Periodic Survey of Fellows

45% of Fellows routinely screen for alcohol use

Six out of 10 pediatricians report having diagnosed or treated adolescent patients ages 12 through 17 for substance abuse, according to a 1995 AAP Periodic Survey of Fellows. Among this group of pediatricians, nearly three-fourths have identified adolescent patients who are abusing tobacco and/or alcohol (72 percent and 70 percent, respectively). Sixty-three percent have diagnosed or treated adolescents for marijuana use, and 53 percent reported adolescents' use of other illegal drugs.

When asked about their methods of screening or diagnosing substance abuse, less than one-half of pediatricians (45 percent) report they always ask their adoles- cent patients about alcohol or drug use, while 50 percent ask some adolescents about substance use. Sixty percent of pediatricians make inquiries of parents, siblings, school personnel or others when screening some adolescents for substance abuse; 10 percent do so with all adolescents. Most pediatricians (84 percent) do not use written questionnaires that inquire about adolescent patients' substance use; 10 percent use questionnaires with some, and 5 percent do so with all of their adolescent patients.

Sixty percent of pediatricians who see adolescents use urine drug tests when screening some patients for substance abuse; 39 percent do not use such tests. Nearly 3 out of 10 pediatricians perform or order blood alcohol or breath tests when screening some patients for substance abuse; most pediatricians (73 percent) do not use these tests.

During the survey year, about one-half of pediatricians who treat adolescents (51 percent) said they had an average of 3.8 parental requests to order a urine or blood drug test without the adolescent's knowledge. Among pediatricians saying that a parent asked them to order a drug test for their son or daughter without the adolescent's knowledge, 20 percent acted on the request during the past year. This figure represents 11 percent of all respondents who see adolescents. Among pediatricians not asked by a parent to test their adolescent for substance abuse, 3 percent ordered a urine or blood drug test without the adolescent's knowledge.

Pediatricians were asked to respond to a hypothetical case scenario in which a parent asked the pediatrician to perform a urine drug test without telling the adolescent patient. Nearly half (47 percent) said they would give the urine test if the adolescent consented (See chart page 12.).

When asked by an adolescent's parent to order a urine drug test without the child's knowledge, almost all pediatricians (94 percent) said the most important factor in their decision is the effect such an action would have on the trust between themselves and their patient. Eighty-five percent of pediatricians agree that the morality of testing adolescents without their knowledge must be considered. Other important factors in this decision are: early diagnosis of chemical abuse in adolescents (87 percent); a drop in the patient's grades (86 percent); and the patient's report of having friends who use alcohol/drugs (83 percent).

Two-thirds of pediatricians think the parent and patient's report of communication problems and the legality of testing adolescents without their informed consent are important factors. More than half of pediatricians (57 percent) thought the age of the patient and the pediatricians' expertise (or lack of expertise) in identifying alcohol/drug problems in adolescents are also important factors.

Most pediatricians (91 percent) believe early discovery and treatment of adolescent chemical abuse/ dependence improves the long-term prognosis. Fewer than half of pediatricians (42 percent), however, think urine drug testing is the most accurate method of screening for chemical use in an adolescent, and 30 percent are unsure. An even smaller number (29 percent) think random urine drug testing is an accurate indicator of chemical abuse/dependence in an adolescent and 27 percent are unsure.

The vast majority of pediatricians (82 percent) believe urine drug testing without the adolescent's consent is a violation of privacy; 11 percent are unsure. Three-fourths (77 percent) say it is unethical to do a urine drug screen on an adolescent who is not aware that the purpose of the test is for drug screening; 12 percent are unsure; and 12 percent disagree.

Pediatricians are evenly divided in their opinion on whether parents should be informed of their adolescent's urine drug test results only if the adolescent authorizes release of the information - 40 percent agree and 39 percent disagree. Nearly all pediatricians (93 percent), however, agree parents should be informed of their adolescent's drug test results when there is a likelihood of possible serious outcome.

AAP Periodic Survey 31 was conducted between July and November 1995. Surveys were mailed to a random sample of 1,636 active U.S. members. In total, 1,099 questionnaires were completed for a 67 percent response rate. The drug screening questions were addressed to the 940 respondents who provide direct patient care to adolescents 12 years of age and older.

Pediatricians were asked to respond to a series of questions based on the following hypothetical case scenario: A 15-year-old male who hasn't been seen by his pediatrician in two years is brought in for physical examination. His mother asks that a drug test be performed without telling the adolescent. His grades have slipped and there are communication problems at home. Privately, he candidly admits to having problems with school and family. He says many of his friends use drugs and alcohol and he has experimented with drugs but says he does not now use them. He makes good eye contact with you, and he does not seem evasive in his replies. The physical exam is normal.

Is a urine drug test clinically indicated for this patient?

Yes No Uncertain

33.0% 46.7% 20.3%

How would you proceed under the circumstances as presented?

Ask for the patient�s consent and order the urine test only if the patient gave consent Inform the patient that the urine drug test will be done before ordering it Would not order the test, but would refer the patient for counseling Defer the testing until more diagnostic test are done Would order a urine test without telling the patient, as the mother had requested

47% 20% 14% 8% 5%