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The parent knows better than to ask why and retrieves the invariably bristling, sullen “What is up with this lame doctor?” patient.

“It’s not your pee,” I say.

“It’s not my pee?” Shock, outrage, and denial.

“It’s not your pee.” This can go on for a while.

“How can you tell?”

“It’s too cold. And it came from a girl. If your parents think you need a drug test and you can’t beat the test with someone else’s pee, you don’t have a gift for getting away with things.”

“Are you going to tell my parents?”

“No, you are. I’d rather not deal with your parents directly. The only reason for me to test your urine for drugs is to help you stay clean when you’ve decided that’s what you want. The fact that you’re fifteen years old trying to pass off someone else’s urine as your own means to me that marijuana is probably not your friend and might get in the way of whatever else it is you want your life to be about. Did you pay for this pee or was it from a friend?”

On the Internet you can buy fake pee to pass drug tests that comes in a realistic penis container so that when the test is strictly monitored, which means someone is in the bathroom with you and watches the pee go into the cup, you can squeeze the pee into a cup from the fake penis.

I don’t monitor my patients giving urine, mostly because my job is hard enough without hanging out in bathrooms with adolescents who are trying to pee. Partly I’m trying to give them a shred of privacy and dignity, and partly I’m curious as to whether, given the chance, they’ll try to give me someone else’s pee. Catching them at it, especially early in the process, especially when I’m not really trying, has led to conversations in which the patient actually ends up caring about whether or not he does drugs. Sometimes.

When the urine drug screens I send out are negative, sometimes it’s even because the patient involved isn’t doing drugs. Consider all the possibilities.

If I see someone and I don’t recognize him because all the softness and pinkness has melted out of his face, I assume he’s doing drugs. Addictive drugs take all your little problems, like having a difficult family or feeling insecure, and trade them in for one big problem, having to have drugs. Childhood isn’t fun for everyone. One of the attractive things about drugs is that they give children a way to stop being a child. Bye-bye pain and fear; hello addiction.

If there is a last judgment, if there’s an outside chance of a last judgment, do you want to be standing there with someone else’s pee?

Parents tend to think that a negative or positive drug test accomplishes more than it possibly can. If their child has clean urine, all is not necessarily well. If the test is positive, very few children, confronted with proof of drug usage, will stop. They can’t. I care about the results of the drug test, but the real goal is for the child to have a life that doesn’t involve being in my office, handing me a cup of urine that might not be his.

A positive drug test is an opportunity for collaboration. If we can’t come up with clean urine, we’re going to have to keep doing tests that cost money and take valuable time out of our day. The easiest way to come up with negative drug tests is to stop doing drugs, but it goes better if you let the child think of that on his own. Then not doing drugs is no longer a moral issue but a practical, cost-effective way to deal with the annoying problem of having illegal drugs in your urine.

“Hey, Jack, this is Dr. Vonnegut. I’ve got some good news and some bad news. There’s no more THC in your urine and that’s great, but now there are some cocaine metabolites in there.”

“I wonder how those got in there?”

“I don’t know, Jack, maybe you left the window open or something, but now we have to do another test. Cocaine is a whole different deal. Are you still talking to Frank? Going to those meetings? Do you want to come in and talk to me about it or just go over to the lab and pee?”

Most of life is a soggy mess, but you can make the world a very different place. As hard as addiction