Elizabeth Wise Testimony to the Cle Elum School Board

Dear School Board Members, Mr. Keyser, and Ms. Nelson,

I am writing again in regard to the plan for random drug testing. First, I want to apologize for not having been aware of the committee working on drafting the policy many months ago, as I would have liked to have been able to offer this input earlier in the process, when you would have had more time to digest it. I also do feel hampered that I must submit this without knowing what modifications are in progress for the policy you will in fact consider at the May School Board meeting.

I am well aware that the intent in drafting this policy, the goal, is to help students by identifying drug users and then assisting them into treatment and by deterring drug and alcohol use. These are good goals. But the reading I have been doing suggests the policy may in fact result in the opposite outcome - increased problem drug or alcohol use. If you will pardon my tendency to use medical analogies, I will mention that a core motto in medicine is “Primum, non nocere - first, do no harm.” The history of my profession is full of examples of treatments that seemed to make sense, until finally well-designed outcome studies were done that in fact showed that they didn’t provide benefit, or even caused harm. Physicians also are accustomed to weighing cost vs. benefit tradeoffs - so that at times there are treatments that indeed “work”, but at an unacceptable price either in dollars terms, in increasing other health risks, or in adverse side effects, so we don’t adopt these treatments. It’s not always the right action to do something just for the sake of doing something.

I would like to call your attention to some of the outcomes research on drug testing in schools that I was able to review. The articles are long, so I will not copy them for each of you but will leave a copy with Evelyn Nelson. Ryoko Yamaguchi, et al, in “Relationship between student illicit drug use and school drug-testing policies,” in Journal of School Health, April 2003, compared self-reported drug use in schools with and without drug testing and found that “among the eighth-, 10th-, and 12th-grade students surveyed in this study, school drug testing was not associated with either the prevalence or the frequency of student marijuana use, or of other illicit drug use. Nor was drug testing of athletes associated with lower-than-average marijuana and other illicit drug use by high school male athletes.” They conclude, “Research has shown that the strongest predictor of student drug use is students’ attitudes toward drug use and perceptions of peer use. To prevent harmful student behaviors such as drug use, school policies that address these key values, attitudes, and perceptions may prove more important in drug prevention than drug testing.”

The second Yamaguchi, et al, article, “Drug Testing in Schools: Policies, Practices and Association with Student Drug Use”, provides a good review of the relevant literature, and adds analysis of data from an additional 209 schools, again finding no effect of testing on decreasing drug use. In fact, although there was a non-statistically significant trend toward lower marijuana use in schools with testing than without, (32.2% vs. 34.1% after controlling for other student variables predicting use) there was a trend the opposite direction for other illicit drugs, with more use in schools with testing than without (22.8% vs. 16.6%). While these differences may in fact be random, they also may represent a real effect of students deliberately switching from marijuana to “hard” drugs because of less chance of detection due to their shorter half-life, not an outcome we would be seeking, I think.

The third paper I wanted to share with you, “Compensating Behavior and the Drug Testing of High School Athletes,” Robert Taylor, Cato Journal, 16:3, 1997, argues that it is likely that suspicion less drug testing of athletes will in fact “lead to the perverse outcome of increased student drug usage.” This is based on the concept that committed athletes tend not to use drugs, anyway, but that increasing the “cost” of participation by requiring drug testing will deter a population of less committed students from going out for sports, shifting them out of the “positive peer pressure” milieu to a more drug-using social environment.

So this reading has not convinced me that there is any expected benefit of suspicionless testing to counterweigh the very real costs. These costs include, perhaps, paradoxically increased drug use or shift to more dangerous drugs; the direct financial implementation costs; the invasion of privacy in the “unreasonable search” involved in obtaining the specimen, in the requirement “to complete a food and medicine form” (it’s not the school’s business what medications a student is on, unless this privacy is waived because of requesting meds to be administered at school), and certainly in the fact that any positive results cannot in practice remain confidential; the consequences to the student and family in the case of a false-positive result; the decay in trust. In addition, the legal grounds for this testing are uncertain. While it is true that the United States Supreme Court permitted testing in Vernonia and in Earls, Pennsylvania’s Supreme Court struck down random suspicionless testing there on the basis of its state constitution, and we have not yet had a ruling in Washington State.

What I heard at the April School Board meeting is that Mr. Keyser offered an alternative that would better serve the goals at hand. He has expressed the frustration that the present system, building in a delay between evidence or suspicion of use and actual testing, allows students truly in trouble and in need of help to game the system and test negative. If the saliva test kits were adopted so that testing could be done in-house promptly, including prior consent for testing for cause, our school could target its resources where they would do the most good, without all the disadvantages that come with suspicionless testing. This alternative still allows the message to be heard that the school is concerned about illicit drug and alcohol use and is taking action to identify and help students in need, while not putting up a barrier to the effective deterrent of cocurricular participation. I ask you to take this alternative instead of the proposed policy.

Sincerely,

Elizabeth Wise, MD