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Step 7: Develop Written Policies and Procedures 9
Policies help to formulate a course of action that determines the way specific decisions are made. There are several key issues that must be addressed by substance-testing policies and procedures.
Scheduled and Random Testing
Some agencies may schedule testing of youth at specific points in the system's process:
- At intake to detention.
- Following any furlough from a residential placement.
- At intake to probation.
However, for ongoing substance testing, random specimen collection is recommended. Random or unscheduled testing reduces the possibility that youth will attempt to schedule their drug use to avoid detection.
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Frequency of Testing
Youth should be tested randomly and frequently enough to detect and deter illicit drug use. Agency resources and a youth's drug(s) of choice will influence how often testing occurs. Some drugs typically remain in the system longer than others. Table 7 indicates the approximate duration of detectability of selected drugs. As the table shows, a youth using marijuana might be tested less frequently than one who is using amphetamines.
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Table 7: Approximate Duration of Detectability of Selected Drugs
in Urine |
Drug
Amphetamine
Methamphetamine
Barbiturates
Short acting
Intermediate acting
Long acting
Benzodiazepines
Cocaine metabolites
Methadone
Codeine/Morphine
Propoxyphene/Norpropoxyphene
Cannabinoids (marijuana)
Single use
Moderate use (4 times weekly)
Heavy use (daily)
Chronic heavy use
Phencyclidine (PCP)
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Duration of Detectability*
48 hours
48 hours
24 hours
48-72 hours
7 days or more
3 days (therapeutic dose)
2-3 days
3 days (approximate)
48 hours
6-48 hours
3 days
4 days
10 days
21-27 days
8 days (approximate)
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| * These are general guidelines only. Interpretation of the duration of detectability must take into account many variables, such as drug metabolism and half-life; the youth's physical condition, fluid balance, and state of hydration; route of administration; and frequency of ingestion.
Source: Council on Scientific Affairs. 1987. Scientific issues in drug testing. Journal of the American Medical Association 257(22):3112.
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Specimen Collection
If the person collecting specimens does not personally know each youth being tested, a process for identification of youth should be implemented to ensure the sample is from the appropriate individual. Urine collection should be observed by juvenile justice personnel to avoid the possibility of youth switching or adulterating specimens. The collection facility should have both a sink and toilet and should afford privacy for the youth and staff involved in the collection process from other youth, staff, or the public. Youth should be instructed to wash their hands and then void into the collection cup within the view of the attending staff member, who should be of the same gender as the youth. The youth also should seal the cup and verify on the attached paperwork that the specimen is theirs.
Youth may consume enough liquid to dilute the sample sufficiently to influence test results. Therefore, if enough of the drug has already been excreted so the level is at or near the cutoff, dilution could be effective in rendering the test negative. Similarly, youth could add something to the voided specimen that would dilute or change its chemical composition so the test will be inaccurate. The amount of liquid a youth drinks affects the concentration of creatinine, a substance eliminated from the body in urine. Many current drug-testing technologies can measure creatinine and detect youth's attempts to dilute specimens by drinking fluids. Similarly, some tests check for specific gravity by measuring the concentration of solid particles in urine to ensure youth have not diluted or adulterated a specimen (Elbert, 1997).
Additional precautions may be taken to prevent youth from switching or adulterating samples:
- Have youth take off jackets, empty pockets, and leave purses outside the collection area.
- Place a blueing agent in the toilet to avoid substitution of toilet water for the specimen.
- Use pH paper to measure the pH level or a temperature strip to record the temperature of the specimen. (The temperature should be measured within 4 minutes of urination.)
- Keep soap and other chemicals outside the collection area.
- Allow only one observer and one juvenile to be in the collection area at a time, and prohibit youthful offenders from participating in the collection of another youth's sample or having access to testing equipment, supplies, storage
facilities, or documentation.
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Chain of Custody
All possible steps should be taken to ensure the integrity of youth's drug test results. Chain of custody means procedures are used to document that the specimen collected is that of the intended youth and the specimen, testing procedures, and results of the tests are handled properly throughout the process. In addition to the specimen collection procedures already discussed, the following elements of chain-of-custody procedures are needed:
- Handling. There should be a record of the whereabouts and names of persons handling the urine specimen and test results at all times.
- Storage. Urine specimens should be refrigerated immediately after they are collected or, if tested immediately, right after they are tested. After testing, negative specimens may be discarded, but positive samples should be frozen until all relevant court proceedings are completed.
- Transportation. Packaging and transportation procedures should include secure sealing and identification and should safeguard against tampering or the possibility of misidentification of specimens.
- Testing. Agency staff or laboratory personnel testing specimens must properly document all steps taken to analyze the specimen.
- Results. Forms and logs should be completed to document the instrumentation used, drugs tested for, test results, and cutoff level of each test.
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Confirmation Tests
If an initial test is positive, it may be necessary to perform a confirmation test, especially if serious sanctions will be applied or if the results will be used in court. It may not be necessary to perform confirmation tests if results are being used solely for case management and treatment purposes. Both costs of testing and legal issues are considerations when determining whether to perform confirmation tests. Three types of confirmation are possible:
- Admission statement. A youth signs a statement acknowledging drug use.
- Second test using the same methodology. A specimen is tested a second time with the same test method. This is not recommended if sanctions for a positive test will result in loss of liberty.
- Second test using a different methodology. The second test methodology used must have an accuracy rate that is at least as high as the initial screening instrument, and the cutoff level must be the same or lower. High performance liquid chromatography (HPLC) and GC may be used for confirmation tests. However, GC/MS is the most specific and most sensitive method of urinalysis.
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Cutoff Levels
The cutoff level is the amount of drug or metabolite that must remain in the specimen for a test to show a positive result. Thus, a positive test means a youth has an amount of the substance in his or her system that exceeds the cutoff level. Negative results indicate the youth either has none of the drug in his or her system or its concentration is below the cutoff level. The Division of Workplace Programs, Center for Substance Abuse Prevention, recommends the cutoff levels in table 8 for initial and confirmation tests for cannabinoids, cocaine, opiates, amphetamines, and methamphetamines. Cutoff levels for benzodiazepines, barbiturates, and methadone are consistent with recommendations by the scientific community.
If the results of drug tests are challenged, cutoff levels that are consistent with those recommended by the U.S. Department of Health and Human Services guidelines (SAMHSA, 1998a) are more likely to be accepted by courts.
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Table 8: Recommended Cutoff Levels |
Drug
Cannabinoids*
Cocaine*
Opiates*
Amphetamine/Methamphetamine*
PCP*
Benzodiazepines**
Barbiturates**
Methadone**
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Initial Tests
50 ng/ml
300 ng/ml
2,000 ng/ml
1,000 ng/ml
25 ng/ml
300 ng/ml
300 ng/ml
300 ng/ml
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Confirmation Tests
15 ng/ml
150 ng/ml
2,000 ng/ml
500 ng/ml
25 ng/ml
250 ng/ml
250 ng/ml
250 ng/ml
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| * U.S. Department of Health and Human Services Mandatory Guidelines for Testing Levels.
** Cutoff levels for these drugs are not included in the HHS guidelines because they may be legally prescribed. The cutoff levels cited are those recommended by the scientific community.
Sources: Substance Abuse and Mental Health Services Administration (1998), Mandatory Guidelines for Federal Workplace Drug Testing Programs, Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; American Probation and Parole Association (1992), Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies, Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
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Health and Safety
According to the Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor (Clark, 1993), employers must make a determination about jobs that involve an occupational risk of exposure to bloodborne pathogens such as HIV and hepatitis. Bloodborne pathogens are most likely to be transmitted from an infected to a noninfected person through blood-to-blood or sexual contact. When there is a risk of exposure to blood or semen, vaginal secretions, and other body fluids containing visible blood, universal precautions should be used to minimize the risk; however, "universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine and vomitus unless they contain visible blood" [emphasis added] (Update, 1988). Several problems may cause blood in the urine, but the most common are kidney and urinary tract diseases. For girls, menstrual blood also may become mixed with urine. Any urine containing visible blood should be discarded, and if the cause could be anything other than menstruation, the youth should be referred for medical care. However, if no visible blood is present in the urine sample, the risk of infection from bloodborne pathogens, even if one comes in direct contact with urine, is considered negligible. No cases of HIV transmission through laboratory contact with urine have been reported.
For general health and sanitation, however, personnel should take standard precautions to protect themselves from possible contact with urine. Because accidental spills and splashes can be hazardous, it should be standard procedure for staff to wear rubber gloves, lab coats, and goggles, as procedures require, when conducting urine testing.
Specimens also should be protected. Smoking, eating, or drinking should be prohibited in the area where specimens are stored or handled. No food should be stored in the same refrigerator with specimens.
Because of the strong association between injection drug use and HIV transmission, youth who have injected drugs may need guidance and assistance in being tested for HIV. Health and safety procedures also should be developed for working with youth. Personnel should be able to identify possible withdrawal symptoms or side effects of substance abuse that might endanger a youth's health and safety. Erratic behavior that could endanger the youth or others may be provoked by some substances. Some youth may also become upset when positive results are revealed. There should be a crisis intervention protocol so staff know how to intervene appropriately in emergencies.
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Interventions
Besides the policies and procedures needed for the actual testing process, guidelines should be in place for interventions, including appropriate responses to both positive and negative test results.
Rewards and Sanctions
The general purpose and approach to responding to youth should be incorporated in policy documents, including the requirement that youth receive an appropriate response for every drug test result. Listing suggested graduated sanctions can be helpful in assisting staff working with youth to select appropriate responses, but these should allow enough flexibility to make them suitable to the particular circumstances of individual youth.
If testing is voluntary, it is not appropriate to punish or otherwise intervene with youth who refuse to give a specimen. In a voluntary testing program, youth probably would refuse rather than attempt to adulterate or dilute a specimen. However, where testing is mandatory, some youth may attempt to refuse or to provide an adulterated or diluted sample, and policies should be designed for responding to these situations. For youth who are required to submit to drug testing because of probation or paroling authority orders or program rules, a refusal to provide a specimen (either by failure to report for collection or by being unable to provide a specimen) may be considered a violation of program rules or probation and paroling authority conditions. However, if a youth is unable to provide a specimen at the appointed collection time, he or she should be given a reasonable amount of time (and liquids) to allow for specimen production.
If it is evident that a youth has switched samples or diluted or adulterated the specimen, policies should be in place for responding to the situation. Sometimes such attempts are addressed as if results would have been positive if the person's own urine or an uncontaminated or undiluted specimen had been available.
Referrals for Substance Abuse Assessment and Treatment
Policy documents should include procedures to be used when youth require referral to other service providers for substance abuse assessment and treatment. Interagency agreements should be developed between juvenile justice agencies and substance abuse treatment providers that spell out these processes, the requirements of practitioners in each agency, and any special concerns of the youth and family/caregivers.
Support of and Cooperation With the Treatment Process
The policies and procedures document should describe interagency agreements between juvenile justice agencies and treatment providers. Policies should underscore the expectation that juvenile justice staff and treatment providers will work in concert toward the treatment and best interests of the youth. In addition, procedures should stipulate that youth be informed about the treatment process. Some programs develop a written agreement for youth to sign regarding their role in, responsibilities toward, and understanding of the treatment process. Important information to incorporate in discussions or written agreements with youth include the following (Aukerman and McGarry, 1994):
- A description of the treatment program.
- Types of misconduct and their consequences.
- Information that will be shared between the treatment and juvenile justice agencies.
- Criteria for successful completion of treatment.
- Results that can and cannot be achieved through treatment.
- Demands of treatment and recovery.
- Description of the typical recovery process and information about relapse.
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9. This section highlights some of the important areas to consider in developing policies and procedures for substance testing. For more details on these and other policy issues, consult Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies, published by the U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention (APPA, 1992). Suggested forms to use with a substance abuse testing program may be found in Drug Identification and Testing in the Juvenile Justice System (Crowe, 1998) and Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies (APPA, 1992). References used to develop this section include American Probation and Parole Association (1992), Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies, Washington, DC: U S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention; and Crowe, A.H., and Schaefer, P.J. (1992), Identifying and Intervening with Drug-Involved Youth, Lexington, KY: American Probation and Parole Association.
| Ten Steps for Implementing a Program of Controlled Substance Testing of Juveniles | JAIBG Bulletin
May 2000 |
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