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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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Man and boy arrested on suspicion of arson after restaurant fire leaves two in critical condition

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Man and boy arrested on suspicion of arson after restaurant fire leaves two in critical condition

A 54-year-old man and a 15-year-old boy have been arrested on suspicion of arson with intent to endanger life after a restaurant fire in east London on Friday.

Three people were taken to hospital in a life-threatening condition after the fire at the Indian Aroma in Ilford.

Two remained in a critical condition on Sunday morning, according to the Metropolitan Police.

The restaurant suffered extensive damage in the blaze.

Two further victims are thought to have left the scene before officers arrived, Scotland Yard said.

Woodford Avenue from above. Pic: UK News and Pictures
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Woodford Avenue from above. Pic: UK News and Pictures

Police are still trying to identify them.

CCTV footage seen by the PA news agency appears to show a group of people wearing face coverings walk into the restaurant and pour liquid on the floor.

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Seconds later, the inside of the restaurant is engulfed in flames.

“While we have made two arrests, our investigation continues at pace so we can piece together what happened on Friday evening,” said the Met Police’s DCI Mark Rogers.

“I know the community [is] concerned and shocked by this incident.

The moment the fire broke out.
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The moment the fire broke out.

“I would urge anyone with any information or concerns to come forward and speak to police.”

Hospital porter Edward Thawe went to help after hearing screams from his nearby home.

He described the scene as “horrible” and “more than scary and the sort of thing that you don’t want to look at twice.”

He said: “I heard screaming and people saying they had called the police.”

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The 43-year-old said he saw a woman and a severely burned man who may have been customers.

Another witness, who did not want to be named, said he saw three “severely burned” people being doused by the emergency services and given oxygen.

“I can only imagine the pain they were going through,” he said.

On Saturday, the London Ambulance Service told Sky News: “We sent resources to the scene, including ambulance crews, an advanced paramedic, an incident response officer and paramedics from our hazardous area response team.

“We treated five people for burns and smoke inhalation. We took two patients to a major trauma centre and three others to local hospitals.”

The police investigation is continuing.

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Fast-track asylum appeals process to be introduced – as average time for decisions is more than one year

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Fast-track asylum appeals process to be introduced - as average time for decisions is more than one year

A new fast-track asylum appeals process will be introduced to speed up the process of deporting people without a right to remain in the UK, the home secretary has said.

As it currently takes, on average, more than a year to reach a decision on asylum appeals, the government plans to set up a new independent panel focused on asylum appeals to help reduce the backlog.

Home Secretary Yvette Cooper said “completely unacceptable” delays in the appeals process left failed asylum seekers in the system for years.

There are about 51,000 asylum appeals waiting to be heard.

The new independent body will use professionally-trained adjudicators, rather than relying on judges.

Ministers are introducing a new 24-week deadline for the first-tier tribunal to determine asylum appeals by those receiving accommodation support and appeals by foreign offenders.

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Police clash with protesters in Bristol

But they believe the current tribunal system, which covers a wide range of different cases, is still failing to ensure failed asylum seekers can be returned as swiftly as possible, nor can it accommodate a fast-track system for safe countries.

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It comes amid protests about the use of hotel accommodation for migrants.

The home secretary said the overhaul would result in a system which is “swift, fair and independent, with high standards in place”.

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She said: “We inherited an asylum system in complete chaos with a soaring backlog of asylum cases and a broken appeals system with thousands of people in the system for years on end.

“That is why we are taking practical steps to fix the foundations and restore control and order to the system.

“We are determined to substantially reduce the number of people in the asylum system as part of our plan to end asylum hotels.

“Already since the election, we have reduced the backlog of people waiting for initial decisions by 24% and increased failed asylum returns by 30%.

“But we cannot carry on with these completely unacceptable delays in appeals as a result of the system we have inherited which mean that failed asylum seekers stay in the system for years on end at huge cost to the taxpayer.”

Official figures released earlier this month showed a total of 111,084 people applied for asylum in the UK in the year to June 2025, the highest number for any 12-month period since current records began in 2001.

‘Waving immigrants through even faster will not fix the problem’

Chris Philp, the shadow home secretary, said: “I think this goes nowhere near far enough.

“The underlying rights, which allows most illegal immigrants to stay here, are not changing. Simply waving illegal immigrants through even faster to full housing and welfare rights will not fix the problem.”

Chris Philp
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Chris Philp

He added: “Immigration judges will still apply ever expanding common-sense defying definitions of ECHR rights to allow foreign criminals and illegal immigrants to stay here.”

But the Liberal Democrats have been more positive in their response, with shadow attorney general, Ben Maguire, saying: “A faster application process would mean that those with no right to be here are sent back swiftly and those who do have a valid claim can get a job, integrate and contribute to the community.”

Asked for his thoughts on the policy, immigration lawyer Harjap Singh Bhangal told Sky News that it “definitely sounds like some sort of solution”.

He pointed that the backlog of asylum seekers waiting for a decision is “huge”, around 51,000 people – and that during this time, they are not allowed to work.

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A new fast-track asylum appeals process will be introduced to speed up the process of deporting people without a right to remain in the UK.

He said: “The equivalent would be saying that imagine if A-level students this year sat the exams and were told ‘well, hold on, you’re not going to get your results for two years’ time. But in the meantime, you can’t go to university.’

“You’d have mayhem, and it’d be pandemonium in the street. You’d have broken people idle with nothing to do. Essentially, this is what’s happening to asylum seekers.”

He added that one of the reasons it takes so long for cases to be heard is because asylum seekers have to represent themselves in court, which can mean upwards of half a day is spent translating and explaining everything to them.

Mr Bhangal also said the immigration system is “broken”, because “they take ages to make a decision which could be made in one week”.

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Family pay tribute to ‘beloved’ man who died in ‘accident while working on fairground ride’

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Family pay tribute to 'beloved' man who died in 'accident while working on fairground ride'

A man who died after suffering “serious head injuries” while “working on a fairground ride” has been named as Corrie Lee Stavers.

Emergency services were called to the Spanish City Summer Funfair in Whitley Bay in North Tyneside after reports that a man, in his 20s, had been injured around 2.15pm on Saturday, police said.

Mr Stavers, 28, was treated at the scene but was declared dead a short time later.

In a statement issued by the police, his family said: “It’s with broken hearts that we share the devastating news that our beloved Corrie has passed away.

“He was tragically taken from us in an accident while working on a fairground ride. None of us were prepared for this, and the pain of losing him so suddenly is impossible to put into words.

“Our lives will never be the same without him, but his memory will live on in our hearts forever.

“We love you endlessly Corrie, and we miss you more than words can ever say.

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“You’re with our mam now – rest in peace Corrie.”

The funfair, which is in Whitley Bay’s Spanish City Plaza area, has been shut “until further notice” and the Health and Safety Executive has been informed.

The annual funfair had opened on Thursday and had been due to run until Bank Holiday Monday.

Read more from Sky News:
Man and boy arrested after restaurant fire
Fast-track asylum appeals process to be introduced

A Northumbria Police spokesman said: “Emergency services attended and a man in his 20s was found to have suffered serious head injuries.

“Despite the best efforts of medical staff, a short time later the man was sadly declared dead.

“His next of kin have been contacted and are being supported by specialist officers.”

The spokesman added: “Our thoughts are with the man’s family at this extremely difficult time.

“We have contacted the Health and Safety Executive and are working with them to establish exactly what happened.

“The fair has been closed to the public and will remain closed until further notice.”

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