Truly random drug testing: ADHD patients face uneven urine screens and, sometimes, stigma

Some adults who take prescription medication for attention-deficit/hyperactivity disorder are required to have their urine tested for drugs several times a year. Some are never tested.

These screenings are done to ensure that ADHD patients are taking Adderall safely and not taking too many or selling them.

KHN was told by several doctors that there were varying opinions on the use of urine testing to monitor ADHD-treated adults. Patients have different needs depending on the policies of their health insurance companies and clinics.

Dr. Margaret Chaplin, a Connecticut psychiatrist, said that there is not much literature on ADHD or other mental illnesses.

Chaplin and her colleagues first observed the absence of standards for testing eight years ago. Proposed ways To prevent adult ADHD patients from using stimulants in excess.

Her team recommended that urine tests be performed only for patients who exhibit “red flag behavior,” which is when they appear intoxicated, report lost prescriptions repeatedly, or switch doctors frequently. Doctors and clinics may decide to test patients individually, taking into consideration red flags or patient histories. Some policies are universal and may not be discriminatory. Some Insurance companies And Medicaid programs in the states There are also testing requirements.

ADHD stimulants, opioid pain medication, and other drugs are all classified as controlled substances. They are tightly regulated due to the possibility of addiction or misuse.

ADHD patients who are subject to frequent drug screenings say that the tests can be expensive and time-consuming. Others feel ashamed.

A.C. Shilton was relieved to be diagnosed with ADHD in her thirties. A farmer from rural Tennessee and freelance journalist said that the diagnosis explained why her brain felt disorganized and forgetful. Shilton explained that her medication slows down the motor.

Photo of ADHD medication tablets on a table.
For ADHD stimulant medication to continue, some doctors and insurance companies require that patients be drug tested on a regular basis.(Arielle Zionts / KHN)

Jamestown resident, 38, said that her first doctor had ordered urine tests every year. Shilton stated that her next doctor made her test every visit.

Shilton stated, “You go in to receive the standard of care which is this medicine and you’re kinda treated like a bad person again; that’s some shame.”

She was also upset when she learned that office staffers had misled her about urine testing being required by law. This was something other ADHD patients posted on social media forums as having happened to them.

Shilton stated that few doctors in rural areas treat adults with ADHD. Shilton now drives over an hour to another clinic that doesn’t require her take as many drug test.

Travis Gordon, 47 years old, is from Charlotte, North Carolina. He has been going to the same ADHD clinic since more than 10 year. Gordon stated that he was not drug-tested during the first few years. He was required to submit a urine sample every three years for the next several years. He was not tested during the covid-19 pandemic. He’s now screened every six-months.

Gordon stated, “We shouldn’t feel like street criminals to obtain the drugs we need for our daily success.”

Gordon stated that doctors should order more tests as they become familiar with new patients. He said that he does not understand why such testing should be continued for established patients like him who take their medication as prescribed.

Traci Camper (50) from northeastern Tennessee said that she has never tried to smoke or used illegal drugs. However, her doctor has required her to take urine tests three times a month for the past ten years. Camper acknowledged that the testing can be tedious, but she is able to go along with them because she lives in an area where drug abuse is common.

KHN did not request interviews with the clinics Shilton, Gordon and Camper visited about their testing policies.

ADHD is a condition in which an adult has multiple, severe symptoms that interfere with their work, relationships, and other aspects of their lives. The most common treatment options are medication and therapy, with the majority of stimulants.

ADHD patients have been affected in some way by the opioid crisis response. This has resulted in increased scrutiny of all controlled medications. Some have. Trouble reported Filling prescriptions is difficult because drug distribution companies restrict sales to specific pharmacies. If the federal government places restrictions on certain pharmacies, some patients, particularly rural, may face difficulties. Reverts to pre-pandemic guidelines To receive controlled drugs via Telehealth, you must make at least one appointment in person.

Chaplin stated that doctors treating ADHD might feel the need for extra scrutiny when testing drugs, either because they are more concerned about misuse or because it is a higher risk.

In 2021, an estimated 3.7 million Americans aged 12 and older used prescription stimulants. 1.5 million also had a prescription stimulant use disorder. According to the National Survey on Drug Use and Health. The agency found that Americans are more likely than others to abuse or become addicted to prescription opioids and sedatives.

ADHD adults are more likely According to the Substance Abuse and Mental Health Services Administration, people with a substance abuse disorder are more likely to be in the same situation as those who don’t have the condition.

While there aren’t any formal standards, many have been established. Organizations that provide health care And Professionals I have offered recommendations to detect and prevent adult ADHD stimulant misuse. Suggestions include requiring patients to sign prescription-agreement contracts and regularly checking databases This will show the list of controlled medications that each patient has purchased.

Chaplin stated that there is little research on the effectiveness of any method to prevent medication misuse.

Recent survey Random urine drug screenings are required by 42% of college and family doctors who treat adults with ADHD.

Gordon, Camper and ADHD patients who spoke on social media said that their drug screens came at predetermined intervals instead of randomly.

Dr. Sidarth Wakhlu is a psychiatrist at the University of Texas Southwestern Medical Center, Dallas. He specializes in treating substance abuse disorders. He recommends drug testing ADHD patients at least once a year. He said that a drug test every three months for someone with no history of addiction or red flags is excessive.

Drug testing costs are as variable as their frequency.

Johns Hopkins University’s Dr. Michael Fingerhood uses urine tests that can cost as low as $60 without insurance. Fingerhood reviews each case and makes testing decisions for patients who use controlled substances to treat ADHD, pain or opioid addiction.

Photo of the $545 urine test bill. width=
ADHD patients have very different requirements for drug testing. These tests can also be expensive. A.C. Shilton, a journalist, claims she changed doctors after being charged $545 for a single urine screen.(A.C. Shilton)

Gordon used to pay $110 each for his tests, even though he had insurance that his doctor refused to accept. Shilton was charged $545 by her insurance for a test. Shilton claimed she complained to a nurse, who suggested that she use a cheaper test in the future.

Shilton replied that she didn’t think so. “Why are we doing such fancy drug testing?”

Wakhlu stated that the more expensive urine tests can be used to identify certain types and amounts of drugs. These tests are often used to identify drugs. Confirm the results According to the Centers for Disease Control and Prevention, these tests are less expensive than those performed initially.

Wakhlu stated that if a patient’s test results indicate they might be using stimulants in a dangerous manner, doctors should have a conversation with the patient to talk about it and offer any necessary help. Wakhlu also stressed safety and said that excessive ADHD medication, or mixing it with stimulants such as methamphetamines, can lead to death.

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