Fort Worth, Texas,
09:49 AM

Drug testing

Doc Smitty looks at pros and cons

“I’m just pretty sure he’s using drugs, can you go ahead and run a test?”

“Mrs. Jones wants to talk with you about something before you go in the room with Jimmy, want me to grab her?”

I overhear this conversation regularly between parents and nurses in my offices. Usually it leads to a long discussion between the parent and me. We discuss the pros and cons of a drug test, including the implications of a positive or negative test. It’s a conversation I would like to have with you who are reading this today.

Here are some signs that your teenager might be using drugs from the article Early Detection of Illicit Drug Use in Teenagers from the Innovations in Neuroscience:

  • Change in behavior or mannerisms
  • Change of friends/social circle
  • Prefer to be alone
  • Skip family time-daily family dinner or bigger events
  • Impaired sense of judgment
  • Sudden, unexplained drop in grades

On May 26, 2014, the American Academy of Pediatrics (AAP) released a statement against the involuntary drug testing of adolescents. I’m not sure how the rest of my fellow conservative Texas pediatricians will feel about this statement (they don’t always agree with the AAP on certain things), but I have to admit that I applaud this statement.  It's how I've addressed this issue since I started practicing and here's why.

There are a couple of instances where getting a drug test (even if it is not consented to) are critical:

  1. A teenager who is not acting normal or having other symptoms that could be related to drug intoxication (seizures, abnormal heart rhythms). In these situations knowing what the adolescent has taken is critical in choosing the correct treatment plan.
  2. A teenager has shown a change in behavior over time that could be consistent with drug use. This should only be done after careful conversation with and without the parents to see if the patient will admit to using in those contexts.

Some other situations where drug screens are commonly requested, but caution should be used:

  1. Juvenile delinquency - We want to know if our adolescents are doing drugs but I'm not a prosecutor and it's not my job to report them should I get a positive screen. Thus, I need to have clear documentation of who is requesting the drug test and why before I'll do a drug test that I'm not requesting because of a clinical need.
  2. Foster care - Again, I'm not in the prosecution business so if CPS wants a drug test because there were drugs in the house where a child lived, etc., I like to see who is requesting the test and why.
  3. School requests or general screening - If there has been a history of drug use and the school is requiring for re-entry, I understand. Of course, if your child is balking at random drug screening, then there's probably a conversation that needs to happen anyway.
  4. Just because - I actually get this request from parents more often than you'd think. This is the primary reason I thought commenting on this AAP statement was important.

4 Reasons Why "Random" Drug Testing for Your Teenager Could be a Bad Idea

Again, this is not to say that you should fight the school district if they are requesting for athletic participation or for other reasons. I am talking about going into your doctor’s office and requesting a drug test.

  1. Trust - A request for a drug test commonly comes in the form of a little note handed to my staff or a hallway conversation outside of the context of the visit. In those cases, it seems that the parent is requesting that I check the urine for drugs without the child knowing. This sets up a scenario where we have violated the trust of your teenager on multiple fronts. What if the test is positive? How do you handle that information? "Son, remember that urine sample that you gave at the doctor’s office, that wasn't actually for a kidney test and, by the way, why are you smoking dope?"
  2. False positives - This is rare, but can happen and imagine the headaches that it causes. Families end up chasing an unnecessary rabbit trail of therapies and other interventions because a test is imperfect.
  3. False negatives - Even if a child shows all the above symptoms of drug use and everyone is sure they are using, sometimes the tests come back negative. Now the adolescent has a free pass (at least for a while) because they can refer back to their negative test for months when you are "bugging" them about their behavior.
  4. Cheating the test - If a child is resourceful enough to get drugs and hide their use from you, they can probably find a way to cheat a drug test. This again provides a false sense of security to the parent and a free pass for the teenager for a while.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.


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