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

Published

2 years ago

March 28, 2023

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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.

Politics

Chancellor Rachel Reeves dodges wealth tax calls from predecessor

Published

2 hours ago

August 1, 2025

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Chancellor Rachel Reeves dodges wealth tax calls from predecessor

Chancellor Rachel Reeves has dodged calls from her predecessor Anneliese Dodds for a wealth tax to be considered ahead of this autumn’s budget.

When Sir Keir Starmer became Labour leader in 2020, Ms Dodds was his first pick for shadow chancellor. However, she did not last long and was replaced by Ms Reeves, who then got the government job after last year’s election win.

Speaking to the Sky News political editor Beth Rigby on the Electoral Dysfunction podcast, Ms Dodds said she had examined wealth taxes when she was briefly in the shadow chancellor job and how one could be implemented.

She said: “I would hope the Treasury is considering that kind of evidence, as well as other changes that have been put forward.”

Asked today if about Ms Dodds’ intervention, Ms Reeves said: “Decisions around tax are decisions that are made at a budget and we’ll make those decisions in the appropriate way, but the number-one priority of this government is to grow the economy.

“And that means bringing more investment into Britain, creating more good jobs paying decent wages here in Britain.

Listen here to hear Ms Dodds’ full comments:

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“We’ve got to get the balance right on taxation because we want that investment, we want those jobs to come here.

“That’s why we’re reforming the planning system, secured three trade deals in the first year of this Labour government, cutting back on unnecessary regulation, and reforming our pension system to unlock money for businesses to be able to invest here in the UK.”

The government’s financial position is stretched ahead of the next budget, due at the end of autumn.

Ms Reeves has committed herself to not changing her fiscal rules, leaving little wiggle room to avoid tax rises or spending cuts.

This is due to the government’s inability to save money through policies like welfare reform, which were gutted due to a rebellion of backbench Labour MPs.

Last week, Business Secretary Jonathan Reynolds branded the suggestion of a wealth tax “daft” – but he has less influence over the writing of the budget than the chancellor.

Politics live: Tory MP calls for more deportations

Meanwhile, reports from the Daily Telegraph suggested that Deputy Prime Minister Angela Rayner backed increasing taxes, including reinstating the pensions lifetime allowance and a higher corporation tax level for banks.

Ms Dodds also wants to see those considered.

World

Cambodian soldiers returned by Thailand after ceasefire deal

Published

2 hours ago

August 1, 2025

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Cambodian soldiers returned by Thailand after ceasefire deal

Two Cambodian soldiers have been returned by Thailand ahead of a key meeting aimed at maintaining a ceasefire between the countries.

In Bangkok, Thai government spokesperson Jirayu Houngsub said on Friday that two Cambodian soldiers had been sent back, and the remaining 18 were being processed for violating immigration law.

“The Cambodian soldiers intruded on Thai territory and the army took them into custody, treating them based on humanitarian principles,” he said.

In a statement, the Cambodian defence ministry asked Thailand to return all the detained soldiers.

“Cambodia is actively engaging in negotiations to secure their release, and reiterates its firm call for their immediate
and unconditional release in accordance with the international humanitarian law,” a ministry spokesperson said.

It follows days of deadly fighting along the Thai-Cambodian border which saw at least 43 people killed and left over 300,000 people displaced.

The violence – the worst fighting between the neighbours in over a decade – ended with a truce reached on Monday following a push from Malaysia and calls from US President Donald Trump who threatened to hold off tariff negotiations with both countries until fighting ceased.

Thailand and Cambodia previously faced tariffs of 36% for sending goods to the US, their largest export markets.

Following further negotiations, they will now pay a 19% tariff, the White House announced on Friday.

Cambodia said Friday it plans to nominate Mr Trump for the Nobel Peace Prize over his intervention, according to its deputy prime minister.

Pakistan said in June it would recommend Trump for the prize for his work in helping resolve a conflict with India.

Officials from both Thailand and Cambodia will be meeting in Malaysia next week for talks aimed at maintaining the ceasefire along the disputed border.

The two nations have been at loggerheads over border areas for decades, and simmering tensions escalated into an exchange of gunfire, shelling and rockets on last week, with both sides accusing one another of initiating the violence.

Both countries recalled their ambassadors, and Thailand closed its border crossings with Cambodia.

Relations between the pair deteriorated sharply after an armed confrontation in May that killed a Cambodian soldier. Nationalist passions on both sides have further inflamed the situation.

Environment

Tesla (TSLA) is not paying its bills and it is destroying small American businesses

Published

2 hours ago

August 1, 2025

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Tesla (TSLA) is not paying its bills and it is destroying small American businesses

Tesla (TSLA) is not paying its bills, and this has led to at least two small American businesses going bankrupt. The automaker had over $110 million in liens with contractors over the last 5 years.

CNN released a new report that examines lien claims from contractors hired by Elon Musk’s companies in Texas, particularly Tesla.

In Texas, contractors have filed liens for more than $110 million against Tesla in the last five years. Over $24 million is still allegedly owed to dozens of businesses, according to the report.

In two cases, contractors, most often small American businesses, had to file for bankruptcy due to the unpaid bills.

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The report highlights the example of a small pipe welding business that landed a multi-million-dollar contract with Tesla to build the Gigafactory Texas in Austin in 2022.

The owner, Jennifer Meissner, dedicated her whole crew to the project for a year, hired more people, and bought new equipment for the project, including some with loans she guaranteed herself:

For the first seven years Meissner’s company was in business, she prided herself on not once being late to pay her workers, she told CNN. After securing the business deal with Tesla in 2022, she said her company’s annual revenue grew exponentially, and she hired even more employees. With business booming, she was also hopeful that she would finally be able to start setting aside money for her special needs daughter, whom she adopted at the age of seven.

Her dream quickly turned into a nightmare when Tesla stopped paying its bills. It started putting incredible pressure on Meissner’s company, leading her to take more loans, thinking that Tesla would eventually pay.

Eventually, it led to her inability to pay her own employees and subcontractors, and ultimately, it contributed to her own bankruptcy.

Tesla ultimately paid $650,000 to cover her subcontractors, but claimed it was “overbilled.”

Another local small business, Full Circle Technologies, found itself in a similar situation after Tesla didn’t pay them $600,000 for installing security systems at the factory:

In bankruptcy filings, Full Circle Technologies said Tesla owed it nearly $600,000 and that it was “forced to take on short term high interest loans to bridge the gap between performing the work for Tesla and the payment for its services.” When a creditor began to levy the company’s bank accounts, the company said it had no option but to file for bankruptcy. Tesla then made its own claim in the bankruptcy hearings, stating Full Circle actually owed the carmaker money for allegedly breaching its contract. The two companies ultimately settled, but Full Circle CEO Abheeshek Sharma told CNN that Tesla was released from its obligation without paying a cent.

Another case involved Sun Coast Resources, a company that delivered fuel to Tesla’s factory, claiming that the automaker wasn’t paying millions in bills.

In this case, Tesla never denied receiving the fuel or subpar service, but it provided a myriad of procedural reasons to explain why it did not pay.

The case was publicized a bit earlier this year, and it was reportedly solved following the publicity.

All these cases are linked to Tesla, but some are pointing out that it is Elon Musk’s modus operandi, as his other companies also have a lot of lien claims against them.

The report found seven companies that filed for bankruptcy after Twitter simply stopped paying their bills after Musk acquired the company.

One of Tesla’s subcontractors said about Musk:

“His goal is to run through everything now – he doesn’t care what or who that impacts – to save the future of the world,” said one entrepreneur about his impression of Musk. He spoke with CNN anonymously and said he remains a fan of Musk but that Tesla has a reputation in Austin of leaving contractors desperate to get paid – noting that his company had to take out extra lines of credit while awaiting payment from Tesla. “Tesla was probably one of the only companies we did business with where it just felt like they absolutely did not care about putting a company out of business.”

In one of the lien cases, Tesla’s own outside counsel agreed that Tesla is not great at paying on time. He said: “I don’t disagree that it does take Tesla some time to pay, that goes for legal bills, too … I know it full well.”

Electrek’s Take

It’s quite something for someone to say that a company “doesn’t care about putting another company out of business by not paying what you owe them” and “I’m still a fan” in the same breath.

The excuse of “saving the future of the world” doesn’t make sense if it also happens to “coincidentally” result in Musk becoming extremely wealthy while his contractors go bankrupt.

If that’s the case, the goal is not saving the future; it’s getting rich.

Regarding the claims in the report, Tesla has a reputation for poor payments. That much is clear when its own outside counsel complains about it in the middle of defending Tesla against claims of not paying its bills.

Some of that is simply due to things slipping between the seat cushions. At any given time, Tesla has about $13 billion in accounts payable.

But it seems to be its way of doing business also because over $100 million in liens in Texas alone is concerning and that’s just for Tesla. Musk has employed a similar approach at other companies, including telling Twitter contractors that they will only pay when forced to.

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