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…
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