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Column originally published Feb 27, 2024

Drug Screening For Those On ADHD Medication Can Cause Anxiety

Question: Our daughter was diagnosed with ADHD when she was in grade 6. Her teacher noticed that she was daydreaming a lot, and she struggled to complete homework. She was assessed by a psychologist, and was diagnosed with ADHD. Our family doctor started her on Vyvanse, with remarkable results. She could pay good attention in class, and homework became a breeze. She did very well in school, and started university in September. When she was in grade 12, her doctor made her sign a form that she agree not to use drugs. We never thought much about it until her follow up in October. The doctor took a urine test, and to our horror, it was positive for multiple drugs. The doctor gave her a prescription for one month instead of the usual 3 months, and said that if she has another positive test, she will never get another prescription. Our daughter still lives at home, and we know that she doesn’t go to parties or use drugs. She became distraught and paranoid, making all the food herself. I went with her the following visit. Her urine test was negative, but the doctor was very judgemental, accusing her that she will become a drug addict. Is it normal practice for doctors to require drug screening before prescribing ADHD medicine?


I am sorry to hear that your daughter has this unpleasant experience with her doctor. From my knowledge, it is not a common practice to require drug screening before prescribing ADHD medications. However, it is not uncommon for those with ADHD to experiment with drugs, and some become addicted to them. This is called substance use disorder (SUD).

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric condition in children. Most often boys are recognized because of their hyperactivity: difficulty sitting still and interrupting in class. Girls can be talkative, but less likely to get into trouble.

As a result, I saw mostly boys for diagnosis of ADHD when I was a consulting paediatrician. Your daughter was fortunate that her teacher noticed the daydreaming and alerted you. Many psychologists can diagnose ADHD with their assessment, but not always. I have seen some children being diagnosed with learning disability only, without recognizing their co-existing ADHD.

Vyvanse is a stimulant medication based on dextroamphetamine (also called Dexedrine). Vyvanse is a prodrug, and requires an enzyme in the blood to release dextroamphetamine to the brain, where it helps to improve executive function: focus of attention, reduce distraction, improve organization and motivation, etc. As a prodrug, it cannot be abused. You have seen the benefits of Vyvanse over the years. It will continue to be effective, although the dose may need to be adjusted over time as she grows, and when demands on her cognitive function increase.

Unfortunately, over the decades, stimulants like dextroamphetamine and methylphenidate (also known as Ritalin) have been abused, because they were short-acting medications. As a result, many doctors refuse to prescribe them, and avoid making diagnosis of ADHD.

Furthermore, those who have ADHD also tend to be impulsive, doing things without thinking. They are more likely to try drugs, including nicotine, cannabis, alcohol, and other street drugs. This is partly due to poor self esteem: they don’t do as well in school, or have poor relationship with family. These drugs may help to calm their brain, or make them feel better, although briefly. However, they often lead them down the path of addiction.

Physicians who treat those with drug addiction often require them to provide urine for drug screening. This is because they can slip and dabble into drugs even during treatment.

I know many teenagers and young adults drink alcohol and use cannabis on occasion, whether they have ADHD or not. I always advise them to reduce their use: less is better, and none is the best. As her mother, you should have frank discussions with her about the dangers of drug addiction, and lead by example.

If her doctor insists on routine drug screening which increases her anxiety level greatly, you should have a discussion with the doctor. Urine tests can produce falsely positive results; it can do more harm than good.