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For all the docs out there who prescribe add meds, do you do urine drug testing on everyone on add meds? Here, I do it but I see some docs who don't do it and some docs who do. Most docs I talk with, if the drug is not in their system, the patient tells him he hasn't taken it for a few days and it is no big deal. If other drugs are found, other docs tell the patient don't do them anymore or the doc won't write add meds in the future. How do you all do add drug testing?

This would depend on the child.
I do a lot more meds in grade school kids than high school, the latter are at higher risk.
How involved are the parents, what's my sense of where the child is coming from? All these play a roll.
What will you do if they are positive for their med and cannabis? This will be the top abused drug.

I just test urine on older teenagers and adults. Taking an ADD is hard enough on a kid without making them pee in a cup. I test once or twice a year. A positive result for a drug of abuse would be a wonderful opportunity for a conversation that might later save a life.

As an IM , addiction medicine, and pain physician, I can tell you from my experiences. There is a drug we use occasionally, suboxone, which basically allows the DEA to come in unannounced to review charts and record keeping on patients who are receiving suboxone for opiate dependency. There is nothing in the regs that say that urine testing is necessary, however the agents always ask to see the results. From what I have been told, a big concern is confirming that controlled substances you are prescribing are actually being taken by the patient. We do this as a routine to protect ourselves as well as our patients. I.e. Someone alleges that a patient is selling their meds, there is at least some random proof that medication are present in the urine. From what the DEA has told me, in the case of addiction patients, the presence of other drugs (I.e. Relapse) is a clinical decision not a legal one.
With that being the case, we do testing in a random fashion on anyone receiving controlled. There is a side benefit, if the urine is sent off for GC/MS confirmation you can see the rations of the metabolites of the ADD drugs and sometimes use that as a reason to suspect someone is a fast or slow metabolized which can be confirmed by pharmacokinetic testing. This information has led us to Change medications on Monday patients resulting in better clinical outcomes.
Call me cynical, but when it comes to children, how do you know the parents are not diverting their child's ADD Rx. In the addiction part of my practice, it is not an unusual finding.