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Reviewed by Emily Henderson, B.Sc. Mar 28 2023

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.

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Angelina Jolie on her legacy, family and new film Maria

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Angelina Jolie on her legacy, family and new film Maria

Angelina Jolie says although she appreciates being an artist, she would prefer for her legacy to be “a good mother” and to be known for her “belief in equality and human rights”.

The Oscar-winning actress stars as Maria Callas in the new Pablo Larrain film about the opera singer’s life.

Pic: StudioCanal
Image:
Pic: StudioCanal

She has called Maria “the hardest” and “most challenging” role she has had in her career and put months of preparation into immersing herself into the world of opera.

Jolie, who recently reached a divorce settlement with actor Brad Pitt, told Sky News: “To be very candid, it was the therapy I didn’t realise I needed. I had no idea how much I was holding in and not letting out.

“So, the challenge wasn’t the technical [side of opera], it was an emotional experience to find my voice, to be in my body, to express. You have to give every single part of yourself.”

The biopic combines the voice of the Maleficent actress with recordings of Maria Callas.

Jolie believes it “would be a crime to not have [Callas’] voice through this because, in many ways, she is very present in this film”.

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Who was Maria Callas?

Born in New York in 1923, Maria Callas was the daughter of Greek immigrants who moved back to Athens at the age of 13 with her mother and sister.

After enrolling at the Athens Conservatory, she made her professional debut at 17 and went on to become one of the most famous faces of opera, travelling around the world and performing at Covent Garden in London, The Met in New York and La Scala in Milan.

Callas’s final operatic performance took place at Covent Garden in 1965 when she was 41 but she continued to work conducting master classes at Juilliard School, doing concert tours and starring in the 1969 film Medea.

Written by Peaky Blinders creator Steven Knight, Maria focuses on the artist’s final years in the 1970s when she moved to Paris and disappeared from public view.

She died on 16 September 1977 at the age of 53.

Pic: StudioCanal
Image:
Pic: StudioCanal

Jolie on changing motivations as an actor

Maria follows the life of an artist fully consumed by the art she creates and even remarks that “happiness never developed a beautiful melody”.

Reflecting on her own life in the spotlight, Jolie said she noticed her own career motivations change over the years.

“There’s this kind of study of being human that we do when we create, and we communicate with an audience because our work is not in isolation – it’s a connection.

“I think when I was younger, I had different questions about being human and different feelings and now as I’ve gotten older, I understand some things and now I have different questions.

“It’s a matter of life, right? And so maybe that’s interesting that this now is a character really contemplating death and really contemplating the toll of certain things in life that I, of course, couldn’t have understood in my 20s”.

Jolie at the New York Film Festival in September with three of her children (L-R) Pax, Zahara and Maddox. Pic: AP
Image:
Jolie at the New York Film Festival in September with three of her children (L-R) Pax, Zahara and Maddox. Pic: AP

A family affair

Two of Jolie’s children, Maddox and Pax, took on production assistant roles during the filming of Maria and witnessed their mother perform opera for the first time in public.

She says the film allowed them to create new experiences together and for her children to see her approach to playing a difficult role.

“Everyone in my home, we all give each other space to be who we are and we’re all different.

“I’m the mom, but I’m also an artist and a person and so my family has been very kind and gives me their understanding. They make fun of me, and they support me and just as you’d hope it would be.”

She adds: “When you play somebody who is dealing with so much pain, it’s very important to come home to some kindness.”

Maria is in cinemas now.

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LA fires: Data and videos reveal scale of ‘most destructive’ blazes in modern US history

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LA fires: Data and videos reveal scale of 'most destructive' blazes in modern US history

The fires that have been raging in Los Angeles County this week may be the “most destructive” in modern US history.

In just three days, the blazes have covered tens of thousands of acres of land and could potentially have an economic impact of up to $150bn (£123bn), according to private forecaster Accuweather.

Sky News has used a combination of open-source techniques, data analysis, satellite imagery and social media footage to analyse how and why the fires started, and work out the estimated economic and environmental cost.

More than 1,000 structures have been damaged so far, local officials have estimated. The real figure is likely to be much higher.

“In fact, it’s likely that perhaps 15,000 or even more structures have been destroyed,” said Jonathan Porter, chief meteorologist at Accuweather.

These include some of the country’s most expensive real estate, as well as critical infrastructure.

Beachfront properties are left destroyed by the Palisades Fire, Thursday, Jan. 9, 2025 in Malibu, Calif. (AP Photo/Mark J. Terrill)
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Beachfront properties in Malibu were destroyed by the Palisades fire. Pic: PA

Accuweather has estimated the fires could have a total damage and economic loss of between $135bn and $150bn.

“It’s clear this is going to be the most destructive wildfire in California history, and likely the most destructive wildfire in modern US history,” said Mr Porter.

“That is our estimate based upon what has occurred thus far, plus some considerations for the near-term impacts of the fires,” he added.

The calculations were made using a wide variety of data inputs, from property damage and evacuation efforts, to the longer-term negative impacts from job and wage losses as well as a decline in tourism to the area.

The Palisades fire, which has burned at least 20,000 acres of land, has been the biggest so far.

Sentinel
Sentinel satellite imagery of the Pacific Palisades from space, taken around 15 minutes after the Palisades Fire was first reported. The red indicates the area of land that had already burned. Pic: Sentinel Hub
Image:
Sentinel satellite imagery of the Pacific Palisades from space, taken around 15 minutes after the Palisades fire was first reported. The red indicates the area of land that had already burned. Pic: Sentinel Hub

Satellite imagery and social media videos indicate the fire was first visible in the area around Skull Rock, part of a 4.5 mile hiking trail, northeast of the upscale Pacific Palisades neighbourhood.

These videos were taken by hikers on the route at around 10.30am on Tuesday 7 January, when the fire began spreading.

At about the same time, this footage of a plane landing at Los Angeles International Airport was captured. A growing cloud of smoke is visible in the hills in the background – the same area where the hikers filmed their videos.

The area’s high winds and dry weather accelerated the speed that the fire has spread. By Tuesday night, Eaton fire sparked in a forested area north of downtown LA, and Hurst fire broke out in Sylmar, a suburban neighbourhood north of San Fernando, after a brush fire.

These images from NASA’s Black Marble tool that detects light sources on the ground show how much the Palisades and Eaton fires grew in less than 24 hours.

 

On Tuesday, the Palisades fire had covered 772 acres. At the time of publication of Friday, the fire had grown to cover nearly 20,500 acres, some 26.5 times its initial size.

The Palisades fire was the first to spark, but others erupted over the following days.

At around 1pm on Wednesday afternoon, the Lidia fire was first reported in Acton, next to the Angeles National Forest north of LA. Smaller than the others, firefighters managed to contain the blaze by 75% on Friday.

Fires map

On Thursday, the Kenneth fire was reported at 2.40pm local time, according to Ventura County Fire Department, near a place called Victory Trailhead at the border of Ventura and Los Angeles counties.

This footage from a fire-monitoring camera in Simi Valley shows plumes of smoke billowing from the Kenneth fire.

Sky News analysed infrared satellite imagery to show how these fires grew all across LA.

The largest fires are still far from being contained, and have prompted thousands of residents to flee their homes as officials continued to keep large areas under evacuation orders. It’s unclear when they’ll be able to return.

“This is a tremendous loss that is going to result in many people and businesses needing a lot of help, as they begin the very slow process of putting their lives back together and rebuilding,” said Mr Porter.

“This is going to be an event that is going to likely take some people and businesses, perhaps a decade to recover from this fully.”


The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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They are hurting but managing to find hope in ‘tomorrow’ – the residents who have lost everything in the LA fires

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They are hurting but managing to find hope in 'tomorrow' - the residents who have lost everything in the LA fires

They are the displaced and there are tens of thousands of them, 600 in an evacuation centre we visited.

From elderly people who fled without their medication, to pregnant mothers desperate to escape the smoke, they had nowhere else to go.

Jim Mayfield, who has lived in the northern suburb of Altadena for 50 years, wept as he told me his dogs, Monkey and Coca, were all he had left.

He said: “The fire was coming down, a ball of fire, it hadn’t made it to my house, but then I woke up and I seen it so I had to start evacuating.

“I had to grab my dogs, I didn’t have enough water and my house is burned down to the ground.”

Thousands of buildings have been burned to the ground
Image:
Thousands of buildings have been burned to the ground since the fires in Los Angeles started

Sheila Kraetzel, another elderly resident, relived the sense of terror as homes were engulfed by the flames.

She said: “I smelt smoke, I was sleeping, and my dog alerted me that there was trouble.

More on California Wildfires

“When I looked outside, there were embers floating across my yard.

“My whole neighbourhood is gone.”

“It was a beautiful, unique place,” she added, smiling.

Thousands of firefighters have been working around the clock to contain the wind-driven fires in California
Image:
Firefighters have been working around the clock to contain the wind-driven fires

Asked how she could smile, she fought back tears and replied: “Well, there’s tomorrow you know.”

How anyone could find hope amid the destruction we have witnessed here is beyond me.

Read more:
Scale of ‘most destructive’ blazes in modern US history
In pictures: Before and after the blazes
What caused the fires?

There are people handing out food and water, medical staff doing what they can. Volunteers have rallied from far and near.

Buildings destroyed in fires

One of them, Stephanie Porter, told me it felt “heavy” inside the centre.

“You walk through and see the despair on people’s faces, not knowing what their next step is, not knowing if their house is still standing,” she said.

“I had to take a few moments… and kind of cry, and then you go back to serve.

“It just breaks your heart.”

Three miles up the road, Altadena resembles a war zone, but residents have not been allowed to return.

When they finally do, they’ll discover there’s nothing left of the material lives they left behind.

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