Q: I’m facing a urine drug test for employment, what can I do?

A: It depends on how much time you have. Because a recovery program can take several weeks or months to produce significant progress, your options are more limited if the test is in a few days. If you know the test isn’t likely for quite a while, get into a recovery program immediately.  You may be able to provide a sample without any additional measures.

Every person with paruresis needs to document their condition with a doctor before taking a drug test.  This step helps establish that you have a medical condition that makes providing urine difficult. Unfortunately, regulations for drug testing currently in force (which IPA is working to change) state that inability to provide a urine sample is the same as refusal to provide one. Essentially, a person with paruresis is assumed guilty of drug use without any evidence of drug use. If your drug test is in a few days, get to your doctor immediately. Have the doctor write a letter that documents your paruresis and provide that letter to the drug-testing monitor when the test is done. If possible, also have your doctor perform a blood, saliva, or hair test as close as possible to the date of your urine test so there is an independent verification of your drug-free status. While this will cost you some money, it may protect you from loss of your job, or help you in getting one if you are unemployed. A hair test is considered to be the best one for establishing drug-free status, as it can detect use for up to three months prior to the date of the test. Blood tests are more expensive and considered less useful because most chemical traces of drug use are cleared quickly from the bloodstream.

The way urine-based drug testing programs work, having an alternative test before the urine test is not considered hard evidence of a person being “clean.” The purpose of taking this test is to help protect you legally if you decide to take court action against the employer, or file a complaint with your state’s employment rights protection board.

Anyone who is asked to take a drug test should probably take his or her own test immediately afterward. This protects you from false allegations resulting from errors or inaccuracies; they do happen.

The most certain way of being able to provide a urine sample is to learn to use a urinary catheter. A urologist can teach you how to use one in advance of the test. It will likely take at least a week to schedule an appointment, learn to use a catheter, and practice with it in advance of the drug test. When scheduling the appointment, get an assurance from the urologist or nurse that you will be instructed in the use of the catheter.  Explain the reason you are seeking help is to pass a drug test. Do not allow a urologist to delay, ask for more tests, or prescribe drugs as a solution. Your job is on the line. Under no circumstances should you try to use a catheter without instruction, as there are risks associated with improper use, and you may have a physical problem that can only be discovered through a doctor’s examination. See IPA’s Catheters page for more details.

If you are seeking Federal employment, an important regulation to be aware of is that SAMHSA regulations apply to you. Under these regulations, ONLY a Medical Review Officer (MRO) can make the determination that a failure to provide a sample is a refusal to test. The MRO is a person who reviews drug test results, and usually is not present at the time of the test. If you bring documentation of your paruresis with you to the test site and can’t provide a sample, the MRO could be your best friend. Make sure that person gets your documentation.

If the drug test is several weeks away, you have time to desensitize to the drug test situation by working on some simulated drug testing with a pee buddy acting as the drug-test monitor. Try to arrange most of the day to spend with the person, drink a fair amount of water throughout the day, and ask the person to choose random times (unknown to you) to whip out a cup and say "time for a sample."

If possible, use a restroom that closely simulates the one you'd find at the lab. Have your buddy simulate as closely as possible what the monitor would do, stand the same distance away, give you a time limit, etc. If you do this exercise several times a week for a few weeks, giving a sample will get a lot easier. It’s important to remember that your rate of progress may differ, so do not depend on this practice to get you through the test. Do all the other things listed in the summary below to increase your chances of having a good experience at the test. 

In summary:

If you have a few days before the test, do the following:

• Document your condition with a doctor (see sample letter below)
• Familiarize yourself with the DOT (Department of Transportation) or SAMHSA (Substance Abuse and Mental Health Services Administration) regulations so you can demand your rights if necessary.
• Be aware that the DOT and SAMHSA rules do not apply in most testing situations, particularly in the private sector.  Private employers have a great deal of freedom to do as they wish consistent with the laws of their own state.
• Ask your doctor for instruction on how to use a catheter
• Get an independent test of hair, oral fluid, or blood to establish you are not a drug user.

If you have a few weeks or months, do this:

• Document your condition with a doctor (see sample letter below)
• Get into a recovery program immediately
• Stay absolutely clean as far as drug use so that you can pass a hair test if needed
• Begin practicing simulated drug tests with a trusted person so you can reduce anxiety in the test situation.
• As the time for the test approaches, you will know from your rate of progress if you’ll need to learn to use a catheter in order to be sure you can provide a sample.

Once your doctor establishes a diagnosis of paruresis, here is a sample letter the doctor can provide that may help in persuading drug test labs to provide reasonable accommodation for you:  

"Re: Drug Testing (via urinalysis)

This is to document the fact that NAME has been a patient of mine since YEAR, and from the time of his first office visit, was unable to produce urine samples on demand, necessitating the need for him to bring urine samples from home. The inability to urinate on demand or under time pressure (and also frequently in the presence of others in a public setting) is called paruresis (more commonly known as "shy bladder") and is a bona fide social anxiety disorder listed in the Diagnostic Statistical Manual of Mental Disorders IV with Code 300.23.

NAME has shared with me that he is quite willing to be drug-tested at work, as frequently as he is selected to do so, but given his paruresis condition which in the past he has attempted to over-come by drinking un-healthy and potentially-dangerous amounts of water, I suggest an alternate form of testing (such as saliva, sweat, hair or blood analysis) be employed."