Dr. Oelhaf: Your teen's drug test was positive -- now what do you do?

Staff Writer
Columbus Parent

Dr. Robert Oelhaf is back with Columbus Parent to continue our conversation about teens and drugs. This is part one of two parts. Read part two in July on ColumbusParent.com.

Columbus Parent: Dr. Oelhaf, last time we went over how to get your teen to agree to home drug testing. So now that we did the test, if nothing shows up, everybody's happy. But what if we find the test shows something?

Dr. Robert Oelhaf: This is a delicate and challenging interaction with your teen, no doubt about it. I think it's important to lay out the groundwork ahead of time, to decrease the teen's anxiety about the test. Then, I think it's important to follow through with the promises you made to your teen to get them to do the test in the first place.

CP: What if your teen won't do the drug test unless you promise that "nothing will happen" if there's a positive result?

RO: Well I don't think this is really a realistic request on the part of the teen. The teen needs to know that you understand a couple of things. First of all, you are trying to discover illegal behavior. Illegal activities are supposed to have consequences. If you are suspected by government agents or agencies of covering up a teen's illegal behaviors, and this is discovered to be a purposeful cover-up, that's conspiracy. And that is generally also a crime. It is not fair for this teen to expect their parent to become law-breakers and be at risk for jail time just because they found out their teen was doing drugs. This is an impossible promise, and it just can't be made by the parent.

CP: Okay, so there has to be a consequence. Do you have some advice for what the consequence of a positive drug screen should be?

RO: I think one of the simplest and most basic contracts would be to lock the teen into a schedule of mandatory drug tests, perhaps once a month for a year. Subsequent tests have to be comprehensively negative to avoid any further imposed rules. I think some version of this has to be part of any testing contract. Then the parent can impose additional chores around the house.

CP: What if all future tests are negative for the rest of the year? Would you have the parent back off on the chores?

RO: Drug rehabilitation usually follows a pattern of levels of privilege for good behavior, and negative drug screen in this setting certainly counts as good behavior. The production of a negative drug screen has become the teen's job for the home at this point. Other than that it seems like a question of parenting style as far as how intense to be for how long.

CP: I've heard there are ways to cheat on a drug screen test.

RO: The internet is full of resources to help someone cheat a drug test. The most popular is fake urine. It is usually dried then reconstituted with water. Another way is to buy someone else's urine and submit it as your own. But the drug screen test manufacturers know this and there is usually a temperature measuring bar on the side of the urine cup. The dipstick testing does not have the benefit of that, but the concerned parent has a lot of possible drug screen devices to choose from and can usually find one with a temperature measuring device built in. If for some reason it's a metric scale, remember that 37 C is normal body temperature. I would not expect natural urine that was just produced by the teen to be much different than normal body temperature. If it's off, then check the teen's temperature and compare it to the sample. It can be a little bit cooler, but certainly not much warmer or much cooler than the teen themselves.

CP: What do you say if your teen gets confrontational about the accuracy of the test?

RO: The tests are quite accurate but not 100 percent. Retest them in a week to a month and insist that whatever was in there is gone, unless the teen's doctor can confirm that the teen is taking something that would cross-react. One example would be methylphenidate (Ritalin) which would show up as amphetamines. The doctor can order a drug screen through the hospital lab and have it sent on to a reference lab for confirmatory testing if necessary.

CP: Can I buy these tests at my corner pharmacy?

RO: These days just about every pharmacy has some sort of retail home urine drug test for sale.

CP: Do these drug tests miss anything?

RO: Unfortunately the answer is yes they do miss things. For example, in my practice codeine, hydrocodone (Vicodin) and morphine appear on the general opiate (heroin) line. However, oxycodone (Oxycontin, Percocet), propoxyphene (Darvocet), methadone and buprenorphine (Suboxone) all have their own individual test lines. So the lesson is that if you test for opiates in general on a single test strip you may miss a number of possibilities.

You have to inspect the test to know what it is checking for. In general, it seems that the more you spend the more drugs the test looks for. A small number would be around 5 different drugs and a really good over the counter test should look for up to 15 to 20 different compounds. If a test says that it tests for 15 drugs and only has 5 strips, that means there are multiple drugs tested for on different lines on the same strip in the test. As far as I know this does not interfere with test accuracy.

CP: Are there drug tests that you can recommend?

RO: There are so many tests available now commercially and they are so similar in accuracy to the ones I use myself in my practice that it wouldn't be fair to recommend one brand over another. I can say however that if money is not an issue, a parent can get a very sophisticated test kit online. If you want to spend money, you can test for just about any abused chemical you can think of. A reputable vendor should have a customer service representative to talk to you about what drug you are looking for. Just remember that you generally need a specific strip for each chemical you want to test for.

CP: Okay, so we test again and everything is negative. We get a plan of action, and future tests are negative, and our kid goes on and has a productive life. But what if the second test is also positive?

RO: Well, I think you have a serious problem on your hands. Either you have a child that is a lot more stupid than you hoped, or you have an addicted child. If my experience is any indication, children are usually smarter than we expected. So the child probably has an addiction that needs treatment. It's very tempting to deny reality, but I think that this is the time to get the child to a specialist.

CP: Does the child have to go to the ER for this?

RO: That is a difficult question to answer. Certainly this can be a very emotional conversation, and if suicidal-type statements come forth then I don't think you can mess around. That is a clear indication that the child needs to come to the hospital and you need to call 911 if necessary to get that done. If the professionals at the hospital cannot settle the issue enough for outpatient stability from a psychiatric standpoint than an inpatient psychiatric assessment may be necessary. Is the child being manipulative by making suicidal statements? It's certainly a possibility but assuming that can be dangerous. Sometimes an inpatient assessment is the only way to get certainty of stability.

CP: So can I call the pediatrician about this?

RO: If the child has confirmed to you to your satisfaction that they won't go off and do something crazy to hurt themselves, I think it's time for a call or a visit to the pediatrician. The reason to involve the child's pediatrician is to review what local resources are available to you and to coordinate future care. Because this will now be a lifetime battle for you and your child against a chemical and a desire to consume it.

Join us next month to continue our conversation with Dr. Oelhaf.