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The cost of drug testing is making it harder for poor people to afford treatment

This article was published by and written by Elizabeth Brico.

When Laura Keck was pulled over for turning without a signal in Boulder, Colorado, her blood alcohol content was .08, just over the legal limit. She was a new grad student, still adjusting to the demanding schedule of academia. For the next two years, that would also include urinalysis tests up to six times per week as a result of her DUI charge—with out-of-pocket costs every time.

Across the United States, people are mandated to take drug tests for a variety of reasons, ranging from employment, to drug treatment, to probation. While employers and insurance companies typically cover these fees, court-ordered tests are often at the expense of the individual. The costs vary widely, and can result in hundreds of dollars of fees depending on type and location. For urine and saliva tests, costs run $25 to $80—though one facility in West Palm Beach, Florida is reported to charge as much as $2,300 for a urinalysis. Hair tests range from about $100 to $150 each. Regular breathalyzer tests are usually only a few dollars, but ignition interlock devices—the breathalyzer tests some people are required to install in their cars after getting a DUI—range from about $50 to $100 per month. As for how often individuals have to pay, it is entirely up to the courts. Most people are tested once or twice a week—or even just a few times a month, depending on the severity of the offense—but as Keck discovered, that number can go up drastically.

As part of her probation sentence, Keck was required to attend a Mothers Against Drunk Driving seminar but was given no formal treatment for alcoholism. The most demanding mandate was, by far, her drug tests. As she put it, “Basically all I had to do for a solid year was drug testing … There was no follow-up. They didn’t care if I was actually getting clean.”

Average urine tests can’t detect alcohol, so Keck was instructed to take an ethyl glucuronide urine test. Today these tests generally cost around $25 a piece, with some testing centers charging $75 to $100, but Keck was lucky—she only had to pay around $12 to $15 per test in 2012. It was the frequency of the tests that hit her pocketbook the most. Working as a waitress while also paying for living expenses, textbooks, and other school-related costs, Keck says she got by, but just barely.

Like many college students, Keck liked to drink with her friends. She says she was able to recognize that she was a problem drinker, but without any evidence-based treatment offered as part of her probation, she didn’t have much motivation or help discontinuing use. Instead of actually ceasing her drinking, she researched ways to get around the test. She discovered that if she drank about 10 cups of water before providing the sample, she could dilute her urine to the point that alcohol metabolites would be undetectable.

“I kept getting false negatives because I kept having diluted pee,” Keck admits. “Because of the false negatives I started having to go three to four times a week.” By the end of her probation she was required to test six days a week, costing her close to $100 weekly in drug testing fees alone. That doesn’t account for transportation costs or other probation fees, like the cost of classes and a mandatory donation to Mothers Against Drunk Driving.

Some might say it was Keck’s own fault that she had to test so much. After all, if she simply quit drinking, she could have passed without raising suspicions. But addiction is defined by the inability to stop despite negative consequences. It makes sense that someone faced with a penalty but no treatment would have difficulty discontinuing use.

“I’m not drinking and driving,” she says. “I don’t want to deal with that anymore. So at least that aspect worked out, I guess.” Nevertheless, she admits to nursing a hangover during the interview. Maybe there’s one less drunk driver on the streets—certainly a good thing—but it seems Keck’s money could have been better spent in a treatment program that provides real help for her problem drinking.

It’s not just people who “cheat the system” who are paying exorbitant costs. Kenny Ernst was placed on probation in Palm Beach County, Florida for one year in 2016 on a petty theft charge. He traded five years in prison and a felony larceny charge for the year of probation, which is a common trade-off among people who accept plea deals instead of going to trial. But unlike prison, probation shifts the financial burden of the sentence from the government to the probationer—and drug testing fees are no small part of that burden.

There are currently 3.7 million people on probation in the United States and 840,000 on parole. Arrest rates are already considerably higher for people of color and low-income individuals, especially for drug-related offenses. Because probation is often offered as part of a plea bargain, low-income offenders who can’t afford private lawyers or trial costs are more likely to become caught up in this financially demanding system.

Ernst, who studied photojournalism in college before becoming addicted to heroin, says he was stealing to fuel his addiction, which was in full swing when he was arrested. Opioid addiction is notoriously difficult to kick; in Ernst’s case this was one of many relapses during his long struggle for sobriety. Unlike Keck, Ernst entered a recovery program and managed to kick his habit in order to genuinely pass his drug tests. Unfortunately, the probation fees prevented him from enjoying the financial benefits that should accompany the cessation of an expensive drug habit.

“I paid 50 dollars a visit [to my probation officer],” he says, “and 25 whenever I had to be drug tested.” Probation drug tests are random, so Ernst essentially had to be ready with $75 at all times, just in case. He says he had to take up to three tests per month, in addition to regular probation visits.

In response to the question of whether probation helped his recovery, Ernst said “absolutely not.” “If anything, it made you want to use more. Imagine the pressure. Bills are hard enough to cover, then I have to go in and pay for a drug test.” He describes days when he would have $100 set aside for groceries, until he got the call that he needed to come in for a test. Suddenly that $100 was reduced to $25.

If someone doesn’t have the money for the drug test, probation officers get to decide whether or not to “violate” someone, which could lead to incarceration. The single time Ernst didn’t have the money for his test, his probation officer let him off the hook until he was able to borrow the $25. But that was a choice; if his probation officer had been in a bad mood or simply didn’t like him, Ernst could have been sent to jail or prison.

It’s supposed to be illegal to incarcerate people for being unable to pay debts, but court-ordered fees like probation and drug testing open the doors for exactly that. Human Rights Watch has published several reports following the stories of low-income people involved in probation who have experienced consequences like homelessness and imprisonment due to the cost demands of these programs.

Ernst and Keck were relatively lucky. Their finances were consumed by drug testing and other related fees, but they were able to pay. What about those who aren’t? Some judges will waive fees when clients can prove they are indigent, but again, that’s the judge’s choice. For many who are caught up in a substance use disorder, the difference between freedom and incarceration is little more than dollars and chance.—a project of the Center for American Progress—is dedicated to covering poverty in America by lifting up the voices of advocates, policymakers, and people struggling to make ends meet.

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It's disheartening to hear that the escalating costs of drug testing are becoming a barrier for those in need of treatment, particularly for individuals facing financial challenges. Healthcare should be a right, not a privilege, and the rising expenses associated with essential services like drug testing only exacerbate existing disparities. This issue highlights the urgent need for more accessible and affordable healthcare options. Introducing or expanding online pharmacy services could be a vital step in the right direction. By providing affordable medication options online, we could alleviate some of the financial burdens that prevent people from seeking the treatment they require. It's time for a comprehensive reevaluation of healthcare affordability, ensuring that everyone, regardless of their economic status, has the…

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