Next month, a federal advisory board responsible for drug testing will commence discussions regarding the potential inclusion of a fentanyl testing component for drivers and other federally designated safety-sensitive workers. The Substance Abuse and Mental Health Services Administration’s advisory board recently announced its intention to conduct an open virtual session on December 5. This session will serve as a follow-up to the Fighting Opioid Abuse in Transportation Act, which tasks the U.S. Department of Health and Human Services with assessing the justification for incorporating fentanyl into the analyte table. The assessment will consider factors such as reliability and cost-effectiveness in mandatory testing.

“Fentanyl accounts for a large proportion of overdose deaths in the United States and is therefore an important public safety concern,” said the SAMHSA announcement. “Furthermore, fentanyl is increasingly used as a stand-alone substance of abuse, not in conjunction with heroin and other substances.”

SAMHSA, a subdivision of the Department of Health and Human Services (HHS), is inviting public input both before and for a period of 30 days after the upcoming advisory board meeting. Fentanyl, though technically existing since the 1960s, is now classified as “emerging” by experts. This designation is primarily due to a surge in fatalities among users and increased accessibility for both lawful and illicit purposes.

As outlined by the U.S. Drug Enforcement Administration, fentanyl is a synthetic opioid with potency ranging from 80 to 100 times that of 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.”

The DEA has highlighted the various adverse effects of fentanyl use, including an intense, short-term high, temporary euphoria, slowed respiration, reduced blood pressure, nausea, fainting, seizures, and, in severe cases, death.

According to the DEA, clandestinely produced fentanyl is predominantly manufactured in Mexico. The recent SAMHSA announcement marks the second instance in four years where Congress has sought input from drug agencies on whether federal workers, including truck drivers, should undergo testing for fentanyl use.

During a December 2019 board meeting, advisory board chairman Ron Flegel disclosed that the drug testing board had recommended to former HHS Secretary Alex Azar the addition of fentanyl to the list of drugs tested for by federal authorities. Azar had a 180-day window to decide on approving the board’s recommendation.

Based on a 2021 National Forensic Laboratory Information System report, fentanyl ranked as the fourth-most frequently identified drug, comprising 11.61% of all drugs reported by forensic laboratories. The substance has been detected in various contexts, including oral fluid in pain management patients, overdose cases, and instances of driving under the influence of drugs.

The chemical norfentanyl plays a crucial role in identifying fentanyl users when urine is the specimen matrix. Data from HHS-certified laboratories in 2023 revealed that 84% of these laboratories analyzed unregulated workplace specimens for fentanyl and/or norfentanyl. Moreover, all of them had the capability to analyze urine specimens for fentanyl with sufficiently sensitive detection limits, using commercially available immunoassay kits and confirmatory test instrumentation commonly employed in HHS-certified laboratories.

While federal drug czars had previously rejected the addition of a fentanyl test panel, citing challenges in detection due to its mixing with heroin, some officials argued that users could still be identified through testing for heroin, as explained by Ruth Winecker, a senior research forensic scientist at RTI International.

“When we originally evaluated fentanyl, there seemed to be multiple mixtures of fentanyl with other drugs,” Flegel had 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.”