Opioids and Fentanyl Epidemic Changing the National Landscape for Drug Testing

Written by Lucas Kibby, CleanFleet

The U.S. is in the middle of an opioid epidemic. According to the U.S. Department of Health and Human Services, more than 28,000 people died of opioid overdoses in 2014.

That is more than any past year, and what is one of the most dangerous culprits? Fentanyl.

The Center for Disease Control (CDC) reports that between 2013 and 2014 there was an 80% increase in overdose deaths attributed to synthetic opioids, such as fentanyl.

Together, this epidemic is changing the discussion of drug testing from Congress and across individual states.

The opioid epidemic affects millions

Abusers frequently began taking prescription opioids under a doctor’s care, then became addicted. Approximately 1.9 million Americans met the criteria for prescription painkillers “use disorder” based on their use of prescription opioids in the past year, SAMHSA (Substance Abuse and Mental Health Services Administration) reports.

In fact, SAMHSA reported, 4.3 million Americans are engaged in nonmedical use of prescription opioids, meaning they are taking these drugs without medical authorization, often purchasing them on the black market.

Similarly, the American Society of Addictive Medicine found that, in 2015, 2 million adult Americans had a substance use disorder involving prescription opioids.

Fentanyl is adding to the alarming rise of overdose deaths

Fentanyl is a synthetic opioid which is often prescribed to treat severe pain, such as in cancer patients, but is 40-50 times more potent than heroin and carries a high risk of overdose.

Illicit fentanyl, manufactured in foreign countries and then smuggled into the United States, is a rising factor in the current overdose epidemic.

According to the DEA, China is the primary source of fentanyl sent to Mexico, U.S. and Canada causing 700 people dying between late 2013 and late 2014.

It is usually mixed into heroin products or pressed into counterfeit prescription pills, sometimes without the users’ awareness, which often leads to overdose.

The crisis even became an issue during the 2016 presidential campaign. Republican Donald Trump told a New Hampshire crowd, “I’m going to stop the drugs from pouring across the border, and that’s a promise.”

And why did Trump say this in New Hampshire? The Office of the Chief Medical Examiner in New Hampshire is projecting 488 people will die in 2017 from drug overdoses and the majority of them will involve fentanyl.

DOT wants to add common opioids to driver drug testing panel

With the Department of Transportation’s (DOT) goal to harmonize with the Health and Human Services (HHS) guidelines, the DOT proposed to add four commonly abused opioids to the driver drug testing panel in urine tests.

Slated to take effect October 1st, 2017 (unknown implementation date), HHS indicated that approximately 1% of the submitted specimens is expected to be confirmed positive for the added opioids, according to non-regulated workplace drug testing in 2011 and 2012.

Regarding the Trump Administration’s 60-day regulatory freeze on all recently published regulations for review, the proposed rule should not be affected because the rule is open for a 60-day comment period and this rule is safety related which is exempt from the Administration’s freeze.

The biggest impact this proposed rule could have on DOT regulated companies is that this would increase the percentage of positive tests during Random testing of CDL drivers.

The most recent data has the positive rate during random tests is 0.9% and adding the opioids will easily move it above the 1% threshold and stay there for the foreseeable future, causing 50% of drivers to be tested during random tests.

Pilots and TSA officials are affected too

A KGW investigation found that nationwide, 858 TSA workers tested positive for drugs or alcohol between 2010 and 2016, according to federal records obtained through a Freedom of Information Act request.

In 2015 alone, more than 1,500 drug tests were verified positive out of more than 218,000 tests on safety sensitive employees, which include pilots, mechanics, flight instructors, flight attendants, aircraft dispatchers, ground security coordinators, non-TSA aviation screeners, and non-FAA/military air traffic controllers.

On March 16^th, 2017, the opioid epidemic may be showing up with pilots when a Spirit Airlines pilot and his wife were found dead at their home, most likely the result of a lethal heroin-fentanyl mixture.

The Dayton Daily News reports that the pilot last flew on March 10, 2017 and investigators offered no indication that the pilot used drugs while piloting an aircraft.

The Federal Aviation Administration requires pre-employment, post-accident, reasonable suspicion, and random drug test for pilots, but pilots are not required to be drug tested during annual physical exams.

But gaps in testing may be making it difficult to determine how pervasive the opioid problem is in the aviation industry. Random testing requires every safety-sensitive employee have an equal chance of being tested each time selections are made, meaning a pilot could theoretically go an entire career without testing.

Pilots provide urine samples during a physical exam to check for diseases, but not drugs. There are many who believe having this urine sample to be tested for drugs as well is one solution in understanding how pervasive this problem could be.

Opioid epidemic has made hiring harder for businesses

Pre-employment drug testing and the opioid epidemic is complicating the hiring of new employees. According to the National Safety Council, 71 percent of U.S. employers say they have been affected in some way by employee misuse of legally prescribed medications, including opioids.

“Misuse has grown rapidly, and employers have struggled to keep pace,” said Deborah Hersman, president and CEO of the National Safety Council during a press briefing.

Quest Diagnostics found that 4 percent of 9.5 million urine drug tests performed in 2015 were positive, a 10-year high.

One adviser suggests employers to work with their insurers to cover alternative therapies so that employees can avoid taking opioids or other addictive medications for chronic pain.

Worksite policies overlook prescribed drugs, fentanyl, and other opioids

The best suggestion for employers is updating their workplace drug and alcohol policies. Hersman said that most employers have a drug-free workplace policy directed at illegal drugs, along with an alcohol abuse policy, but most don’t have a prescription drug policy in place.

So can employers screen for fentanyl and other opioids with a urine drug test? Yes, a urine, hair, and saliva sample can be used to look for fentanyl during a drug test. In urine, fentanyl can be detectable for 1-2 days after use.

Employers should update their policies to include testing for prescription painkillers, fentanyl, and other opioids.