Academic journal article Hong Kong Journal of Psychiatry

Position Statement of the Hong Kong College of Psychiatrists on School-Based Drug Tests in Hong Kong: A Review of Its Effectiveness and Our Recommendations

Academic journal article Hong Kong Journal of Psychiatry

Position Statement of the Hong Kong College of Psychiatrists on School-Based Drug Tests in Hong Kong: A Review of Its Effectiveness and Our Recommendations

Article excerpt

Introduction

In response to the significant increase in the number of young people (aged under 21 years) abusing psychotropic substances over 3 consecutive years, a Task Force for Youth Drug Abuse was formed in October 2007. Their report was released in November 2008. Among the recommendations, the assertion that " ... the Administration should undertake a more in-depth study (on school-based drug tests) ... tailored to the local school setting, identify success factors, suggest a promotion scheme for voluntary adoption by local schools, and address the various issues of concern ..." (1) has caught most public attention.

It was initially planned that the study be implemented in the 2009-2010 school year, with preliminary results and recommendations expected in the following school year. However, repeated instances of secondary school students being sent to the accident and emergency departments for management of intoxication with psychoactive substances while in schools or on public beaches sparked demands for early implementation of school-based drug testing in mid-2009. As a result, the secondary schools in Tai Po District were chosen to implement the Hong Kong SAR school-based drug-testing programme in late 2009.

The decision to implement drug testing at schools has precipitated heated discussion in the community. Issues related to confidentiality, consent, and the availability of resources for intervention to students with positive test results have been raised. There is a dearth of data on the effectiveness of school-based drug testing as a means of combating psychoactive substance abuse and its potential harm. To address public concern, the Clinical Division on Substance Misuse and Addiction Psychiatry of the Hong Kong College of Psychiatrists embarked on a literature review of the current evidence on the effectiveness of school-based drug testing.

Overseas Experience

In the United States, government agencies and private employers have adopted drug-testing programmes since 1981. Their reasons for having drug-testing programmes were largely: (1) pre-employment checks; (2) drug detection for specific reasons, i.e. when there is reasonable suspicion of alcohol and drug use following an accident or bizarre behaviour; and (3) routine or random drug screening in the workplace for occupational health, safety concerns and productivity issues.

The recent rise in illicit substance abuse among young people has led to a demand for drug screening in schools. The aims are to: (1) deter students from using illicit substances; (2) allow detection of young substance abusers to enable earlier multidisciplinary interventions that could lead to better outcomes.

Following the 1995 US Supreme Court ruling (Vernonia School District v. Acton [515 US 646]) that random drug testing of high school athletes is constitutional and the 2002 US Supreme Court ruling that public schools have the authority to perform random drug tests on all middle and high school students participating in extracurricular activities (Board of Education v Earls [536 US 822, 122 S Ct 2559, 153 L Ed 2 days 735 {2002}]), the President's Office of National Drug Control Policy published a guidebook designed to encourage schools to incorporate drug-testing policies for all students.

Many reports evaluating the effectiveness of these programmes for school-aged children have subsequently been published. Most rely on anecdotal evidence and journalistic comment with a lack of an evidence-based approach.

Effectiveness of Drug Testing for Deterring Drug Use

The majority of studies adopted a cross-sectional approach to determine the point prevalence of drug use as their outcome indicator after the implementation of drug-testing programmes. (2-6) In the Hunterdon study, (7) a change in the self-reported frequency of drug use before and after the implementation of drug-testing programmes was demonstrated, but the effect of other confounding factors (e. …

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