Frequency of testing

Staff and monetary resources can be wasted if tests are conducted more often than necessary. However, testing should occur with sufficient frequency to ensure there is a reasonable opportunity to detect youth who are using illicit drugs. Policies should establish minimum frequencies for testing (e.g., once per week, three times per month). These should be flexible enough that personnel could test any youth if circumstances so dictated. For example, a youth whose behavior seems erratic might be tested before the next random test time occurs.

Because different drugs of abuse stay in the body for varying lengths of time, ranging from a few hours to several days (see table on following page), it is helpful to know the youth's drug(s) of choice to decide how often he or she should be tested. Many programs test youth initially and periodically during their time in the program for a broad range of illicit drugs, but most of the time they test only for those substances the youth has been known to use. Another factor to consider is the youth's progress in the program. Initially, testing may be performed much more often, with testing frequency being reduced for youth whose results are consistently negative. A response to the youth should always be made following testing, whether the results are positive or negative. A realistic appraisal of staff tasks also is important. Thus, caseloads and other responsibilities of staff must be considered when deciding how often to test.

Some agencies conduct testing at set times, while others advise youth that they are subject to testing at any time. Scheduling tests can help staff members organize their tasks and time efficiently. However, when juveniles know they will be tested at certain times, they may learn to schedule their substance abuse accordingly to avoid detection. Therefore, random testing is generally recommended.

Observed specimen collection

To avoid the possibility of specimens being adulterated or otherwise tampered with, urination should be observed by a staff member who is the same sex as the youth. There are two ways youth may attempt to taint a urine sample: by ingesting something before giving the sample or by adding something to the specimen after it leaves the body. Examples of substances youth might try to ingest before a drug test include large quantities of water, acidic liquids (such as lime or lemon juice or vinegar), diuretics, pectin, and oriental tea. Water, bleach, toilet bowl cleaner, and soap are examples of substances youth might try to add to a specimen during or after urination. Most of these substances will not affect the accuracy of most drug tests unless the amount of drug remaining in the youth's system is already very close to the cutoff level. Test manufacturers also have taken steps to design tests that detect adulterants or ensure specimens are brought to the proper pH level before they are analyzed. Another ploy some youth might use if not supervised is to substitute a specimen they have taken earlier or one from another individual. A substitution should be easily detectable by the temperature of the sample; some collection cups now have temperature strips to ensure the sample is consistent with body temperature. Youth also might make a sample useless by punching a hole in the collection cup. Because of all these possibilities, it is recommended that collection of specimens be observed to rule out any potential for adulteration, switching of samples, or tampering with collection cups.

Chain of custody

There must be a record of the whereabouts and persons handling the urine specimen and test results at all times. This includes documentation of the specimen collection; handling, storage, transportation, and testing; and dissemination of results. All drug-testing specimens, supplies, and equipment should be kept in a locked storage area.

Onsite testing or contracting for services

There are both instruments and field kits that can be used by agency personnel to conduct initial immunoassay tests. If used according to manufacturer's directions, these provide accurate qualitative results. However, it is also possible to contract with a laboratory to analyze the specimens collected from youth. Volume of testing, staff time, training level for processing tests, the time required to obtain results, and the availability of laboratories will be factors to consider in selecting either onsite or laboratory services. Some programs use a combination of onsite and laboratory testing. For example, they may conduct initial tests onsite and, if necessary, send positive tests to a laboratory for confirmation. Using commercial laboratories, health departments, and forensics laboratories might be explored.

Safety measures

One aspect of safety includes procedures for handling and testing urine specimens. There are no known cases of transmission of HIV through laboratory contact with urine. However, it is wise for personnel to take standard precautions when handling urine to protect themselves from any potential disease transmission. Safety procedures should include wearing rubber gloves, lab coats, and goggles.

Safety measures also should be employed to protect the specimens. Therefore, rules should include no smoking, eating, or drinking in the area where specimens are stored or handled. No food should be in the same refrigerator with specimens.

Safety concerns also should be related to the youth in the program. Staff should be trained to identify the possible withdrawal symptoms or side effects of chemical use that might endanger a youth's health and safety. Some substances may lead to erratic behavior that could endanger the youth or others. Staff should know how to intervene appropriately if these are noticed. If youth have injected drugs, it may be important for them to receive counseling and testing for HIV/AIDS and other blood-borne infections.

Finally, safety also refers to the development of guidelines for staff and youth when revealing positive results to juveniles. When working with potentially violent youth, staff should be trained to use designated procedures in case of an emergency.

Quality assurance and quality control

Steps should be taken by agency personnel or laboratories to document the accuracy and reliability of the testing program regularly. Without such measures, the program may be subject to legal liability issues.

Report of results

Onsite noninstrument tests will yield virtually instant results. However, onsite instrument and laboratory testing procedures will take longer. For youth, timely responses to their behavior are important. The type of agency and the way results will be used also will affect how soon results may be needed. For detention programs, results may be needed before the youth goes to court. Thus, the ACA/IBH project recommends "[s]pecimen collection should take place during the intake process, and testing should occur before the pre-hearing or within 48 hours of detention" (American Correctional Association/Institute for Behavior and Health, 1995, p. 4). Initial information also is needed for case planning. The American Probation and Parole Association Guidelines state the turnaround time for receiving a report of results "should be 72 hours or less from the time the specimen reaches the laboratory until the results are received by agency personnel" (APPA, 1992, p. 49).

Confirmation

A positive result may be confirmed in three ways: a statement of admission by the youth, a second test using the same methodology, or a second test using a different methodology. For legal proceedings, especially if a youth's freedom may be limited, a second test using a different methodology may be necessary. Confirmation by GC/MS is required in some jurisdictions because it is the most accurate test. If results are going to be used for treatment planning or for internal program procedures, the other methods of confirmation may be acceptable.

Responding to results

Unless a response follows every test administered, youth may receive an unintended message that drug testing is simply procedural and does not have much impact. Chemical testing, assessments, and drug recognition techniques are tools available to juvenile justice agencies and practitioners to identify and monitor substance abuse among youth. The most critical element of any program is how the results are used to intervene with the youth.