificate (ISAM). GPs, general psychiatrists, child and adolescent psychiatrists, historically haven't been that knowledgeable about addiction despite their common claim that they are. Some of them think they can do surgery and surgeons look askance at generalists operating. In addiction medicine there's the same problem. Lots of people who think they are experts, few are. Look for the certification. If a teen tests positive send them to a certified medical addiction special. When it comes to doing urine testing the Medical Review Officer (MRO) is the most knowledgeable and certified but isn't really necessary for teens unless the teen starts being a jailhouse lawyer. .

I have several patients who are on contract with their parents that if there parents phone me I requisition a urine test at the request of the parents. As the parents are paying for the teens home and school it's reasonable that they want the teen to be present for the experience. It's so much easier to do adolescence, a tough job at any time, if you have your brain in your skull.

Ongoing random urine testing, as opposed to an initial screening test, is only done after a teen has lied but tested positive. If a teen tells me they're using I don't need a confirmation test and I don't like the cost or unnecessary paper floating about. When the teen is clean I order a test to support their claim and to encourage them to remain clean. It's good to sit down and write a voluntary contract with parents and teen so everyone is on board about what will happen next.

Today Narcotics Anonymous has a young peoples group for those under 25. I would definitely send a teen to such an NA group but not the adult one. Often marijuana smokers quit drinking as well and go to AA which also has a young peoples group.

Urine testing isn't 'invasive'. Blood tests are invasive. Urine tests are not.

- Posted using BlogPress from my iPad

No comments: