So I'm familiar with this organization for reasons.
USDTL itself is the real deal. Not a drug testing expert, but it's probable the assay used flags positive for Ecstasy in the presence of either MDMA and/or MDMA metabolites like MDA. Like the guy below you said, it's also common to separate out oxy from opiates - an opiate screen from this lab detects codeine, hydrocodone, hydromorphone, and morphine. The oxy screen flags positive in the presence of oxycodone and oxymorphone.
None of this is to say it's actually Elon's urine, though - I'd usually give USDTL the benefit of the doubt re: chain of custody, but the guy has too much money and brainwashees to totally rule out this being an unsupervised collection where someone else's pee was swapped in. Send me an uncut video of a hair collection, with the specimen id clearly marked and everything packaged up to forensic standards on camera, and I might have less doubt.
At least in that case, any fuckery after the fact is a great way to lose CAP accreditation.