Some adults who take prescription medication for attention-deficit/hyperactivity disorder are required to have their urine tested for drugs several times a year. Others never are tested.
Such screenings are designed to check if ADHD patients are safely taking their pills, such as Adderall, and not selling them, taking too many, or using other drugs.
Several doctors told KHN there are varying opinions and no national standards on the role of urine testing to monitor adults who take ADHD medication. So patients face dramatically different requirements, depending on their clinics' and health insurers' policies.
"There really isn't much literature to guide you on how to do this," said Dr. Margaret Chaplin, a Connecticut psychiatrist who treats patients with ADHD, mental illnesses, or substance use disorders.
Chaplin first noticed the lack of testing standards about eight years ago, when she and colleagues proposed ways to prevent stimulant misuse in adult ADHD patients.
Her team recommended urine tests only if patients exhibit "red-flag behavior," such as appearing intoxicated, repeatedly reporting lost prescriptions, or frequently switching doctors. Some doctors and clinics make testing decisions on a patient-by-patient basis taking into account those red flags or patient history. Others apply universal policies, which may be aimed at preventing discrimination. Some insurance companies and state Medicaid systems also have testing requirements.
ADHD stimulants, opioid pain medications, and some other drugs are classified as controlled substances, which are tightly regulated because they can be addictive or misused.
ADHD patients subjected to frequent drug screens say the tests can be time-consuming and expensive. Some feel stigmatized.
A.C. Shilton felt relieved when she was diagnosed with ADHD in her mid-30s. The farmer and freelance journalist from rural Tennessee said the diagnosis explained why she felt so disorganized and forgetful, and as if her brain were a motor running all day. Shilton said her medication slows that motor down.
The 38-year-old Jamestown resident said her first doctor ordered urine tests once a year. That doctor eventually closed his practice, and Shilton said her next physician made her take a test at nearly every visit.
"You go in to get the standard of care, which is this medicine, and you're kind of treated like you're a bad person again; there's some shame associated with that," Shilton said.
She was also upset after learning office staffers were incorrect when they told her that urine testing was required by law — something that other ADHD patients posting on social media forums said had happened to them too.
Shilton said few doctors treat adult ADHD patients in her rural community. She now drives more than an hour to a different clinic, which doesn't require her to take as many drug tests.
Travis Gordon, 47, of Charlotte, North Carolina, has gone to the same ADHD clinic for more than 10 years. Gordon said he wasn't drug-tested in the first few years. Then, for several years, he had to give a urine sample every three months. During much of the covid-19 pandemic, he wasn't tested. Now, he's screened every six months.
"We shouldn’t have to feel like street criminals to get drugs that are needed for our daily success," Gordon said.
Gordon said it would make sense for doctors to order tests more frequently as they get to know new patients. But he said he doesn't understand why such testing should continue for people like him, established patients who properly take their medication.
Traci Camper, 50, of northeastern Tennessee, said she has "never even tried a cigarette," much less used illicit drugs, but her doctor has required urine tests every three months for more than 10 years. Camper said the process can be inconvenient but she's ultimately OK with the tests, especially since she lives in an area with high rates of drug abuse.
The clinics that Shilton, Gordon, and Camper went to did not respond to KHN's requests for interviews about their testing policies.
Adults are diagnosed with ADHD if they have multiple, frequent symptoms so severe they interfere with work, relationships, or other aspects of life. Treatments include therapy and medication, most often stimulants.
ADHD patients have been affected by the response to the opioid crisis, which has led to more scrutiny for all controlled medications. Some have reported trouble filling their prescriptions as drug distribution companies limit sales to certain pharmacies. Some patients, especially rural ones, could face obstacles if the federal government reverts to pre-pandemic rules that require at least one in-person appointment to receive controlled drugs via telehealth. Forensics And Toxicology eBook Compilation of the top interviews, articles, and news in the last year. Download a free copy
Chaplin said doctors who treat ADHD may feel the need to be extra vigilant with drug testing because of this increased scrutiny, or due to the risk of misuse.
An estimated 3.7 million Americans 12 or older misused prescription stimulants in 2021, and 1.5 million had a prescription stimulant use disorder, according to the National Survey on Drug Use and Health. Americans are more likely to misuse or be addicted to prescription opioids, sedatives, and tranquilizers, the agency said.
Adults with ADHD are more likely to have a substance use disorder than those without the condition, according to the Substance Abuse and Mental Health Services Administration.
Although there aren't formal standards, several health care organizations and professionals have made recommendations to prevent and detect adult ADHD stimulant misuse. Suggestions include requiring patients to sign prescription-agreement contracts and regularly checking databases that show all controlled medications each patient is buying.
Chaplin said there's little research into how effective any method is at preventing medication misuse.
A recent survey found that 42% of family physicians and 21% of college health professionals who treat adult ADHD require their patients to submit random urine drug screens.
Gordon, Camper, and some ADHD patients on social media forums said their drug screens have come at predictable intervals, instead of random ones.
Dr. Sidarth Wakhlu, a psychiatrist who specializes in treating substance use disorders at the University of Texas Southwestern Medical Center in Dallas, said some of his patients also have ADHD. He suggests drug-testing most ADHD patients once or twice a year. For "someone who has no addiction history, has no red flags, every three months is an overkill," he said.
The cost of drug testing is as variable as the frequency.
For example, Dr. Michael Fingerhood at Johns Hopkins University uses urine tests that cost as little as $60 before insurance. Fingerhood makes testing decisions case by case for patients who take controlled substances to treat ADHD, pain, or opioid addiction.
Gordon used to pay $110 for each of his tests when he had insurance his doctor did not accept. Shilton's insurance was billed $545 for a test. Shilton said she complained to a nurse who said, in the future, she could use a less expensive test.
Shilton said she replied, "Well, why aren't we doing that to begin with? Why are we doing this extremely fancy drug testing?"
Wakhlu said the more expensive urine tests can identify specific types and quantities of drugs. Such tests are usually used to confirm the results of initial, less pricey tests, according to the Centers for Disease Control and Prevention.
Wakhlu said that when test results show a patient might be misusing stimulants, doctors should initiate a non-accusatory conversation to discuss the results and, if needed, offer help. He also said it's important to emphasize safety, such as how taking too much ADHD medication or combining it with other stimulants, such as methamphetamine, can be dangerous.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
It is raising new concerns in the global players’ union about whether the stars of the sport are being protected in hot and humid conditions.
FIFPRO has asked FIFA to allow cooling breaks every 15 minutes rather than just in the 30th minute of each half.
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There’s also a request for half-time to be extended from 15 to 20 minutes to help lower the core temperature of players.
FIFPRO’s medical director, Dr Vincent Gouttebarge, said: “There are some very challenging weather conditions that we anticipated a couple of weeks ago already, that was already communicated to FIFA.
“And I think the past few weeks were confirmation of all worries that the heat conditions will play a negative role for the performance and the health of the players.”
Football has seemed focused on players and fans baking in the Middle East – but scorching summers in Europe and the US are becoming increasingly problematic for sport.
Image: England are the tournament’s defending champions. Pic: AP
While climate change is a factor, the issue is not new and at the 1994 World Cup, players were steaming as temperatures rose in the US.
There is now more awareness of the need for mitigation measures among players and their international union.
FIFPRO feels football officials weren’t responsive when it asked for kick-off times to be moved from the fierce afternoon heat in the US for the first 32-team Club World Cup.
FIFA has to balance the needs of fans and broadcasters with welfare, with no desire to load all the matches in the same evening time slots.
Electric storms have also seen six games stopped, including a two-hour pause during a Chelsea game at the weekend.
This is the dress rehearsal for the World Cup next summer, which is mostly in the US.
Image: Players are also feeling the heat at the Club World Cup. Pic: AP
The use of more indoor, air conditioned stadiums should help.
There is no prospect of moving the World Cup to winter, as Qatar had to do in 2022.
And looking further ahead to this time in 2030, there will be World Cup matches in Spain, Portugal and Morocco. The temperatures this week have been hitting 40C (104F) in some host cities.
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FIFA said in a statement to Sky News: “Heat conditions are a serious topic that affect football globally.
“At the FCWC some significant and progressive measures are being taken to protect the players from the heat. For instance, cooling breaks were implemented in 31 out of 54 matches so far.
“Discussions on how to deal with heat conditions need to take place collectively and FIFA stands ready to facilitate this dialogue, including through the Task Force on Player Welfare, and to receive constructive input from all stakeholders on how to further enhance heat management.
“In all of this, the protection of players must be at the centre.”
England are looking to defend their title at the 2025 Women’s Euros.
But conquering this year’s competition will be tricky right from the group stages.
The Lionesses will come up against Wales, who made history by qualifying for their first major tournament, and two other European heavyweights: France and the Netherlands.
Here is everything you need to know about Euro 2025.
Where is Euro 2025 being held?
This year’sWomen’s Euros is being held in Switzerland.
The competition kicks off on Wednesday 2 July, with the final on Sunday 27 July.
Matches will be held in eight venues across Switzerland from Zurich to Geneva, with the final game being played in Basel.
What teams have qualified?
A total of 16 teams have qualified for the competition.
Eight teams progressed directly from the qualifying league stage and seven teams qualified via the play-offs.
As hosts, Switzerland qualified automatically.
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The teams playing in the tournament are:
• England • Belgium • Denmark • Finland • France • Germany • Iceland • Italy • Netherlands • Norway • Poland • Portugal • Sweden • Spain • Switzerland • Wales
How much do the winners get?
This year, the total available prize money for the tournament stands at €41m (£34m) – more than doubling from the prize pot in 2022.
All competing sides receive a €1.8m (£1.5m) participation fee, with the remaining money going to the quarter-finalists, semi-finalists, runners-up and winners.
The maximum prize money achievable for the tournament winners, if they also win their three group stage matches, is €5.1m (£4.3m).
Image: England celebrate their victory at Women’s Euro 2022. Pic: Reuters
Who has (and hasn’t) made the England squad?
Some notable names will be missing from the England squad this year.
Goalkeeper Mary Earps announced in May that she is retiring from international football with immediate effect.
Within days, two other names, Fran Kirby and Millie Bright, also announced they would not be taking part in Euro 2025.
The departure of Bright, Earps and Kirby is a loss of three experienced players – between them they have 218 international appearances.
So who has manager Sarina Wiegman picked for the 23-person squad, and who has been snubbed?
Use our slider below to look through some of the key players, or see a list of the full England squad, here.
History-making Wales squad announced
The Welsh women’s national football team has qualified for an international tournament for the first time.
Their 23-player squad was announced by head coach Rhian Wilkinson at the summit of Yr Wyddfa (Snowdon) on Thursday morning.
Image: Rhian Wilkinson following the squad announcement at the summit of Yr Wyddfa. Pic: PA
Midfielder Angharad James captains the side, and is one of four players to have played over 100 times alongside fellow Wales veterans Jess Fishlock, Hayley Ladd and Sophie Ingle, who also made the cut.
Ingle hasn’t featured for club or country since suffering an ACL injury during a pre-season friendly for Chelsea last September.
The 33-year-old returned to full training at the beginning of the month and her inclusion comes as a significant boost ahead of Wales’ first major tournament.
Fishlock, Wales’ record appearance holder and goalscorer, will hope to add to her 47 international goals as she leads the line.
The side beat the Republic of Ireland 2-1 in a play-off match to secure their spot in the Euros.
Image: Wales have qualified for an international tournament for the first time. Pic: Reuters
Wales head coach Rhian Wilkinson said after the match: “This team found a way. They never broke for each other, they stayed strong. I’ve never been prouder of a team.
“This team stands on the shoulders of giants [the pioneering female footballers] who came before, and now they’ve proven how good they are.”
Similarly to the World Cup, teams in the Euros are split into four groups.
The top two teams in each group will progress to the knockout stage, where games will be decided by extra-time and penalties if needed.
The knockout stage pits the winners of the group against the runners-up, meaning Germany, Poland, Denmark or Sweden could lie in wait for England and Wales in the last eight.
Group A: Switzerland, Norway, Iceland, Finland
Group B: Spain, Portugal, Belgium, Italy
Group C: Germany, Poland, Denmark, Sweden
Group D: France, England, Wales, Netherlands
When are England and Wales playing?
The Lionesses start their bid for the Euros title on 5 July when they take on France. The game will take place in Zurich at 8pm UK time.
Wales kick off their campaign earlier the same day, against the Netherlands. That game starts at 5pm UK time in Lucerne.
The two nations will be the last teams in Group D to face each other.
Their showdown will be held in the city of St Gallen, on Sunday 13 July. Kick-off is at 8pm UK time.
Can England win the Euros again?
The Lionesses lifted the Euros trophy in front of a home crowd in 2022, after beating Germany 2-1.
Chloe Kelly delivered the deciding goal in extra time, but can the team do it all again?
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Can England win the Euros again?
Lucy Bronze admitted to Sky News that the team faces “one of the hardest” groups going into the tournament, but added: “We know on any given day, when we play at our best we can beat any team in the world.”
The right-back said: “We have got one of the most talented squads going into the Euros… I wouldn’t want to be a defender on the other team going against some of our players.
“We know it is going to be difficult, there are maybe a handful of teams that are capable of winning it, and we are definitely one of them.”
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‘Handful of teams could win the Euros – we’re one’
After naming her squad in May, Weigman told Sky News sports correspondent Rob Harris: “This group is a very well-balanced mix of players with multiple tournaments on their CVs and also those that will make their tournament debuts.
“I am excited to see what we are capable of this summer.”
How to watch the Euros 2025
Eevery single match of the Women’s Euros will be shown across the BBC and ITV, with the two broadcasters showing half of the 31 matches each, except the final, which will be shown on both channels.
Every match will also be screened live at three venues across London and Birmingham.
TOCA Social at The O2 and Westfield White City in London and The Bullring in Birmingham is hosting watch parties for fans hoping to catch all the action.
A flight in Australia was delayed for two hours after a stowaway snake was found in the plane’s cargo hold.
The reptile was found as passengers were boarding Virgin Australia Flight VA337 at Melbourne Airport bound for Brisbane.
Snake catcher Mark Pelley said he thought it could be venomous when he approached it in the darkened hold.
Image: The snake in the cargo hold. Pics: Mark Pelley
But it turned out to be a harmless 60cm green tree snake.
“It wasn’t until after I caught the snake that I realised that it wasn’t venomous. Until that point, it looked very dangerous to me,” Mr Pelley said.
He said when he entered the cargo hold, the snake was half hidden behind a panel and he feared it could flee deeper into the plane.
“I had one chance to grab it, and if it escaped past me it would have gone into the panels, and then that would have been extremely hard to catch,” he told Sky News.
“Snakes are very fast-moving, thin and agile,” he added.
Mr Pelley said he told an aircraft engineer and airline staff they would have to evacuate the aircraft if the snake disappeared inside the plane.
“I said to them if I don’t get this in one shot, it’s going to sneak through the panels and you’re going to have to evacuate the plane because at that stage I did not know what kind of snake it was,” he explained in a separate interview.
“But thankfully, I got it on the first try and captured it,” he added. “If I didn’t get it that first time, the engineers and I would be pulling apart a [Boeing] 737 looking for a snake still right now.”