Expanded Opiate Drug Testing

Expanded Opiate Drug Testing

Testing for opiates is very common in the drug testing industry and many drug screening panels include testing for opiates. Testing for expanded opiates is becoming more popular and means that the drug test panel being performed expands the opiate drugs being tested for in the test. Common drug testing panels typically test for opiates, but not necessarily expanded opiates.

The most common and well known drug testing panels, a 5 panel or 10 panel drug test, always include opiates but most likely just test for codeine and morphine. Several years ago, the United States Department of Transportation (DOT) began requiring the opiate panel to include testing for 6-Acetylmorphine also known as 6-AM. Testing of the 6-AM metabolite is used to confirm the presence of heroin in a urine or oral fluid specimen. When you order a 5 or 10 panel drug test, it may or may not include the 6-AM metabolite for heroin; it will depend on the lab you use and the components of the 5 or 10 panel as they may vary by vendor. To be sure heroin is included, always ask for a “DOT LIKE” 5 or 10 panel drug test. The “DOT LIKE” tests mirror the DOT test and do include testing for 6-AM.

What about other opiate drugs like Lorcet, Vicodin, Numorphan, OxyContin, Dilaudid, Percocet and more? These drugs are not detected in the standard 5 or 10 panel drug tests mentioned above and they are not even included in the DOT panel or “DOT LIKE” option. These opiate drugs are typically used to treat moderate to severe pain. The pain drugs listed above fall into the categories of Hydrocodone, Hydromorphone, Oxycodone and Oxymorphone. When we discuss testing for expanded opiates, most SAMHSA certified labs in the United States would recognize this as testing for these categories - Hydrocodone, Hydromorphone, Oxycodone and Oxymorphone. But it is important to double check because some laboratories do not include the Oxycodone as an expanded opiates and separate out the Oxycodone as a separate test. Your drug testing provider should be discussing these options with you and if not you should definitely ask.


SAMHSA certified laboratories

I mentioned SAMHSA certified laboratories and it is important to understand what that means and how it may affect you. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. SAMHSA sets standards for workplace drug testing with the publication of the Mandatory Guidelines for Federal Workplace Drug Testing. Laboratories can become certified by HHS - SAMHSA to conduct drug testing for federal agencies and specific federally regulated industries. With this certification, these labs are subject to rigorous quality control measures and quarterly inspections. You won’t find a better quality control program with any other laboratory. In other words, make sure the lab you use is certified!


Testing for Expanded Opiates

Now back to the testing for expanded opiates. Below we will discuss the typical panels offered by Quest Diagnostics and LabCorp for expanded opiate testing. It is important to note that there are other pain mediation drugs such as tramadol (Ultram), meperidine (Demerol), and fentanyl (Actiq, Duragesic, Fentora) that are not included with expanded opiate testing but can be tested for when health care professional panels are ordered or they can be added to some test panels. These health care professional panels are also listed below.

With Quest Diagnostics, the typical panel we order is a 10 Panel DOT Like with Expanded Opiates and Oxycodones. Quest Diagnostics calls this test panel code - 29550N with the description: SUBSTANCE ABUSE PANEL 10-50, OPI, 6AM, MDA, A5, C15, T - this test includes specimen validity testing and the following drugs:

Cocaine, Marijuana (THC, cannabinoids), Phencyclidine (PCP – angel dust), Amphetamines (including ecstasy and methamphetamines, also known as crystal meth), Opiates (including heroin – 6-AM, codeine, morphine, hydrocodone, hydromorphone), Benzodiazepines (such as Xanax), Barbiturates, Methadone, Propoxyphene, Methaqualone (Quaaludes) and Oxycodones including Oxymorphone and Oxycodone.

Note that the Oxycodones are separated from the expanded opiates. It is important to know whether your laboratory is including the Oxycodone in your expanded opiate panel.

With LabCorp, we also typically order a 10 Panel DOT Like with Expanded Opiates and Oxycodones; this is Labcorp panel code 765480. Labcorp lists the drugs just as above and also includes specimen validity testing in the panel description.

Panel Options

We mentioned specific health care professional panels that are used to detect drugs such as Tramadol, Fentanyl and Meperidine. This may get confusing from laboratory to laboratory as each lab calls these panels by different names. Typically, what we recommend is that the client provide a list of what drugs they need in a panel and then we contact the lab to provide a panel that includes those drugs. Below is a list of the common drugs available in health care professional panels or MedPro panels as some labs call them.

  • Amphetamines including ecstasy and methamphetamines
  • Barbiturates
  • Cocaine
  • Marijuana
  • Methaqualone
  • Opiates including 6-AM
  • PCP
  • Benzodiazepines
  • Methadone
  • Propoxyphene
  • Specimen Validity Testing
  • Expanded Opiates - hydrocodone, hydromorphone
  • Oxycodones - Oxymorphone and Oxycodone
  • Fentanyl
  • Meperidine
  • Tramadol
  • Buprenorphine
  • Nalbuphine
  • Ketamine
  • Antidepressants
  • Antihistamines

Some of the other specific drugs that can be included in the Health Care Professional Panels are:

  • Antihistamines: Chlorpheniramine, Diphenhydramine, Doxylamine
  • Antidepressants: Amitriptyline, Nortriptyline, Fluoxetine, Sertraline
  • Stimulants: Diethylpropion, Ephedrine, Fenfluramine, MDA, MDMA, Methylphenidate, Nikethamide, Phendimetrazine, Phenmetrazine, Phentermine, Phenylpropanolamine, Pseudoephedrine
  • Narcotics: Buprenorphine and/or metabolite, Butorphanol Metabolite, Dihydrocodeine, Nalbuphine, Pentazocine
  • Other Drugs: Flunitrazepam Metabolite, Ketamine Metabolite, Meprobamate, Zolpidem

Testing for Expanded Opiates

Testing for expanded opiates is more important today than ever due to the widespread abuse of opiates and heroin throughout the United States. Laboratories have revealed that the positivity rate for the expanded opiates is 2-3 times higher than that of either codeine or morphine. Expanded opiates drug testing is available with urine specimens, oral fluid specimens and hair follicle testing.

Many times individuals get addicted to pain medications after an injury or accident and then have a hard time once the prescription is no longer being filled by the pharmacy. Getting pain medications without a prescription is illegal and very costly and many of these individuals; which could be your employees, will turn to heroin which is cheaper and often easier to obtain.


Drug Overdose

The Center for Disease Control and Prevention tells us that drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014. Other studies show that four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013.

Dr. Barry Sample, Director of Science & Technology for Quest Diagnostics recently stated at a drug testing industry conference - “Because more U.S. workers are performing their duties while taking prescription opiates, employers, particularly those with safety-sensitive workers, should note this trend and take appropriate steps to ensure worker and public safety”.

Verify your standard 5 and 10 panels with your drug testing provider and make certain you are dealing with a knowledgeable and professional provider of drug testing services. Are your panels detecting 6-Acetylmorphine (6-AM) the metabolite of heroin? If not, you may have heroin users on your payroll even though you operate as a drug free workplace. The cost of adding expanded opiates to your 5 or 10 panel drug test should be $10.00 or less. This is worth the investment. If you have employees abusing pain medications they may graduate to heroin addiction or even worse – death by overdose.