The desire to light up or pop pills can lead to desperation when a drug user has to get tested.
Courts ask for them in custody cases and probation checks. In California, drug tests are administered after a job is offered and before a potential employee begins work.
Urine tests, the most common screening, are taken in a bathroom designed to prevent cheating.
Brian Culbertson walked FOX40 through the process at Comprehensive Medical Inc. in Sacramento.
“As you can see, there’s no sink, so there’s no way for them to get any running water,” said Culbertson.
That doesn’t stop people from trying. Of the 10 to 20 people who get tested each day at Comprehensive Medical Inc., Culbertson says about three get caught cheating.
He’s seen it all, from detox kits to fake genitalia. The most common way to cheat is by flushing the system.
Cheating on drug tests is a growing concern nationwide.
According to a recent study by the American Academy of Addiction Psychiatry, 58 percent of those who cheat on drug tests do so by trying to dilute their urine.
While that can result in a false positive, the watered down sample usually results in a re-test.
That often leads people to synthetic urine, used in various contraptions.
"This warms it up, it has a temperature strip, so you can see, 'Oh, am I in the right zone?'” said Culbertson, demonstrating one device.
Fake urine can be detected right away because the temperature is usually off.
"When you’re waiting in the lobby, the temp is rapidly cooling no matter what you do,” said Culbertson.
For the bold risk-taker there are bigger ticket items, like the whizzinator. It’s fake male genitalia used to dispense synthetic urine.
The problem is they’re easy to spot during an observed test, which is sometimes required.
"You can’t have anything on their hips. Pants need to come all the way down shirt has to come all the way up,” Culbertson said.
If cheaters aren’t caught using any of those methods, chances are they may be caught on camera.
In surveillance video captured last month, a man is seen in the waiting room accepting a urine sample from a woman.
"(She was) ultimately caught on camera and I doubt he’s working at that job,” Culbertson said.
In drug screenings for court cases, cheaters can go back to jail or face other legal consequences.
Employers suffer financially because they pay for tests and potentially lose an employee.
"Slows everything down. No the employer has to start back at square one to find a suitable candidate,” said Culbertson.
Comprehensive Medical Inc. tells FOX40 the most commonly detected drugs at their office are: marijuana, meth and heroin.