Have you ever wondered if your child has tried drugs? Should you test them to find out? Dr. Oelhaf has answers.

We welcome Dr. Robert Oelhaf for another chat about addiction, children and teens.

Dr. Oelhaf, we've spent a lot of time talking about alcohol and tobacco, but I understand that unfortunately these are not the only substances our children have access to.

Dr. Robert Oelhaf: Yes, very sad but very true. In high schools in my area, alcohol and marijuana seem to be the mind-altering drugs of choice, with a lot of tobacco consumption as well. However, heroin and narcotic prescription pills are both smaller and cheaper per dose. So there has been an explosion in adolescent use.

CP: Last time we spoke you asked for questions from staff here at Columbus Parent Magazine and the most asked question was how do I know if my child takes drugs? What can you offer parents?

RO: A great question. I wish I had a good answer. We've all read the advice articles, about the teen with grade problems, who is socially or emotionally withdrawn, defiant, has sleep problems, is hyper-emotional, hangs out with the wrong kids or violates curfew, as some examples. Certainly, there are teens that are exemplary and don't do any of these things.

But let's for example take a normal teen and subject them to a change of neighborhood, a change of school, a new knowledge of divorce proceedings in their parents, the death of a sibling, chronic severe medical or mental illness in a sibling, etc. All of these are examples of potentially severe and relatively common teen stressors.

And what is the psychological expression of a teen stress response? How does a stressed teen behave? They often have poor grades, social or emotional withdrawal, excess internet usage, poor sleep patterns, oppositional defiance, emotional outbursts, bad choices of friends, annoying clothing choices, the list goes on. So the environmentally stressed teen has symptoms very similar to those ascribed to a teen taking drugs!

CP: Are we to assume our teen takes drugs even if they don't? That doesn't seem like a relationship-building assumption. It seems like the teen would assume the adult didn't know what they were talking about.

RO: I'm trying to be both realistic here and yet not completely hopeless. I think it is fair to assume that at least one of your teen's friends takes drugs. It's also fair to assume that an average responsible parent of a teen is anxious at some level about teen drug use. I personally assume, rightly or wrongly, that every adolescent has at least thought about doing drugs, and many I must concede have not tried drugs.

CP: How can a parent decide whether or not to test a child or teen for drugs?

RO: I think all children should be considered candidates for random drug testing by their parents. It already appears that as parents we have a very hard time deciding which children with behavior problems take drugs and which do not.

CP: What about a child who seems to have no behavior problems at all?

RO: Well that's certainly up to the parent. I suppose I tend to be more paranoid than most parents, possibly because of my work environment.

CP: Are you going to test your children for drugs?

RO: Yes.

CP: How are you going to make that happen?

RO: I don't think you should try to get a urine sample by stealth. I think the teen needs to know they are being tested.

CP: What if your teen objects to testing? They could say, "Come on, Dad, what did I do to make you not trust me?"

RO: I think the proper response is, "What are you afraid of?" This really boxes them in. Either they are afraid of a positive result, or they do not fear the test and will go ahead and do it.

CP: What if they are afraid of the fallout from a false positive test?

RO: I think it's fair to discuss that ahead of time. The first thing to say is the tests you can buy at the pharmacy, which tests about 5 to 15 drugs and costs between $20 to $40, are very accurate. Not perfect, but really close. If you absolutely have to know if your kid did a drug or not, well then a doctor can send a sample with a prescription to a lab and request confirmatory testing by NMR [nuclear magnetic resonance] and/or some version of chromatography to get the exact chemical in the sample. But I actually don't think you have to take it that far.

Let's be realistic, I think there are a lot of good kids out there that may have had a slight lapse with friends and will never sample whatever it was again. We also know that there are some drugs, such as marijuana, that persist in the urine for up to 2 months or more. So I recommend sitting down with them and say the following:

1. They will do urine drug testing for you, or be under suspicion of something until it is done.

2. The drug test is not necessarily going to happen right now, unless they really want to get it over with (buy the test ahead of time).

3. Suggest the drug test happen in 4 months, and mark it on the calendar.

4. Suggest that if something appears you are willing to do what it takes to confirm or reject what the test found by confirmatory testing.

5. Remind them the test is coming up, then do the test on the appointed day. What this will do is allow them to read up on whatever they may have secretly sampled, and come to you to clear their name whenever they want to get this over with.

My feeling is a teen who really has nothing to hide might find it a bit strange but not all that threatening. On the other hand, a teen that repeatedly blocks the action plan and gives one excuse after another may be trying to hide something.

CP: Can over-the-counter medications make a drug test falsely positive?

RO: I have to concede that the possibility is there that this could happen. Again, if the teen will abstain from all over the counter medications for perhaps a couple of weeks ahead of time there should be no problem.

CP: How about prescription medications?

RO: Not likely but not impossible. Reemphasize with the teen that if confirmation is necessary you will do that to clear their name. Now this is not cheap. A more affordable method would be to just run the test again.

CP: What if your teen will not submit to testing? Can this be done by force?

RO: Even though the teen is a minor and the parent may know that drug behavior is a big health risk, in my state the age of consent is 12. I do not think one can justify the severe bend of the law regarding civil rights of minors to get a sample by force. The alcohol laws regarding losing a license to drive don't really apply either in my opinion. The teen is simply under suspicion of drug use until proven clean.

CP: What if the teen gets their urine clean only for the test, then goes back to use?

RO: Well, then at least you know they could get clean when they had to! Some can't even do that, and those kids are the ones who really have problems. Those are the ones that we have to find quickly and get into treatment before things get any worse.

CP: You aren't saying a lot of drug use is bad but a little is okay, are you?

RO: I think the point is that we can't know everything about our kids, and we probably wouldn't want to know most of that stuff even if we could. However, as parents we do need to confirm that our kids are not teetering into a chasm of medico-legal danger. I think we all need to know our children and teens are able to keep themselves safe, including in a legal sense and know how to not fail a job interview drug screen. As they say in the legal profession, you can't un-ring the bell. Make sure your child will make all of their job drug tests negative so nobody looks back in anguish at the successful life they didn't have. If it came up, I would suggest that questions from the teen on how to cheat on a drug screen would be a marker of problematic behavior.

Dr. Oelhaf is board certified in emergency medicine and addiction medicine, and practices in the Pittsburgh area. He can be reached at doctoroelhaf@yahoo.com.