When Should I drug Test My Teenager? AAP New Recommendations Reviewed

car_keysAs one of the few board-certified pediatricians in the country who is also board certified in addiction medicine, and father of 10 children (many who have and are struggling with addictions or substance abuse) I feel especially qualified to share some thoughts on the topic of drug testing your child or teenager. 


Key Points of the new Academy of Pediatrics (AAP) Recommendations:

1.   Do not test against your child’s will unless they have one of the following:

            – Just in a serious accident.

            – Suicide attempt.

            – Unexplained seizure.

            – Failure in school (that is unusual).

            – Unusual and excessive moodiness (careful here- some normal teen hormone fluctuations are common).

            – To monitor success of treatment for substance abuse.

            – Adult/parent suspects drug use (careful with this one- I explain more below).


 2.   Home testing is not endorsed (I think done properly it has a place).


 3.   Decide who gets the results, what the action will be for negative or positive results BEFORE you do the test.

 4.   False positives and false negatives are possible, so do NOT rely on just the drug test to prove or rule out drug use.


The two most common drugs used by a growing number of teenagers and young adults are marijuana and alcohol. Without any intention of this blog addressing the debate on legalization of marijuana, I think we can all agree that driving impaired can occur with either drug.  As a parent, death or disability from a motor vehicle accident (MVA) is a huge concern.  You need to think of the car keys as the bullet and the car as the gun.  Would you give an impaired person the bullets when they have access to a gun?  I feel that any teenager or person you are supporting financially in any way should not be given a car or keys to a car if they are using drugs or alcohol and then getting behind the wheel. You might choose, as I have done (reasons below), not to give access to the car if there is any use of drugs or alcohol.  This is the situation where home testing might make sense. 

You need to understand that young adults and teens today know how to produce a clean urine test.  They can borrow a friends or purchase “clean urine” (so the urine needs to be body temperature, and you need to observe them producing the sample), and they can doctor the sample (a drop of bleach will spoil any home test).  The AAP in their new report takes a position against observed collections.  I wholeheartedly disagree. If you really think you have a problem and the person knows they will be tested, they will take the steps to give you a “clean” urine despite their drug or alcohol use. 

The best way to do a home urine drug test is to use the element of surprise. I have done this several times after being fooled by one of my own drug-using children. You wait until you have been home together for a few hours during which they have not gone to the bathroom (so they should be able to void) then call them into your room and let them know they need to give you a sample.  Once you have told them that, they cannot leave your sight until you watch them void. This works best if you have pre-arranged with them that you will be doing random drug tests so they have agreed to do that.  They will usually only agree if there is a consequence to them if they refuse.  The two consequences that have worked best for our family are:

   1. You loose your driving privileges if you cannot prove you are drug and alcohol free.

   2. For adult children- You cannot live in our home if your are drinking or drugging. 


Now this sounds harsh, but the consequences of allowing your young adult to drink or drug and drive, while you pay some of their bills, are that you are an accomplice. How else could they afford to buy alcohol and drugs?  You are also killing them by prolonging their drug or alcohol use.  The longer a person is abusing alcohol or drugs, and the earlier they start, the harder it is for them to stop.  I have also had situations where a particular child would likely die if kicked out at that moment (severe depression and suicidal), so clearly that would not be the right move for such a child.  

The best use of drug testing, is when you have had the discussion ahead of time about what benefits and privileges can be earned back or maintained by making the choice not to drink or drug.  This is a way for your child to prove to you that they can be trusted with the car, for example.  Now parents, don’t get fooled or sucked in by the “you don’t trust me” line.  Respond that your doctor has advised that this is what needs to happen; it has nothing to do with trust.  A drug using teen would make that comment, one who is not would welcome the opportunity to show you that the parent has nothing to worry about. 

If your child or young adult is suicidal, please get professional help. Treating addiction saves lives. Parents, the most important thing may also be the example you provide at home.  You won’t be able to guide your teen or young adult on these maters if you yourself are drinking and driving, or a frequent user of drugs or alcohol. If there is any element of “do as I say and not as I do” you have no voice in this mater.  Teenagers in particular are very attuned in to hypocrisy.

It is now possible to purchase online a breathalyzer for alcohol (search on Amazon), and urine drug tests work quite well for opiates and THC, with more expanded kits available.  Do your best to keep discussions anger free, supportive, and loving, but stand firm when boundaries are needed. 

You can read the AAP article here… 



Dr. Paul





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