Federal Drug Officials Authorize Testing for Fentanyl
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Testing for use of the synthetic opioid fentanyl has been approved by U.S. drug officials, clearing the way for truck drivers and others in federally regulated occupations to be subject to testing for its use.
The Department of Health and Human Services in a Jan. 16 Federal Register post made the announcement, noting that fentanyl now accounts for a large proportion of overdose deaths in the country. The use of both urine and oral fluid drug panels to test for the drug will be authorized for federal agencies beginning in July.
Drug officials since 2015 have been weighing whether to add fentanyl to the list of tested substances for truck drivers and other federally regulated workers. Its growing use as a standalone substance as opposed to combined use with heroin and other substances compelled this move.
Fentanyl is a potent synthetic opioid drug. It is approved by the Food and Drug Administration for pain relief, according to the U.S. Drug Enforcement Administration. But DEA notes that it is approximately 100 times more potent than morphine and 50 times more potent than heroin. Fentanyl can be snorted or sniffed, smoked, taken orally by pill or tablet, or spiked onto blotter paper and patches. It has become the third most frequently identified drug in U.S. testing and accounted for 13.81% of all drugs reported by forensic laboratories, according to a recent report of the National Forensic Laboratory Information System.
Officially, this action by HHS merely clears a path for the Department of Transportation and other federal agencies to begin fentanyl testing. Federal rules require individual agencies to adopt their own version of the testing rule, but most are likely to mirror the HHS requirements.
Lyles
That said, it’s possible DOT could have its own rules in place in time for a July start, said Brenna Lyles, director of safety policy for American Trucking Associations. “DOT could begin testing on July 7, if they finish their own rulemaking by then,” she said.
The trucking industry has long worked to increase awareness of the tragic effects of fentanyl abuse by supporting addiction and recovery programs, endorsing legislation like the END FENTANYL Act, and partnering with law enforcement. Since last summer motor carriers have been able to join the fight by purchasing trailer wraps with fentanyl public service announcements.
In comments filed on the rule proposal, ATA said it “supports the addition of fentanyl and/or norfentanyl to the authorized drug testing panels for federally regulated employers, as proposed by HHS. While fentanyl continues to be an additive or filler in illicit drugs detected in a traditional 5-panel test, the drug is increasingly contained in counterfeit prescription medications, like Adderall, Xanax and oxycodone, commonly taken without other drugs. Within the trucking industry, motor carriers that perform hair follicle testing have seen a substantial increase in positive fentanyl tests in recent years.”
A Trucking Cares Foundation trailer raising awareness of the fentanyl's dangers is displayed in Times Square in August 2024. (Diane Bondareff/Associated Press)
ATA added, “According to one drug testing provider, among three motor carriers who performed hair testing that included fentanyl in their non-DOT testing program, 137 fentanyl positives were detected in 2023 — of which, 77 contained fentanyl only (56%) and 60 showed fentanyl alongside other drugs (44%).”
To authorize new drug test panels and changes, HHS is required to do a thorough review of relevant information, including drug prevalence estimates, the current state of the science, laboratory capabilities, costs associated with the change and benefits of the change to federal agencies. HHS-certified test facilities and medical review officers will incur initial costs for administrative and programming changes for the addition of fentanyl, the agency said.
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Using this process for recommending changes to the analyte table, HHS has proposed but not yet removed testing of methylenedioxyamphetamine and methylenedioxymethamphetamine due to low test failure rates.
Similar to other opioid analgesics or pain relievers, fentanyl produces effects such as relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea and vomiting, urinary retention, pupillary constriction and respiratory depression. An overdose can cause stupor, changes in pupil size, clammy skin, cyanosis, coma and respiratory failure leading to death. The presence of a triad of symptoms such as coma, pinpoint pupils and respiratory depression strongly suggests opioid intoxication.
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