Steroids: To Test or To Educate?

Jersey’s Test Plans

Even more recently, New Jersey has become the first state to mandate testing of high school students for performance-enhancing drugs in all sports.

In December, Richard J. Codey, acting governor at the time, signed an executive order calling for random testing of students in championship tournaments for 31 sports, beginning with the 2006-07 school year. Roughly 220,000 students in New Jersey participate in high school sports; about 10,000 are involved in post-season tournaments each year. The drug-testing plan, which will be overseen by the state’s interscholastic athletic association and cost an estimated $50,000 in its first year, would test 5 percent of those 10,000, or 500 students.

Across the country, more than 50 school districts have received U.S. Department of Education grants this year to establish and fund random drug testing of students involved in extracurricular activities. That’s up from just eight districts in 2003.

The interest is fueled by fear and statistics:

A Monitoring the Future survey, funded by the National Institute on Drug Abuse, reported in 2004 that 1.9 percent of 8th graders, 2.4 percent of 10th graders and 3.4 percent of 12th graders had admitted using steroids at some time. Codey cited larger numbers when he announced his statewide order: a rise in steroid use from 3 percent in 1995 to 5 percent in 2001.

Those percentages may sound small until one considers the big picture. The total number of high school students in the country exceeds 16 million, according to the U.S. Census Bureau. In California alone, there are almost 1.7 million high school students; more than 700,000 participate in athletics where steroid abuse is deemed most likely to occur. Three percent of 700,000 is 21,000.

Of course, no one’s suggesting 21,000 students in California are abusing steroids. In fact, no one really knows how many students use steroids. Drug testing is one way to find out and, say advocates, do something about it. But given the enormous complexities and sensitivities of the subject, it may be easier to hit a major-league home run than devise an effective, affordable and broadly acceptable school-based drug-testing program.

Secret Society

Simply put, anabolic steroids help the body build more muscle faster and better. They make a steroid user stronger, faster, more athletic. “The products are effective,” said Robert Kanaby, executive director of the National Federation of State High School Associations, before a Congressional panel last year. “Let’s not delude ourselves on that point.”

But there’s a price to be paid. Steroids can cause significant, irreversible side effects, both physically and psychologically. Imbued with a youthful sense of immortality, teens often overlook the danger.

“They’re too focused on what works, what they’re seeing in Hollywood, on TV, in professional sports,” said Fernando Montes, executive director of the Taylor Hooton Foundation, named after a 17-year-old Texas baseball player who committed suicide as a result of steroid abuse. “Kids look at professional athletes, models. They know that at least some of them are using steroids and look where they are. They think steroids might get them to that level too.”

Figuring out who is using steroids is difficult because users tend to be extraordinarily covert.

“Steroid use is a very secret society,” said Jeff Rutstein, a former steroid user and author of Steroid Deceit: A Body Worth Dying For? “People will talk about smoking pot, using heroin or drinking too much. But steroid users generally talk about steroids only with other users, if they talk about it at all. I've had friends who have committed suicide after using steroids, and they [had] never told anybody.”

The handful of national statistics cited most tend to reflect those from the Monitoring the Future surveys, which are worrisome enough. But some experts argue that steroid use in schools is much higher. Charles Yesalis, a professor of health policy and administration and exercise and sport at Pennsylvania State University, has estimated at 7 or 8 percent. Rutstein thinks it might even be higher.

“It’s very under-reported and underhyped,” he said.

Not all steroid users are hard-to-miss, muscle-bound jocks pumping up for football, wrestling or some other sport demanding maximum strength. Cindy Thomas, director of external operations for the National Center for Drug Free Sport, said emerging data indicates more girls are turning to steroids to acquire the lean, muscular supermodel physique they see glamorized throughout society.

“Steroids are becoming their drug of choice,” she said.

Scholastic Battlefronts

In 1995, school districts were given the final green light to conduct random drug tests of student-athletes. That year, the U.S. Supreme Court upheld the practice and, in 2002, ruled in Earls v. Tecumseh that students participating in other extracurricular activities could be drug tested too.

Challenges to drug-testing policies, based on asserted violations of privacy rights and the Fourth Amendment’s prohibition of unreasonable searches, did not sway the court, which voted 5-4 that schools have certain “custodial responsibilities.”

Yet very few school districts – just 4 percent nationally — have subsequently embraced any sort of drug testing program. Even fewer districts include testing for steroids or other performance-enhancing drugs.

“My experience with parents and schools,” said Dean Langdon, superintendent of Lincoln Community High School District 404 in Lincoln, Ill., “is that the idea may sound very attractive until you get to the details. When you start talking about sons and daughters producing urine samples, those messy details can turn off a community."

Langdon said his 960-student district and community have not publicly discussed any kind of drug test (urine vs. hair vs. saliva). In 2002, he said, a local student died from an apparent overdose of ephedra, a now-banned component of many popular dietary supplements. Sixteen-year-old Sean Riggins’ death stunned the community and prompted the school district to launch extensive education programs on the dangers of abused supplements, steroids and other performance-enhancing drugs, but the effort stopped there.

“We didn't take any forward steps with testing,” said Langdon. “People weren't clamoring to take that action. This is a pretty conservative place. Testing for steroids would be on the cutting edge. I think most people here are content to see how the issue plays out, to learn lessons from others. Besides, I haven't heard any talk about steroid abuse in our schools.”

Michael Lindley, superintendent of the New Buffalo, Mich., Area Schools, said much the same thing. In 2002, Lindley and a community group that included school board members, parents, teachers, a pastor, sheriff and social worker attempted to hammer out a school district policy on drug testing. They debated every aspect — the frequency of testing, the kind of test (urine vs. hair vs. saliva), the role of education, appropriate punishment and more. They met week after week for six months.

“Ultimately, we did not develop a program,” said Lindley, who has been superintendent of the 660-student district for 12 years. “The issue absolutely split the community in terms of its advantages and disadvantages. Some people couldn't come to grips with the issues of privacy; others said the district was obligated to do everything possible to protect kids.

“We finally decided we would focus on preventive efforts, educate kids about the dangers and deal with any individual problems as they arose. I don't know if that's sufficient. I wonder if we're doing everything we can. But these days, if the problem isn't obvious, most school districts won't go looking for it. Nobody wants more on their plate.”

A Cost Obstacle

Perhaps the greatest obstacle to drug testing is expense. It’s the reason cited most often by administrators. A basic drug panel for recreational drugs like marijuana, PCP and cocaine costs as little as $15 to $20 per test with steroids many times more.

“Cost always comes into play,” said Kanaby, whose national federation in Indianapolis serves as a governing body for interscholastic athletics and other competitions. “Steroid testing is expensive. I think the cheapest price for a basic steroid test is $50 and it goes up from there. Even at that price, when you multiply the cost of the test by the numbers of students in high school sports, it becomes a major expense.”

For school boards and superintendents, the dilemma is how best to spend limited resources. Is money better spent testing for steroids or in programs aimed at more widespread abuses, such as alcohol or marijuana?

Mike Crilly has pondered that question a lot. He is the 12-year superintendent of the Jefferson Union High School District, a 5,500-student district in Daly City, Calif., south of San Francisco. Beginning with the 2005-06 school year, Jefferson Union implemented a California Interscholastic Federation directive requiring student-athletes and their parents to sign a contract with the district promising not to use steroids without medical approval. The program has worked well and seems, for the moment at least, to be enough, according to Crilly.

“Nobody's pushed for (steroid testing),” Crilly said. “There has been talk at board sessions relative to substance abuse, but never a serious discussion. I think we would have to be facing a more serious situation before that would happen.”

Polk’s Test Case

But some districts do test for drugs, including steroids. What sets them apart? How do their programs work? Are they effective?

The Polk County School District in Bartow, Fla. is one of the largest in the state, with more than 92,000 K-12 students. Testing for recreational drugs began there in 1997 as a pilot project at one high school. Reported drug use dropped 25 percent, prompting the district in 2004 to seek a $240,000 federal grant to expand the testing to all students taking part in extracurricular activities.

When school leaders realized last year they would not expend all of their grant monies, they expanded testing to include steroids after polling parents and the community. There were no objections.

“Testing works here because there's strong, overall support from the school board, the superintendent and the community,” said Audrey Kelly-Fritz, senior manager of prevention, health and wellness. “People ask us why we don't test everybody."

Kelly-Fritz said the district’s goal is to randomly drug test roughly 4,600 students over the course of the school year, about 40 percent of the students participating in district-sanctioned sports. Five percent of those tested also would be examined for steroid use. The steroid test costs $100; the standard drug test is $18. So far, said Kelly-Fritz, all has gone well.

“There's been little negative response,” she said. “Parents are obviously in favor; students learn to live with it. They accept testing as a requirement for playing, just as they accept that they must wear their hair only to a certain length. All part of the rules of play.

“We think testing works. Our surveys show there’s reduced use of marijuana and alcohol,” she adds. “And we haven’t had any positive steroid tests.”

Polk’s grant money runs out with the end of the 2005-06 school year, but Fritz-Kelly hopes alternative funding sources can be found. Chances look good. Polk’s experiment with steroid testing has encouraged Florida state legislators to consider expanding steroid testing to all high schools in the fall of 2006, assuming they can find the money.

A Voluntary Process

Bernard DuBray, superintendent of the Fort Zumwalt School District, likes drug testing of students so much he’s tried it twice.

Fort Zumwalt is a suburban school district outside St. Louis. Its 18,700 students make it the sixth largest in Missouri. From 1997 to 2003, the district successfully operated a testing program for recreational drug use (but not steroids). Testing was dropped in 2003 due to budget constraints.

“We were pleased with the program. It was doing what we wanted. It ended strictly for financial reasons,” said DuBray.

When monies became available again in 2005, DuBray and the school board were quick to resume drug testing, with a steroid component added. “We didn’t think there was a lot of abuse here, but steroids is a problem and it seemed a good thing to send the message that abusing steroids was as unacceptable as abusing street drugs,” he said.

The Fort Zumwalt drug-testing program is voluntary, at least in the sense that if students want to play interscholastic sports, they must accept testing. “That’s the beauty of it,” said DuBray. “If they don’t want to participate in the testing, if they object for whatever reason, they don’t have to participate in sports.”

Roughly 75 percent of Fort Zumwalt’s secondary school students agree to the possibility they may be asked to turn over a urine sample for testing during their season of competition.

Students and their parents are required to attend an educational session on steroids and other performance-enhancing drugs. Each week, athletic directors at the district’s three high schools randomly pull the names of five students. These 15 students submit to a standard drug test administered by a private lab. Three to five of the students are also tested for steroids.

DuBray said the steroid tests have produced only a few positives. “If a kid does test positive, the results are known only by the athletic director, the student and his parents,” said DuBray. “The student is then offered therapy and counseling. They are not immediately kicked off the team.”

Those students are given a second test 30 days later. If the student tests positive again, he or she is removed from the team.

DuBray believes steroid testing works because it provides “another reason for students to say no. They can tell their friends they can’t risk it, that they could be tested at any time. You’d be surprised at how many kids just need that little something extra to resist peer pressure.”

Despite its apparent success and mostly favorable publicity, Fort Zumwalt’s drug testing program has not spawned imitation. “There’s been some interest and inquiries from surrounding school districts,” said DuBray, “but nobody has followed through. I think the price tag has something to do with it.”

The testing program costs Fort Zumwalt about $20,000 annually.

Doubts and Concerns

For some school administrators, there are simply too many unknowns, too many unresolved problems to fully embrace the idea of drug testing.

“It’s not a panacea,” said Joel Dvorak, associate superintendent for curriculum and instruction in the Natrona County School District in Casper, Wyo.

As a doctoral student, Dvorak surveyed drug-testing policies at 89 school districts around the country. He found that testing appeared most effective in reducing drug use among younger high school students. Drug use in the 11th and 12th grades was unchanged by the testing.

“I think by then students have made up their minds,” Dvorak said.

His research raised other considerations about student drug testing.

“It goes against a lot of democratic ideals. It assumes guilt, and what kind of message is that to send to students? We don’t test here, but there are districts in the state that do. They say it works; it’s accepted by the community,” Dvorak said. “I’m not sure where I stand, or whether people around here would accept testing.”

David Lett understands the dilemma. He is the superintendent of the Pana Community School District, a 5,700-student K-12 district in rural Pana, Ill. Lett said his district does not have a serious drug abuse problem, but he’s seen the scary news headlines.

“Steroids and the like are an area of increasing concern for me and a lot of superintendents. We live in a quick-fix, take-a-pill society where kids are exposed to all sorts of nostrums that allegedly will give them an edge. This is an issue that will probably be a bigger concern down the road,” Lett said.

At the moment, however, neither he nor his community are considering drug testing. Like many others, he strongly advocates educating students to the dangers of steroids and other substances. He believes districts should have clear rules about what kinds of assistance and advice coaches and other district personnel can give students seeking to improve their bodies. He worries about the potential dangers and liabilities of students using diet supplements, which are legal but unregulated.

But drug testing? Well, that’s a huge step.

Said Lett: “You have to ask yourself and your community: Are you prepared to take that drastic measure?”

Scott LaFee is a science and health reporter for the San Diego Union-Tribune. E-mail: scott.lafee@uniontrib.com