I have to pass a drug test to get my prescription?

Factual Questions
1

I was diagnosed with ADHD - PI seven years ago, and since then, I’ve managed my symptoms with a daily prescription stimulant. Depending on what my financial circumstances and prescription coverage, I either ask my doctor for the cheapest old school generic available or the extended release version of the cheapest old school generic. This is almost always some version of Adderall, which is just a fancy name for amphetamine.

It’s a Schedule II drug, and I have no problem meeting the various requirements the state and federal governments demand. I can only get a one month prescription at a time. I have to get the prescription filled within seven days. In California, I could only get the prescription from a psychiatrist. At least in Texas, my PCP can prescribe it.

So when I saw my doctor yesterday for a post viral cough the OTC meds were not helping, I mentioned that I was coming to the end of my last Adderal XR prescription. My doctor was happy to write the prescription for the next month, but she said that changes in state medical board regulations now required that she have all of her patients on stimulants take a bi-annual urine drug test. The reason, she explained, is because there are many recreational drugs that are contraindicated for use with stimulants, and they can cause serious health problems. No one, she stressed, gets into trouble, but the test provides a baseline to provide counseling and determine the most appropriate medication for the circumstances. She mentioned marijuana twice while explaining this.

Okay, I get that people lie to their doctors. I think it’s an incredibly unnecessary and dangerously stupid thing to do. After all, my doctor does not get to rat me out if she learns that I’m using illegal substances. I also get that drug interactions can be extremely bad, if not downright fatal, especially when the doctor doesn’t know what’s going on. So, I accept that from here on out, I’ll be peeing in a cup twice a year or I won’t get my ADHD meds.

Here’s where I’m confused:

  • I can’t find any contraindications for amphetamine other than heart disease, hypertension, or glaucoma. I checked Wikipedia, PubMed, and the online Merck manual, and there’s no mention of specific medication interactions.

  • The only thing I’m aware of being bad to mix with amphetamines is other stimulants.

  • Urine tests for recreational drugs are notoriously unreliable. If I were the kind of person to lie to my doctor about what I take for happy-party-time, I would also be the type of person to detox before taking a urine test so the results would be clean.

  • While people with ADHD are well known for self-medicating, we tend to self-medicate with stimulants (nicotine, caffeine, cocaine, meth) when we don’t have access to legally prescribed stimulant medications.

I can’t find an online source for what the Texas state medical board requires physicians to do when prescribing Schedule II drugs, so I can’t confirm what my doctor told me. I trust her, and I’d like to think she trusts me (I know, trust but verify), but this whole megillah doesn’t seem to have any connection to the stated reason. So I’d really appreciate answers, thoughts, and speculation by any of the Dopers in the medical community or related areas.

2

with scheduled drugs, the real reason is probably to make sure you’re actually taking them, and not diverting/selling them.

3

So you actually need to fail the urine test, and if you run out of your drugs, you can’t get more? :dubious:

4

. . . because the first thing people think when they see me is ‘she can totes fix me up’?

Did not see that one coming. Guess I’ll make sure I take my meds all the way up to the day of the test.

5

There was that lengthy thread just a few week back, in which several Dopers (:eek:) ranted about the f-ing paranoid idiotic red tape they must hack through to get their pain medications. This point came up somewhere in that thread too: So many people are getting their opioid pain meds and selling them as soon as they get out to the parking lot, now they require you to pee a sample of your very soul into a cup, to make sure you are taking the meds they give you.

ETA: One of the points that came up was about Fentanyl patches: You only get ONE at a time, and you MUST still be wearing it when you go to get your next one. You have to trade it in. If it somehow falls off and gets lost, you’re very highly scrod.

6

I’ve never heard of this in California. I also use a Schedule II stimulant, and my PCP has been writing my scripts for years. OTOH, the initial diagnosis did come from a psychiatrist, as did the initial prescription.

The one thing you do learn is you need to make sure the doctor doesn’t forget to check off the quantity box at the bottom, or the pharmacist may refuse it. Whether you remember to check is probably a good indicator if the medication is helping. :slight_smile:

7

Would this work with immediate release Adderal, though? If you forget your morning dose–which can happen–and show up at the doctor’s office, will the drug show up in your urine? IOW, wouldn’t it already have passed out of your system?

8

Well, part of my problem was that I didn’t have a long standing relationship with my PCP. When I was out of work, I went to a public clinic where I never saw the same doctor twice, and it was very clear that I wouldn’t be getting anything other than anti-depressants or birth control. When I was working and had health insurance, I saw two different PCPs in three years (I switched because I felt like I wasn’t being taken seriously), and neither of them would write a prescription for me. Of course, neither of them were comfortable doing a yearly pelvic exam, which meant I had to see a gynecologist as well as a psychiatrist. Because paying extra for a specialist is just extra fun.

9

I asked this question not long ago here as I am a long term opioid user, taking morphine and percocet for chronic pain. I also take amphetamine to counter the lethargic effects of the opioids. My doctor requested that I take a drug test, but in this instance to make sure that I was taking the drugs and not selling them. He told me that it was required by law and I had no problem with taking one. The thread I started can be found here: DEA required drug test of chronic pain patient - In My Humble Opinion - Straight Dope Message Board