Oxycodone, first developed almost a century ago, is a powerful opioid analgesic with serious addictive potential.
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Drug Testing News
Phencyclidine is a recreational drug that was marketed in the 1950s as an anesthetic pharmaceutical drug. It was taken off the market due to its dissociative hallucinogenic side effects.
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Tramadol is an synthetic opioid analgesic with some antidepressant effects. It is used to treat moderate to moderate-severe pain. It is used and metabolized in the body similarly to codeine.
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Tricyclic antidepressants (TCAs) are a very large class of antidepressant drugs. A small sampling includes: amitriptyline (Elavil) amitriptylinoxide (Ambivalon) amoxapine (Asendin)
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According to the CDC, death rates involving synthetic opioids (other than methadone), which include drugs such as tramadol and fentanyl.
- In 2017, more than 28,000 deaths involving synthetic opioids (other than methadone) occurred in the United States, which is more deaths than from any other type of opioid.
- Also in 2017, the largest increase in synthetic opioid overdose death rates was in males aged 25-44.
- Deaths from synthetic opioids significantly increased in 23 states and the District of Columbia from 2016 to 2017.
- West Virginia, Ohio, and New Hampshire had the highest death rates from synthetic opioids.1
Synthetic opioid overdose death rates (other than methadone) increased across all demographics, county urbanization levels, and numerous states. State reports have indicated that increases in synthetic opioid-involved deaths have been associated with the number of drug submissions obtained by law enforcement that test positive for fentanyl but not with fentanyl prescribing rates. These reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical.2,3,4
There are also fentanyl analogs, such as acetylfentanyl, furanylfentanyl, and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Recent surveillance has also identified other emerging synthetic opioids, like U-47700.5 Estimates of the potency of fentanyl analogs vary from less potent than fentanyl to much more potent than fentanyl, but there is some uncertainty because potency of illicitly manufactured fentanyl analogs has not been evaluated in humans. Carfentanil, the most potent fentanyl analog detected in the U.S., is estimated to be 10,000 times more potent than morphine. 5,6
References
- Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. WR Morb Mortal Wkly Rep. ePub: 21 December 2018.
- Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths – 27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43.
- Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2013-2015. Morb Mortal Wkly Rep. 2016;65(33):844-9.
- O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903.
- O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202.
- O’Donnell J, Gladden RM, Mattson CL, Kariisa M. Notes from the Field: Overdose Deaths with Carfentanil and Other Fentanyl Analogs Detected – 10 States, July 2016-June 2017. MMWR Morb Mortal Wkly Rep. July 2018. 67(27);767–768.
Fentanyl is a synthetic (man-made) opioid 50 times more potent than heroin and 100 times more potent than morphine. There are two types of fentanyl:
- Pharmaceutical fentanyl is primarily prescribed to manage severe pain, such as with cancer and end-of-life palliative care.
- Non-pharmaceutical fentanyl is frequently referred to as illicitly manufactured fentanyl (IMF). IMF is often mixed with heroin and/or cocaine or pressed into counterfeit pills—with or without the user’s knowledge.
Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery and in cases of extreme injury.2 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.3 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects.
In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.3,4 Street names for illegally used fentanyl include Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.
Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.5 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.
References
- https://www.drugabuse.gov/publications/drugfacts/fentanyl
- Nelson L, Schwaner R. Transdermal fentanyl: Pharmacology and toxicology. J Med Toxicol.2009;5(4):230-241. doi:10.1007/BF03178274
- Garnock-Jones KP. Fentanyl Buccal Soluble Film: A Review in Breakthrough Cancer Pain. Clin Drug Investig.2016;36(5):413-419. doi:10.1007/s40261-016-0394-y
- Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration. Fentanyl Fact Sheet. March 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf.
- on. Acetyl fentanyl Fact Sheet. July 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf.
Methamphetamine drug testing entails an analysis of the chemical reaction performed on a biological specimen to detect the presence of methamphetamine metabolites in the person’s body. It can be done using hair, urine, blood, or oral fluid.
The most common drug test administered in the workplace and schools is urine drug testing. Methamphetamine Drug Test Strips are built into instant kits like the 10 Panel CLIA Waived Magenta Dip Card to provide rapid results. When a person has positive drug test results, it means that person has recently used methamphetamine or some other drugs.
Drug testing for methamphetamine helps authorities assess whether or not the person has recently used the drug. This is helpful, especially during forensic investigations. Parents can also administer methamphetamine drug testing through the use of methamphetamine drug test kits to ensure a drug-free family.
Detection Period
Detection period is the timeframe of how long the drugs can be detected in the biological sample. This will vary based on the drugs being tested for and by the person being tested. The detection period depends on the drug class, amount and frequency of use, age, and overall health.
According to LabCorp, for a methamphetamine urine drug test, the detection period is 3 to 5 days; for a hair test it is up to 90 days and for blood and oral fluid, it is within 12 hours.
Although some marijuana derivatives have been approved for use in chemo-induced nausea and epilepsy treatments,1 the Food and Drug Administration (FDA) has not widely approved marijuana as a safe and effective drug.2 However, state laws continue to change regarding medical and recreational marijuana. As a result, the marijuana industry may not adhere to FDA regulations prior to bringing consumer goods to market and consumers may be using products that may not be safe for human consumption like synthetic cannabinoids.3
In February 2019, more than 50 pounds of medical marijuana were recalled in coordination with the Bureau of Marijuana Regulation due to potential contamination with chemical residue, E. coli, arsenic, cadmium, and Salmonella.4 The events unfolded in Michigan, a state that passed medicinal marijuana legislation in 2008. Though the recall was voluntary, it was not the first. Just one month prior in the same state, the first 2019 recall of medical marijuana products5 brought national media coverage and questions about the safety of the drug.
Michigan’s Department of Licensing and Regulatory Affairs (LARA) published consumer information about the recalled products in its January public health and safety bulletin. The notice clarifies that manufacturers who produced the tainted drug were disposing of or retesting the recalled medical marijuana products due to concern for patients who may already have compromised immune systems.5 This is a concern echoed by experts who do not know what effects long-term use of marijuana may have on such patients.1
These recalls highlight the lack of consumer-centric, federal regulation of the marijuana manufacturing process by agencies like the FDA. In addition, the drug remains a Schedule I controlled substance as detailed by the Controlled Substances Act, which means there is no currently accepted medical use and a high potential for abuse.6
As states continue to evaluate their marijuana laws, public awareness regarding what marijuana is and isn’t should continue to be carefully considered. The National Institute on Drug Abuse supports findings that the drug is addictive, can have short- and long-term side effects, and may not be safe.7
1 National Institute on Drug Abuse (NIDA.) “Is marijuana safe and effective as medicine?” https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine. Updated June 2018. Accessed February 27, 2019.
2 Food and Drug Administration. “FDA and marijuana.” https://www.fda.gov/newsevents/publichealthfocus/ucm421163.htm. Update June 2018. Accessed February 27, 2019.
3 Food and Drug Administration. “Statement from FDA warning about significant health risks of contaminated illegal synthetic cannabinoid products that are being encountered by the FDA.” https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm614027.htm. Update August 2018. Accessed February 27, 2019.
4 The Detroit News. “Michigan faces health risks from tainted medical marijuana.” https://www.detroitnews.com/story/news/local/michigan/2019/02/04/michigan-risks-medical-marijuana-recalls/2636648002/. Published February 2019. Accessed February 27, 2019.
5 Michigan Department of Licensing and Regulatory Affairs. “Public Health and Safety Bulletin | Voluntary recall of marijuana products.” https://www.michigan.gov/documents/lara/Public_Health_and_Safety_Advisory_1-4-2019_Final_642608_7.pdf. Update January 2019. Accessed February 27, 2019.
6 Drug Enforcement Agency. “Drug Scheduling”. https://www.dea.gov/drug-scheduling. Accessed February 27, 2019.
7 NIDA. “Is marijuana addictive?” https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive. Updated June 2018. Accessed February 27, 2019.
When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.2
The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.3
Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose. To learn more about the mixture of fentanyl into other drugs, visit the Drug Enforcement Administration’s Drug Facts on fentanyl.
How does fentanyl affect the brain?
Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.4 After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug seeking and drug use take over their lives.
Fentanyl’s effects include
- extreme happiness
- drowsiness
- nausea
- confusion
- constipation
- sedation
- problems breathing
- unconsciousness
References
- https://www.drugabuse.gov/publications/drugfacts/fentanyl
- American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776-789.
- Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration
- on. Acetyl fentanyl Fact Sheet. July 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf.
Drugs have certain “detection windows”—the amount of time after ingestion during which evidence of their use can be detected by a drug test. Though it might not be wise to publicize detection windows and invite employees who may use drugs to push their limits, when implementing drug testing, it is important to understand them. For instance, alcohol is absorbed and eliminated more quickly than other drugs. This is why post-accident testing procedures often require testing for alcohol to occur within two hours. Other drugs are eliminated from the system at different rates and thus detectable for different periods of time, often long after the drug’s effect has worn off. The following are estimates of the length of time that certain drugs are detectable:
- Alcohol – 1 oz. for 1.5 hours
- Amphetamines – 48 hours
- Barbiturates – 2-10 days
- Benzodiazepines – 2-3 weeks
- Cocaine – 2-10 days
- Heroin Metabolite – less than 1 day
- Morphine – 2-3 days
- LSD – 8 hours
- Marijuana – casual use, 3-4 days; chronic use, several weeks
- Methamphetamine – 2-3 days
- Methadone – 2-3 days
- Phencyclidine (PCP) – 1 week