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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.
While I can appreciate that different tests have varying levels of accuracy, the most basic urinalysis is capable of detecting the presence of THC. Why are we faced with a national health emergency where our only option is to rely on patient history (if prior history exists)?
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