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Consent for Treatment of an Adolescent: Drug Testing

March 4, 2019

In most states, adolescent patients have legal capacity to consent to substance abuse treatment. However, in a small minority of states parents have a right to seek substance abuse treatment for their child, even when the child objects. Additionally, treatment information is often legally available to parents, even when the adolescent patient provided the consent for it.1 Consequently, consent for diagnosis and treatment associated with substance abuse should be handled carefully. Consider the following case.

The following case study and the additional two “consent for treatment” cases linked below indicate the different kinds of adolescent consent issues that arise in various practice environments.

Case File

The mother of a 15-year-old patient called a pediatrician and asked him to do a drug test on her daughter during an upcoming annual physical, even if the daughter refused to consent to it. The mother reported that she had observed behavioral changes that indicated her daughter might be drinking alcohol and using drugs, although the daughter denied substance use. The mother planned to have her daughter enter a drug treatment program depending on the results. The pediatrician called the Risk Management department to ask if he could comply with the mother’s request.

Discussion

The answer to this question varies depending on the state in which a practice is located. Assuming the law in this state allowed the pediatrician discretion in deciding whether to test without the minor’s consent, there are many different issues that would play a role in his determination. For example, even when state law allows parents to have a drug test performed on their adolescent child without consent of the adolescent, the American Academy of Pediatrics (AAP) cautions against involuntarily drug testing adolescents except in particular emergency situations.2 Also, in this particular case the parents planned to admit their child to substance abuse treatment based on a positive result to one test. Their plan provided an opportunity for the pediatrician to educate the parents about the limited value of a single test result, which cannot indicate a pattern of abuse, dependence, or impairment and might yield false-positive results.2 Furthermore, a negative result would not rule out substance abuse.3 The pediatrician also had to consider the potential damage that testing without the patient’s consent would have on his therapeutic relationship with the patient. In this case, the pediatrician would have to determine which course represented the best interest of his patient.

Medical Liability Risk Management Recommendations

Consider the following recommendations:2,4

  • Know the minor consent laws about substance abuse diagnosis and treatment in the state in which you practice.
  • Obtain a detailed description of the parents’ concerns prompting the drug test request.
  • Advise parents that a single positive drug test does not indicate substance abuse, and a negative test does not prove its absence.
  • Discuss parental concerns with the patient without the parents present.
  • When appropriate before ordering the test, obtain patient assent and permission to conduct the drug test and to share the results of the test.
  • Consider referring the minor to an addiction or mental health specialist if you suspect substance abuse.

This content from Claims Rx

References

1. Richard C. Boldt. “Adolescent Decision Making: Legal Issues with Respect to Treatment for Substance Misuse and Mental Illness.” J. Health Care L. & Pol’y, 2012 75-115. (accessed 2/1/2019)

2. Sharon Levy, MD, MPH, et al. “Testing for Drugs of Abuse in Children and Adolescents.” Pediatrics, 2014; 133: e1798-e1807. (accessed 2/1/2019)

3. Brunk D. “Is Drug Testing Teens Okay Without Consent?” ACEP News, 2008. (resource not available online at the time of publication)

4. Melissa Weddle, MD, MPH, and Patricia K. Kokotailo, MD, MPH. “Confidentiality and Consent in Adolescent Substance Abuse: An Update.” Virtual Mentor, 2005. 7(3). (accessed 2/1/2019)

Filed under: Patient Privacy, Confidentiality & HIPAA, Case Study, Physician, Pediatrics & Family Practice

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