Random drug testing (RSDT) in schools is a controversial topic. The U.S. Supreme Court has ruled that RSDT is constitutional for certain groups of students. Moreover, funding has been made available for schools to implement RSDT programs through the U.S. Department of Education and the White House Office of National Drug Control Policy. This review provides a comprehensive review of the literature, as well as a summary of recent RSDT events in U.S. public schools. Empirical data that examine RSDT's effectiveness for reducing student drug use is also reported. The implementation of statewide RSDT programs is on the rise, as well as continued support, funding and advocacy through various government channels. Little empirical research examining the effectiveness of RSDT to reduce student drug use has been completed although the largest evaluation of RSDT programs to date is presently underway. RSDT in schools is a polarizing topic, and has been politicized. It is important for school health educators to understand this issue because they play an important role in student drug use prevention and should be involved in discussions of RSDT implementation.