On this episode of Raising Joy, we’re joined by Callie Crow, founder of the nonprofit Drew's 27 Chains, in honor of her son who died of an opioid overdose in June 2020.  The organization provides free Narcan and training to law enforcement agencies and other first responders and is credited with saving more than 30 lives to date.

By Ashley Antle

There is a new clear and present danger for children and it’s coming to them through virtual street corners and hidden social media messages. It’s the highly potent synthetic opioid called fentanyl. Similar to morphine but 50 to 100 times more powerful, fentanyl is sometimes prescribed to control severe or chronic pain. Like many opioids, it’s also made and used illegally with deadly consequences.

So far this year at Cook Children’s Medical Center, 15 children have been treated for fentanyl ingestion, some as a result of their own misuse of drugs and some as a result of exposure through someone else’s misuse. That’s up from zero in both 2019 and 2020, and 10 in all of 2021. 

This increase follows national trends. Fentanyl-related overdoses in the U.S. have exploded in recent years. For teens ages 14 to 18, death from fentanyl nearly doubled in 2020 and rose another 20% in 2021, according to researchers at the David Geffen School of Medicine at UCLA. It’s one tragic story after another of a child lost to the drug. A Los Angeles, California, teen dead and six others were hospitalized in September. Three teens from the same school in San Marcos, Texas, dead in August. Thirty-six Georgia teens dead in 2021, and the list goes on and on from coast to coast.

“What we're seeing in the littles is that they sometimes have exposure to fentanyl just because of their environment,” said Elizabeth Peeler, D.O., M.S., M.S.C.S. “They're at the mercy of their caregiver and it's kind of like a wrong place, wrong time situation. They're toddlers or babies, and so they toddle into drugs that are kept in the home. And that can be really scary because they're so small and fentanyl is so potent. It's so strong that just a little bit is enough to make a young child very sick.”

Dr. Peeler is a member of Cook Children’s Child Advocacy Resources and Evaluation (C.A.R.E.) Team. She and her fellow C.A.R.E. Team physicians specialize in examining and treating children who have suffered abuse, including from neglect and drug exposure. This year the team added fentanyl to their regular drug-testing panel due to a sharp increase in the number of fentanyl exposure cases they now encounter.

Drugs in Disguise

The clandestine nature of many fentanyl overdoses is what makes this battle a particularly difficult one.

When it comes to teens — and adults for that matter — it’s not that they are specifically buying fentanyl for a high, it’s that fentanyl is laced into other illicit or counterfeit drugs like Xanax, Percocet and Adderall, to name a few. These drugs don’t come with warning labels from their illegal dealers, so buyers have no idea their purchase may contain hidden fentanyl until it’s too late.

In the most recent fentanyl overdose cases at Cook Children’s, at least two were a result of marijuana laced with fentanyl and two from counterfeit Percocet pills containing fentanyl. The same is true in cases all across the country. According to the U.S. Drug Enforcement Agency (DEA), 42% of pills tested for fentanyl contained a potentially lethal dose of the drug. 

“There’s lots of different reasons why teenagers or adolescents may take a substance, whether it’s to have a good time because of peer pressure, whether it’s because they do suffer from depression or anxiety, whether it’s because they’re curious or because it was in the house and it was an accident,” said Artee Gandhi, M.D., Cook Children’s medical director for pain management and endowed chair for the Center for Pain Management and Integrative Health.

For dealers, adding a synthetic and highly addictive opioid that is cheap, easy to make, and keeps users coming back for more is easy money. However, get the dosage even slightly wrong and it’s deadly. Just two milligrams of fentanyl — the weight of a mosquito — can kill.

“Fentanyl is about 50 times stronger than heroin,” Dr. Peeler said. “Even a small amount can block the brain’s ability to remember to breathe. I want to remind all parents and children that substance misuse can have life-threatening consequences.”

A Mother’s Heartbreak

Callie Crow knows the devastation of fentanyl all too well. For years she watched her son, Drew, spiral into drug addiction, despite raising him in a home where alcohol and drugs were never a factor.

“He breaks that mold of what we sometimes think of as a stereotypical person that's addicted to drugs,” Crow said. “That's one of my biggest pushes is, you know, it's not even what I thought, because I've never done a drug in my life. I don't drink. I don't smoke. That's not something that my kids were exposed to in any way. And so in my mind, they were exempt and it wasn't going to happen to us.” 

Crow describes her son as having an old soul. He was articulate, even as a very young child, smart, funny and loved to learn. Drew was first offered cocaine by a trusted family friend at the age of 14. That eventually led to other drugs and pills and, by 17, he was addicted to opioids.

“We did detox. We did rehab. We did therapy. We did all of the things that, you know, are supposed to help,” Crow said. “And it just never, ever happened. I don't think he ever turned a corner from the time he was 17 on. It was really difficult watching that struggle.”

But there were moments of light. Drew got married and, at the time of his death at age 27, was studying political journalism at the University of North Texas. By then, his opioid use had morphed into a way to survive withdrawal, not necessarily to get high, Crow said, describing her son as a “functional addict.”

That’s what happened the night he died in June 2020. Crow says Drew purchased pills from someone in the town where he lived and took them to avoid withdrawal symptoms of nausea, vomiting, sweating and pain. The pill he took was unknowingly laced with fentanyl. Ten minutes after ingesting it, he was in cardiac arrest and died.

Four doses of Naloxone, also known as Narcan — the FDA-approved drug used to reverse the effects of fentanyl overdose — were within feet of Drew at the time of his overdose. Two on his bedside table that Drew’s wife did not know about and two on the police officer who initially responded to the 911 call placed by his wife. For reasons unknown to Crow, the officer did not administer the Naloxone he carried. Any one of the four doses in Drew’s presence at the time could have reversed the effects of the fentanyl and saved his life.

Since her son’s death, Crow, an EMT- paramedic, has made giving out Naloxone and teaching others how to administer it her life’s mission. She calls the organization she founded in her son’s honor Drew’s 27 Chains. The name is a reference to Drew’s love for disk golf. So far, 36 people have escaped a fentanyl-related overdose death as a result of Narcan handed out at a Drew’s 27 Chains event, and that’s just the ones Crow can track.

Like Crow, Dr. Gandhi is a proponent of keeping Narcan in your home and on your person.

“I think it is important for parents to know that there is a medication that's a nose spray that's available at any pharmacy and it does not require a prescription,” Dr. Gandhi said. “They can walk up to the counter and say, ‘Can I please have a dose of Naloxone?’”

Parental Interference Strongly Advised

“For the first time we are seeing an increase in overdose deaths in adolescents, and it’s predominantly due to the effect of fentanyl, which was not an intentional effect that the adolescent was going for,” Dr. Gandhi warned. “The number of overdose deaths itself has risen every year, but this is the first time that the adolescent population has actually had an increase.”

There are things parents can do to help protect their kids and teens. Running interference for your child against these dangers starts with a conversation. Not just one, but many.

“First and foremost, these conversations have got to happen all the time,” said Lisa Elliott, Ph.D., licensed psychologist and manager of Cook Children’s Behavioral Health Clinic in Denton. “There needs to be dinner conversations. There needs to be conversations in the car. They need to be constantly talking about it and making their kids very well aware of the reality and risks of drugs.”

Dr. Elliott says one way to talk to teens about these dangers is to frame the conversation as information they may need to help a friend. This takes the attention off your kid, she says, and they’re more likely to listen. These conversations should start early, as young children are at risk of fentanyl poisoning, too. Many dealers are disguising pills as candy, and there is always a risk of children ingesting a pill they’ve found on the ground.

Staying as involved as possible in your child’s life is the key to knowing if they are abusing drugs or participating in behaviors that could lead to addiction or overdose. This includes keeping a close eye on their online habits, social media accounts and text threads. A generation ago, keeping kids safe from drugs meant knowing their friends and steering them away from certain hangouts and street corners. Today, social media sites have brought an entire world of virtual street corners and strangers right into your child’s bedroom.

“Being vigilant about your kid’s social media use I think is important,” Dr. Gandhi said. “Your kids can have freedom on those devices but they still need monitoring.”

And for good reason. The prefrontal cortex of kids and adolescents is not fully developed until they are in their 20s. That’s the part of the brain that controls impulse, and that’s why young people have poor reasoning skills when it comes to risky behaviors.

“Kids and adolescents are basically a high-speed car going down a highway at a hundred miles an hour without any brakes,” Dr. Gandhi said. “They have no breaks. They have no self-regulation. They don't know the difference between what's real, what's not real, and what’s just something that you would think is a fluke. They don't understand the long-term implications or consequences of their actions. So don't fool yourself into thinking that your 15-year-old does. They don't. You've got to be involved in screening and monitoring and knowing what your children are having access to.”

Know their friends, Dr. Gandhi says, and communicate with their friends’ parents. She also encourages parents to find activities that kids enjoy but also make them feel like they’re a part of a community.

If you suspect your child is using opioids or other substances, reach out to their school counselor, drug counselor, a mental health professional or their pediatrician for help. If you suspect your child has overdosed on fentanyl or any other drug, call 911.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

Over the last six months, Cook Children's has released 20 articles regarding mental health, suicide in youth and teens, and resources to help young people in crisis. Recently, we spoke with experts to learn more about what families can do to help reduce the risk of suicide attempts and learned that there are a few things that start at home. 

What do you do with expired and unused prescription drugs? Do you throw them in the trash? Do you continue to take them after expiration? Or do you simply let them sit in your home?

Experts at Cook Children’s Medical Center say it is more important now than ever to dispose of unused drugs because of the alarming statistics of young people overdosing. In July, Cook Children’s reported a record number of pediatric hospitalizations for drug overdoses in 2021 compared to previous years, particularly with opioids. 

"It is a huge problem right now. We’re seeing more kids in the hospital for opioid overdoses than ever before. The vast majority of them are intentional ingestions," said Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s. 

“Teens and young adults are having ‘pill parties,’ where they are taking pills from their homes, and bringing them to a party with their friends. They then put them in one large bowl and grab handfuls,” Dr. Gandhi explained. “Not only is this unsafe, but different medications have potencies after their expiration dates and you can get sick from the medication being expired.”

Experts at Cook Children’s say the best thing to do is to safely dispose of any drugs that are expired or no longer being used for their intended purposes.

Savannah Panagopoulos, a child safety, and poison prevention specialist for the Center for Children’s Health led by Cook Children’s, says there are a plethora of take-back boxes in the area that allows people to dispose of drugs safely.

“These are permanent sites, where people in the community can come and drop off drugs, to get them out of the house. Taking medications that are no longer needed or expired out of the household could significantly reduce the chance of accidental poisoning or misuse that's intentional,” Savannah said.

Savannah says “50% of potential drug and substance abuse cases start with a friend or family member giving it to someone in the home that it’s not intended for.”

She goes on to explain that only 4% are purchased from a stranger or a drug dealer.

“Not only does disposing of the drugs safely give you peace of mind, but it’s also important to dispose of them to keep our environment safe. Not flushing the drugs down the toilet, putting them in cat litter, etc.,” Dr. Gandhi said.

She also reminds families that flushing drugs down the toilet is dangerous because of the harm it can do to our water systems. Dr. Gandhi says Cook Children’s pharmacy has a take-back box, which is easy and convenient to use. The box is located inside the retail pharmacy at Cook Children's and accepts any medication, with the exception of liquids. 

“You don’t have to talk to anybody, you don’t have to see anyone. You put it in the disposable container and walk away,” she said. 

Cook Children’s also has a system in place that also texts families to remind them to take back their unused medications and to keep them out of the reach of children.

“We do this so families don’t run into a problem with children unintentionally or accidentally ingesting medication that is not safe for them,” Dr. Gandhi said.

Savannah says while most take-back locations are located in pharmacies, there are other locations, such as police stations, that are open 24 hours a day for safe disposal.

“A good rule of thumb is to take off all labels with any identifying information before you drop them off,” Savannah said. ”Although all drop-off locations are in secure areas that is something we tell people to practice for safety and privacy.”

The United States Drug Enforcement Administration (DEA) also hosts national take-back days across the country every year. In April, more than 4,000 law enforcement agencies participated, which resulted in nearly 900,000 drugs being taken out of homes and disposed of safely. The next National Take Back Day is Oct. 23, 2021. Information about national takeback days can be found here.

Both Cook Children’s experts want families to know and spread the word about this resource. It is important to know that you don’t have to wait for a medication to expire and if the medication is expired, you can drop it off before you go and get a fresh prescription.

Cook Children’s Center for Children’s Health has a page dedicated to poison prevention. The North Texas Poison Center is open 24/7 and can be reached at 1-800-222-1222. You can find information about drop-off locations in North Texas, pain management, and more.

It is important to note you cannot dispose of items such as needles, oxygen tanks, thermometers, and sharps when dropping off your medication.

Dr. Gandhi says the most important thing to remember is, if you are done taking medicine and have used it for the intended purpose, dispose of it like you would an antibiotic or anything else.

“This goes for over-the-counter medication such as Tylenol, Ibuprofen, Aleve, etc,” she said.

Tracy Jensen often thinks about her son, Ethan. He was someone with an amazing aptitude for learning. “He was a boy who had eyes to notice others who, like him, were in pain and suffered silently, Tracy said. “He was a boy who had the heart to care.”

Ethan never stopped caring about life. It was just the pain became too frequent and too painful for him. Ethan suffered from muscle pain in his back and right leg. At 5 months old he had a fatty tumor removed from his spine. His spinal cord was unable to be untethered and the scar tissue that remained was also troublesome.

Tracy and her husband, Eric, wonder when their son’s suffering began. Was it before his birth? Was it at 5 months old when he had the surgery? Was it later as scar tissue tangled the cord?

As they became aware of their son’s pain, they tried to help but they weren’t sure how, other than with over-the-counter medications, massage therapies and hugs.

Ethan didn’t really know how to help his pain and neither did most adults in his life. When he asked for medication or begged to lie down or go home, his requests were typically met with scoldings for him at school. Most didn’t understand how such a usually active child could truly be suffering.

Over time, Ethan learned to mask his pain.

“A child in chronic pain who is continually misunderstood is going to have emotional struggles such as depression,” Tracy said. “It is not reasonable to expect a child to know how to understand these issues, and my son was no exception. He struggled to process the facts of his life and this caused him to be more and more frustrated.”

Before he entered middle school, Tracy found a book on healing a child’s chronic pain. She continued to research and found that Cook Children’s offered a pain management program. It was there that the family met Artee Gandhi, M.D., medical director of pain management.

“Dr. Gandhi and company were incredibly responsive and devoted to Ethan's needs,” Eric said. “He was enamored with her in particular because she took his interests seriously and treated him as a young man rather than a child. However, Ethan was not always honest with her about the severity of pain he was experiencing. He sometimes believed that the doctors would not believe him or that they would think he was exaggerating his pain level to get medications.”

All through high school and beyond, Ethan studied science online. He taught himself subjects such as organic chemistry, DNA and gene therapy, and pharmacology. He learned how drugs, and different doses, acted and interacted in the body. He thought he understood enough to be safe with whatever he used for pain. He thought he was in control of his pain as he learned to manage it himself. He bought over-the-counter meds and used them off-label. He found ways to obtain prescription pain medication without a prescription.

The pain management team knew Ethan's level of self- education made him a challenge. Dr. Gandhi warned him about self-medicating and the dangers. Unfortunately, like many in their late teens, Ethan believed he was indestructible.

Ethan never stopped coming to clinic, but as time progressed he began to cancel and reschedule appointments more frequently. His parents believe that by mid-2015, Ethan thought surgery was his only chance for relief. The surgeons were able to straighten a significant portion of his lower spine regarding the pain, and as he was tapered off of his pain medication he began to once again self-medicate.

Eventually, drugs, especially opioids, were the only things that made him feel better. It was only slightly better, but that was OK for him, at least for a while. After the realization that his surgery failed to entirely alleviate his pain, Ethan became increasingly afraid of how his pain would continue to impact his life. He was afraid of what others would say, or what they thought of him. He believed no one would understand. He ultimately decided that he would have to treat his pain himself.

According to the Medical Examiner, Ethan died of mixed drug toxicity.

“We are only now looking back and asking ourselves if we could've done much better,” Eric said. “That day, my son was freed from his pain, but our pain would just be beginning.”

About the source

Artee Gandhi, M.D., is a pediatric pain management specialist and anesthesiologist. She has trained across the country including residency at the University of Missouri and fellowship at Stanford Univeristy. Cook Children's Pain Management program cares for infants, children and adolescents with chronic and acute pain. C​ook Children's is one of a few children's hospitals in the U.S. providing a comprehensive pediatric pain management program.

About Pain Management

The Cook Children's Pain Management program uses a team approach in caring for infants, children and adolescents with chronic and acute pain. Cook Children's is one of a few children's hospitals in the United States providing a pediatric pain management program. 

Our team includes a board certified anesthesiologist trained in pain management, a licensed clinical social worker specializing in psychophysiology, a dedicated physical therapist and pain management nurse coordinator.

Because of our team approach, patients will see their physician, physical therapist and psychophysiologist in one visit. 

Patients can make an appointment and physicians may refer a patient by calling our offices at: 682-885-PAIN (7246). New patients, for your convenience, please have your insurance information ready when you call.

Welcome to today’s drug culture of “code names” and “street terms.” You may not know what those words mean, but more than likely your kids do.

Russell Johnson, a sergeant in the Narcotics Unit for the Fort Worth Police Department, says the world of recreational drug use has changed dramatically from even just a few years ago.

The availability and quantity of drugs has changed. It’s not nearly as hard to obtain drugs today because it’s more accepted and isn’t criticized as much by parts of society.

Johnson says if your child is using drugs, there will be an overall change in behavior and friends. Teens might be more lazy than normal and their grades will drop across the board. “This could be an indicator of something else that’s extremely stressful on a teen’s life too, but when you look at all of them, something is not right,” he said.

Rosanne Thurman, director of Pharmacy at Cook Children’s, believes it’s important for parents to make sure that their kids are aware they shouldn’t take any drug that’s not prescribed by their doctor and to make sure they follow the instructions of the prescription.

“It’s so hard for parents to stay informed on what is happening out there as far as illegal drugs. So, I think you have to talk to your kids a lot from a young age,” Thurman said. “Let them know that just because a friend is doing something, that doesn’t mean you should be doing it too. Along with these drugs that aren’t prescribed, we’ve also seen problems with teens and college-aged kids exchanging prescription medication. So let them know that a prescription is only for the person who has been prescribed the medication from a doctor and should be the only person taking the medication. It’s so important to sit down and talk to your children about these issues and to let them know the dangers that are involved.”

In an effort to help you stay informed, here’s a list of 11 unsafe drugs that are either trending or have been popular recently that parents need to know about:

1. “Beezin”- This most recent trend involves teens rubbing Burt’s Bees lip balm onto their eyelids. The balm contains peppermint oil, which creates a tingling sensation that teens claim enhances the feeling of being drunk or high, helps keep them alert after a long night and increases their attention span. However, this can irritate eyes and even cause an eye infection or swelling. Teens think it’s safe to do this because Burt’s Bees is “natural” and won’t cause any harm, but that is far from the truth.

2. “Sizzurp” – This concoction is made by combining soda, candy and prescription cough medicine with codeine in it. This lethal cocktail is highly addictive because of the sweetness and is supposed to provide the user with a euphoric high. But it is extremely dangerous because it can lead to seizures and possibly cause you to stop breathing. Popular culture, including hit songs and Internet videos highlight this drug and refer to it as “purple drank,” “lean” and “syrup."

3. Caffeine powder – This powdered caffeine is used by teens to enhance their workouts and accelerate the process of weight loss. This substance is extremely easy to overdose on – one serving is a sixteenth of a teaspoon and is difficult for people to measure. According to the FDA, a teaspoon is roughly equal to 25 cups of coffee. Teens assume it’s safe to mix this powder into drinks because caffeine is in sodas, energy drinks and coffee. But high levels of caffeine can lead to rapid heartbeat, seizures and even death. You won’t see this in stores, but it’s cheap and easy to buy online.

4. E-cigarettes – This electronic form of cigarettes are battery-operated devices that produce flavored nicotine that look and feel like tobacco smoke. Even though e-cigarettes do not contain tobacco, they still supply nicotine which is a highly addictive drug. But still, e-cigarettes are legal for adults. Some teenagers have used e-cigarettes to smoke marijuana and replace the nicotine with THC. Synthetic marijuana in liquid form can be ordered from the Internet and the user can get a high that is extremely potent because there is no method of dose control.

5. Club drug: MDMA – This stimulant enchants users because of its euphoric and energetic effect. It can come in a crystallized powder form “Molly” and in pill form “ecstasy.” Teens and young adults take this drug at raves, nightclubs and concerts to dance vigorously and heighten the feelings of emotional closeness. However, taking this substance can lead to dehydration, high blood pressure and severe rises in body temperature. It also can result in complications including heart attacks, heart failure, strokes and kidney failure.

6. Club drug: Rohypnol – This substance is commonly known as the “date rape drug.” At parties, people secretly place the drug in drinks. Due to the strong amnesia produced by the drug, victims have limited or no recollection of the night after taking the substance. This is why it is crucial to never take your eyes away from your drink. This drug also is referred to as “roofies” and “forget-me pill.”

7. Synthetic weed – This fake weed is a popular option for teenagers because it doesn’t show up in drug tests like regular weed. But it is incredibly unsafe and toxic because as chemists synthesize the weed, it becomes stronger and up to 80 times more potent than regular weed. There are several detrimental side effects including extreme agitation, anxiety/paranoia, vomiting, hallucinations and even brain damage. "Spice," "K-2" and "Yucatan Fire" are names associated with it.

8. Bath salts – This substance is not what we put in our bathtubs. People inject it, snort it and mix it with food or drink to receive a euphoric high. But it also can make users hallucinate, execute violent behavior and have suicidal thoughts. Watch out for these street terms: “Ivory Wave," "Purple Wave," Vanilla Sky" and "Bliss.”

9. Prescription drug: Xanax – This pill is prescribed to alleviate anxiety and panic disorders. It is extremely addictive and highly abused. Teenagers mistakenly believe that because it’s a prescription drug, it’s safer than street drugs and is free from harmful side effects. The most common street names are “bars” and “Z-bar."

10. “Huffing” – This term refers to purposefully inhaling chemical vapors to get high. Users will inhale several household items including nail polish remover, glue, felt-tip markers, spray paint, hair-care products and deodorant. This practice is not healthy and initially causes drowsiness, lightheadedness and loss of inhibition.

11. Palcohol – this new product is freeze-dried alcohol in powder form. It is packaged in small packets which makes it easy to prepare a to-go drink. But the risk of abuse and misuse is high because the accessibility of the packets could stimulate over-consumption of alcohol and lead to drunk driving. This powdered substance can be snorted as well and cause an immediate high with other harmful side effects.

*Article written by Amanda Burmeister

“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.