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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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Global markets have given Trump a clear no-confidence vote – and his fickleness is making the problem worse

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Global markets have given Trump a clear no-confidence vote - and his fickleness is making the problem worse

Global financial markets gave a clear vote of no-confidence in President Trump’s economic policy.

The damage it will do is obvious: costs for companies will rise, hitting their earnings.

The consequences will ripple throughout the global economy, with economists now raising their expectations for a recession, not only in the US, but across the world.

Tariffs latest: FTSE 100 suffers biggest daily drop since COVID

Financial investors had been gradually re-calibrating their expectations of Donald Trump over the past few months.

Hopes that his actions may not match his rhetoric were dashed on Wednesday as he imposed sweeping tariffs on the US’ trading partners, ratcheting up protectionism to a level not seen in more than a century.

FILE PHOTO: U.S. President Donald Trump holds a "Foreign Trade Barriers" document as he delivers remarks on tariffs in the Rose Garden at the White House in Washington, D.C., U.S., April 2, 2025. REUTERS/Carlos Barria/File Photo
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On Wednesday, Donald Trump announced global tariffs, ratcheting up protectionism. Pic: Reuters

04 April 2025, Hesse, Frankfurt/Main: Stock exchange traders watch their monitors on the trading floor of the Frankfurt Stock Exchange while the display board with the Dax curve shows falling prices. US President Trump had issued a huge tariff package against trading partners around the world. The European Union and China have already announced countermeasures. Photo by: Arne Dedert/picture-alliance/dpa/AP Images
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Traders at the Frankfurt stock exchange watched the DAX plummet on Friday. Pic: Picture-alliance/dpa/AP

Markets were always going to respond to that but they are also battling with another problem: the lack of certainty when it comes to Trump.

More on Donald Trump

He is a capricious figure and we can only guess his next move. Will he row back? How far is he willing to negotiate and offer concessions?

Read more:
No winners from Trump’s tariff gameshow
Trade war sparks ‘$2.2trn’ global sell-off

These are massive unknowns, which are piled on to uncertainty about how countries will respond.

China has already retaliated and Europe has indicated it will go further.

Aerial view of a ro-ro terminal for vehicle shipment in Yantai in eastern China's Shandong province, Thursday, April 3, 2025. (Chinatopix Via AP) CHINA OUT
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Vehicles destined for export, like these in Yantai in eastern China, face massive US tariffs. Pic: Chinatopix/AP

Cargo containers line a shipping terminal at the Port of Oakland on Thursday, April 3, 2025, in Oakland, Calif. (AP Photo/Noah Berger)
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Container ports like Oakland in California might expect activity to fall. Pic: AP

That will compound the problems for the global economy and undoubtedly send shivers through the markets.

Much is yet to be determined, but if there’s one thing markets hate, it’s uncertainty.

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Hundreds of names removed from official Gaza war death list

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Hundreds of names removed from official Gaza war death list

Gaza’s health ministry has removed 1,852 people from its official list of war fatalities since October, after finding that some had died of natural causes or were alive but had been imprisoned.

The list of deaths currently stands at 50,609 following the removals. Gaza’s health ministry records do not distinguish between civilians and combatants.

Almost all of the names removed (97%) had initially been submitted through an online form which allows families to record the deaths of loved ones where the body is missing.

The head of the statistics team at Gaza’s health ministry, Zaher Al Wahidi, told Sky News that names submitted via the form had been removed as a precautionary measure pending a judicial investigation into each one.

“We realised that a lot of people [submitted via the form] died a natural death,” Mr Wahidi said. “Maybe they were near an explosion and they had a heart attack, or [living in destroyed] houses caused them pneumonia or hypothermia. All these cases we don’t [attribute to] the war.”

Others submitted via the form were found to be imprisoned or to be missing with insufficient evidence that they had died.

Some families submitting false claims, Mr Wahidi said, may have been motivated by the promise of government financial assistance.

It is the largest removal of names from the list since the war began, and comes after 1,441 names were removed between August and October – 54% of them originating in hospital morgue records rather than the online form.

chart

Mr Wahidi says his team audited the hospital data after receiving complaints from people who had ended up on the list despite being alive.

They found that hospital clerks, when operating without access to the central population registry and lacking full names or dates of birth for the dead, had marked the wrong people as dead in their records.

In total, 8% of people who were listed as dead in August have since been removed from the official death toll. Many of those may later be added back in, as the judicial investigations proceed.

‘It doesn’t look like manipulation’

Gabriel Epstein, a research assistant at US thinktank The Washington Institute for Near East Policy, said there’s no reason to think the errors are the result of deliberate manipulation intended to inflate the share of women and children among the dead.

“If 90% of the removed entries were men aged 18-40, that would look like manipulation,” he said. “But it doesn’t look like that.”

Of those entries removed since the start of the war and whose demographic information was recorded, 41% are men aged 18 to 60, while 59% are women, children and elderly people.

By comparison, 44% of remaining deaths are working-age men. This means that the removals have had the effect of slightly reducing the share of women and children in the official list.

chart

Names were previously added to the list without verification

Until October, Mr Wahidi said, names submitted via the online form had been added to the official list of registered deaths before undergoing a judicial confirmation process.

The publication of unverified deaths submitted via the form had previously led to issues with the data, with 1,295 deaths submitted via the form being removed from the list prior to October. This included 474 people who were later added back again.

Sky News previously understood that names from the form were only published after undergoing judicial confirmation. However, Mr Wahidi says this practice only began in October.

“This does cause me to downgrade the quality of the earlier lists, definitely below where I thought they were,” said Professor Michael Spagat, chair of Every Casualty Counts, an independent civilian casualty monitoring organisation.

Read more:
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A Ministry of Health document from July 2024 confirms that names submitted through the online form were, at the time, included in the official fatality list before being verified.

These names “are initially included in the final count of martyrs, but verification procedures are undertaken afterward”, the document says.

“They basically said that they were posting these things provisionally pending investigation,” said Prof Spagat.

“There may have been literally zero people, including us, who actually absorbed this message, but they weren’t hiding it either.”

More than 1,200 Israelis have been killed in the 7 October attack and ensuing war.


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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Children among 19 killed in Russian attack on Zelenskyy’s home city

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Children among 19 killed in Russian attack on Zelenskyy's home city

At least 19 people, including nine children, have been killed in a Russian attack on Volodymyr Zelenskyy’s home city, according to Ukrainian officials.

Around 50 people were also wounded in the attack, according to emergency services, and regional governor Serhiy Lysak said more than 30, including a three-month-old baby, were in hospital.

Ukraine’s president said Friday’s attack on Kryvyi Rih showed Russia “does not want a ceasefire”.

“The whole world sees it,” said Mr Zelenskyy.

“Every missile, every strike drone proves that Russia only wants war.

“And only on the pressure of the world on Russia, on all efforts to strengthen Ukraine, our air defence, our forces – only on this does it depend when the war will end.”

Russia’s defence ministry claimed it had struck a military gathering – a statement denounced by the Ukrainian military as misinformation.

Mr Lysak wrote on the Telegram messaging app that 18 people were killed when a missile hit residential areas and sparked fires.

Later on Friday, Russian drones attacked homes and killed one person, Oleksandr Vilkul, the city’s military administrator, said.

Latest updates: President’s home city hit by missile attack

Local authorities said the missile strike damaged about 20 apartment buildings, more than 30 vehicles, an educational building and a restaurant.

They said emergency responders were at the scene and psychologists were helping survivors.

Confirming the “high-precision strike”, the Russian defence ministry said on Telegram it targeted “a meeting of unit commanders and Western instructors” in a city restaurant.

“As a result of the strike, enemy losses total up to 85 servicemen and officers of foreign countries, as well as up to 20 vehicles,” the ministry added.

Volodymyr Zelenskyy says at least 14 people have died, including six children, following a Russian missile strike on Kryvyi Rih. Pic: Telegram/Zelenskiy
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Pic: Telegram/Zelenskyy

Volodymyr Zelenskyy says at least 14 people have died, including six children, following a Russian missile strike on Kryvyi Rih. Pic: Telegram/Zelenskiy
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Pic: Telegram/Zelenskyy

US ‘not interested in negotiations about negotiations’

It comes after the US secretary of state issued a veiled threat to Russia as talks about a ceasefire with Ukraine continue.

Speaking in Brussels during a NATO meeting, Marco Rubio said the US was “not interested in… negotiations about negotiations”.

“We’re testing to see if the Russians are interested in peace. Their actions – not their words, their actions – will determine whether they’re serious or not, and we intend to find that out sooner rather than later,” he said.

Read more:
Israeli troops expand ‘security zone’ in northern Gaza
UK in talks with Brazil over ‘potential sale’ of warships

In March, the US agreed a proposed 30-day ceasefire with Ukraine after talks in Saudi Arabia. Later, Washington negotiated a limited ceasefire about energy infrastructure with Russia.

Since then, the warring countries have accused each other of violating the energy ceasefire.

UK Foreign Secretary David Lammy, who was also in Brussels on Fridaym said Vladimir Putin “continues to obfuscate, continues to drag his feet” on ceasefire talks.

He added that while the Russian president should be accepting a ceasefire, “he continues to bombard Ukraine, its civilian population, its energy supplies”.

“We see you, Vladimir Putin. We know what you are doing,” he said.

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