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Fentanyl technically has been around since the 1960s, but experts now are labeling the synthetic drug as “emerging,” largely because users are dying in greater numbers and it has become more readily available for legal and illegal use.
Now, for the second time in about four years, Congress has asked drug agencies if federal workers, including truck drivers, should be tested for use of the drug used legally for pain and illegally for its high.
Previously, federal drug czars said no to adding a test panel for fentanyl because it was being mixed with heroin, making it difficult to detect in drug tests. Officials reasoned that users could be identified through testing for heroin, according to Ruth Winecker, a senior research forensic scientist at RTI International.
“Back then, users were being identified through morphine testing,” Winecker said in a presentation June 11 to U.S. Substance Abuse and Mental Health Services Administration’s Drug Testing Advisory Board. SAMHSA is a subagency of the U.S. Department of Health and Human Services, which is responsible for issuing drug-testing guidelines for the government.
“When we originally evaluated fentanyl, there seemed to be multiple mixtures of fentanyl with other drugs,” DTAB Chairman Ron Flegel said. “I think that is changing over time. Now you see a lot more fentanyl by itself and/or mixed in as a contamination product of other drugs.”
Flegel added, “Specifically, as we try to move forward around the testing of synthetic opioids, I think that people that are illicitly using those drugs are moving in new directions, and some of that is due to cost and other issues.”
This time around, a case could likely be more easily made to add the drug to federal testing panels, which currently include urine testing for such commonly abused substances as marijuana, four synthetic opiates, PCP, cocaine and amphetamines. Increasing deaths associated with fentanyl and its easy reach are becoming more apparent to the drug testers and regulators.
“One-half or more of drugs being identified contain only fentanyl,” Winecker said.
In limited research, she said initial tests for fentanyl showed commercial lab positivity rates of 2.7% to 3.7%. Only two commercial HHS-certified labs currently test for fentanyl, Winecker said.
When it passed the Fighting Opioids in Transportation Act in late October, Congress requested that HHS report back on its decision whether the testing of fentanyl would be “reliable and cost-effective.” So far, the agency is late in meeting Congress’ six-month deadline for a decision.
According to the U.S. Drug Enforcement Administration, fentanyl is a synthetic opioid that is 80 to 100 times stronger than morphine.
“Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin,” the agency said in a fact sheet. “Because of its powerful opioid properties, fentanyl is also diverted for abuse.”
DEA said fentanyl use can result in an intense, short-term high; temporary euphoria; slowed respiration; reduced blood pressure; nausea; fainting; seizures; and death.
Clandestinely produced fentanyl primarily is manufactured in Mexico, DEA said.
In its 2018 National Drug Threat Assessment, DEA said, “Fentanyl’s availability is widespread and increasing, while also becoming more geographically diverse.”
DEA said in recent years “sudden outbreaks” of overdose deaths have occurred.
The Centers for Disease Control and Prevention reported a 103% increase in synthetic opioid deaths from 2015 to 2016 — from 9,580 deaths to 19,413.
“Synthetic opioids are now involved in more deaths than any other illicit drug,” CDC has said.