February 5, 2016
By: Lowry Heussler
The "opiate epidemic" seems to have caused the public and our elected officials to come around on the matter of addictive illness; fewer of them favor jail over treatment, and you don't hear as many people arguing that addiction is a choice, not a disease. It's encouraging, but we aren't acting like we believe our own rhetoric, even as the word "epidemic" appears in nearly every news story on the topic.
To control an epidemic, you have to identify the affected population and commence treatment while working to stop new cases. So why aren't urine screens for opiates a routine part of health care? I think the answer is that we've allowed the notion of drug testing to become co-opted by supporters of so-called “law-and-order” policies. Drug tests often connote risk; they’re used as qualifiers for jobs and punishments by courts. The very concept of drug testing is enmeshed in privacy because we assume that someone other than our doctor will learn the results and take a punitive action. If we're serious about eliminating the stigma and treating addictive illness as a medical condition, then we have to put drug testing back where it belongs, as a tool for the medical profession to identify people who have a disease or are at risk for it.
Malpractice litigation will soon cause opiate screening to become standard for primary care medicine in adults, but I think we should add opiate testing to the functions of school nurses. Public schools are used by public health efforts to detect various conditions, not all of them contagious. In addition to TB tests and head lice inspections, during the 1970s, adolescent girls were checked for scoliosis. Recently the attention has turned to obesity, and nurses are monitoring weight and blood sugar. No one has argued that calculating a child's BMI, blood pressure, and blood sugar levels is an invasion of privacy or an unreasonable governmental interference. Schools are a good place to find teenagers, so why not use them for screening?
Addictive illness is not contagious, but we're not wrong to use the term "epidemic" in regard to opiate addiction, because it does spread. We know that teenagers, especially in certain areas, are taking oral opiates in record quantities, and they usually get them from a friend or someone they meet at school. They are secretive about it; there's no odor or immediate physical symptom that might alert a parent to abuse. By the time the parents learn the truth, their child may be addicted. In many cases, discovery of opiate abuse in young people only happens after a terrible event, such as a car accident, an arrest, or an overdose. A urine-screening program, administered by school nurses, with results sent to the parents and pediatricians, would do nothing more than allow for early detection, which is critical in harm reduction.
I realize that my solution will be unpopular, but here it is: high schools, especially in certain high-risk areas, should conduct school-wide urine screenings on a quarterly schedule, reporting results only to parents and pediatricians. Current perceptions of screenings will, of course, cause resistance. I asked a random selection of parents how they'd feel if their teenager was tested for drugs at school, and they were unanimously opposed. Then I asked if they would want to know if their child was dabbling in pills. Again, the response was unanimous. They would all want to know. So there is a sense of urgency that we take the tool of drug screening out of the regressive "just say no" camp and drag it back into health care, where it belongs.