You can add location information to your Tweets, such as your city or precise location, from the web and via third-party applications. You always have the option to delete your Tweet location history. Learn more
Outbreak investigations -whether foodborne or vape product related- are hard. Requires input from/ cooperation by patient, family, physician, lab, local & state health department, and sometimes coroner. @CDCgov is giving the best advice it can based on the data it has/ gets.
I understand your question, and the honest answer is that CDC can’t compel any of 
folks to get a urinalysis or any other test, and even if they could, it would still require an index of suspicion. Local docs aren’t gonna urine test everyone who comes in w cold/ flu symptoms.
And even when urinalysis is done, there are different tests that are better or worse at detecting substances/ metabolites. Long story short, a good history - which is dependent on patient and physician- is the best we have in most cases. Hard to establish “certainty.”
I sympathize with the difficulties in establishing "certainty," however, as evidenced by this outbreak, patients may or may not be forthcoming with prudent information regarding substance use. I still stand by my statement that the CDC's wording for this could use better clarity.
As I understand (based on my limited experiences), if a patient's symptoms are inconsistent with a specific diagnosis (or the patient is unconscious), doctors perform toxicology screenings to rule out possible causes. Does that not apply? Is that data unavailable to the CDC?
If it's a patient in pain they are compelled to get urinalysis or are refused treatment. People can and are tested for suspicion based only on their symptoms. You are lying again, seek help.
Twitter may be over capacity or experiencing a momentary hiccup. Try again or visit Twitter Status for more information.
