Juvenile Urine Drug Testing: the Importance of Observed Collections

The importance of witnessed collections (for urine drug testing) cannot be over-emphasized. Urine collections that are not witnessed are of little or no abstinence assessment value because of the propensity of juvenile substance abusers not to provide a legitimate sample (denial, efforts to hide relapse/use).
The definition of “witnessed collections” is direct, full-frontal, line-of-sight observation -- basically, staring at a participant‘s genitals while he or she produces a urine sample.
Difficult? Yes! Uncomfortable? No doubt! Necessary? Absolutely critical!

If programs don’t directly observe urine collections, they should not waste their time and money on drug testing efforts. It‘s that important. The success of abstinence monitoring depends on a legitimate urine specimen for testing. The most likely guarantee that a valid specimen will be produced is provided when collections are directly observed.
All of that said, we need to appreciate the unique collection challenges that juveniles pose. Many come from family backgrounds where sexual abuse and/or physical violence have shaped the behavior that has led to their involvement in the justice system. As a result, juvenile programs should:
 

• recognize previous sexual/physical abuse and develop collection strategies that incorporate “compassionate” practices, but understand that direct observation is a necessity, regardless of age;
• review state laws regarding juveniles for guidance, and to avoid legal conflicts;
• for participants who are not “wards of the court”, obtain both parental and juvenile consent;
• for participants that are “wards of the court”, no consent may be required for collection policies; however, juvenile programs should obtain consent anyway, as a tool for educating the juvenile of the program requirements;
• practice only same-gender observed collections;
• utilize two “observers” when necessary, to ensure collector safety and to avoid sexual accusation claims from manipulative juveniles.

Alternatives to direct observation (such as mirrors, cameras) are not as effective and pose their own unique risks.
 
There are two issues that drive participants to attempt to 'beat the test."  First, if you accept that substance abuse is a disease, then you have to acknowledge that denial is a huge component. Combating denial represents a cornerstone of nearly all drug treatment modalities. Those who abuse drugs will allow the entire fabric of their lives to disintegrate, rather than confront their addiction. A positive drug test provides the “proof” of substance use and creates an environment in which denial can be confronted. In order to avoid that confrontation and extend denial, juveniles often use whatever measures are necessary (except abstinence) to elude detection.
 
Second, the ramifications of a positive drug test result are significant: sanctions, imprisonment, program expulsion, etc. This fact, in and of itself, creates a powerful stimulus for juvenile clients to attempt to avoid detection by tampering with the sample. In order to evade the inevitable sanctions that will accompany a positive drug test, participants will use every opportunity to thwart the court’s drug surveillance efforts.
 
Given that sanctions are critical to positive therapeutic outcomes, tampered samples that fail to provide accurate data about relapse seriously compromise the recovery process. Not to mention that the failure to identify drug use within the family milieu can result in devastating consequences for the family. 
 
One final comment: direct observation of urine collections for drug testing also has a therapeutic component. The goal of substance abuse treatment is to limit a juvenile‘s options associated with drug use to one: abstinence. Once participants understand that they cannot beat the system by tampering with samples, they are much more likely to engage in the therapeutic process toward recovery.
 
[See also, "Why You Should Avoid using UA Levels in Drug Court Proceedings," which draws on and links to more of Mr. Cary's work. -Ed.]
 

Paul L. Cary, M.S., is director of the Toxicology and Drug Monitoring Laboratory at University of Missouri Health Care in Columbia Missouri.  For the past thirty years, Mr. Cary has been actively involved in the management of a nationally-recognized toxicology laboratory (SAMHSA certified) that performs drug testing for drug courts, hospitals, mental health facilities, attorneys, coroners and medical examiners, athletic programs, and public and private employers. He has authored numerous scientific publications and monographs, has served on a variety of clinical and technical advisory committees, teaches at the university, is involved in drug testing research, and serves as a consultant in toxicology-related matters. Mr. Cary has been a resource to drug court teams throughout the nation and overseas and serves as visiting faculty for the National Association of Drug Court Professionals, the Center for Court Innovation, the National Council of Juvenile and Family Court Judges and the National Drug Court Institute.
Photo: watz.