CLINICAL ISSUES :: FENTANYL
2. Thinking even more broadly, how does a community know its drug supply is contaminated with fentanyl? While “drug checking” test strips at the point-of-use exist to test the drugs themselves and potentially prevent fentanyl overdoses, many states consider them to be contraband.4
Therefore, these
test strips are illegal in many cases, even though they can save lives and community resources dedicated to overdose- related emergency incidents. Identifying whether fentanyl is present in a community
serves as a warning sign—not only at the community level, but at the individual patient level, as well. To support drug policies and rehabilitation efforts, a community must know fentanyl is present and is an ongoing, active threat. Treatment of substance use disorders and identification
of fentanyl contamination start with a laboratory test. There are several types of laboratory tests available to detect the presence of fentanyl with different sample types depending on the test. For example, several laboratory diagnostics manu- facturers offer urine drug screening and serum toxicology which is performed via immunoassay methods on automated chemistry and dedicated drug testing analyzers. Rapid urine drug testing, which is considered point-of-care testing, also is available as cups, strips, and cartridges, and is manually performed and interpreted. Additionally, there is oral fluid testing to screen for the presence of fentanyl. Regardless of the screening method, it is always recommended that laboratories confirm preliminary results with a confirmatory method such as liquid chromatography followed by tandem mass spectrom- etry (LC-MS/MS). Drug screening for fentanyl, and specifically norfentanyl (the
major metabolite of fentanyl) serves a vital purpose as the first line of defense in combating this fentanyl contamination crisis. Since fentanyl is primarily excreted as metabolites, with only ~10% of the drug remaining unchanged in urinary excretion, it is imperative the screening assay detects norfentanyl. This helps reduce the risk of false negatives.5
It is simply not enough
to offer just any fentanyl-specific screening test. Laboratories must offer a fentanyl-specific test that demonstrates excellent sensitivity and specificity for detection of fentanyl and excellent cross-reactivity with norfentanyl. If test strips are not available to test the drug itself and if
laboratories aren’t testing patient samples for fentanyl, there is no way for physicians, patients or anyone else involved to know of its presence. This lack of information could hinder a patient’s treatment plan, including a patient’s ability to secure space in a treatment facility, for example.
Treatment of substance use disorders and identification of fentanyl contami- nation start with a laboratory test.
Conclusion Fentanyl drug screening provides that critical level of awareness needed to help facilitate proper treatment, pre- vent overdoses or recurrent overdoses, guide public health initiatives, and ultimately save lives—not just on Halloween, Thanksgiving, or Christmas—but on any day of the year. It is imperative that collective community resources such as hos- pital systems, laboratory diagnostics companies, government
or local/state agencies, treatment centers, police or sheriff’s departments and other organizations work together to help put an end to this “hidden” epidemic. Empowered labo- ratories offering fentanyl testing deliver vital test results, enabling actionable efforts that drive towards a safer and healthier population.
REFERENCES
1. Trafficker-quantities of “rainbow fentanyl” arrive in New York. DEA. Accessed October 25, 2022.
https://www.dea.gov/press-releases/2022/10/04/ trafficker-quantities-rainbow-fentanyl-arrive-new-york.
2. Fentanyl: What you need to know - national coalition against prescription drug abuse. National Coalition Against Prescription Drug Abuse. Published December 1, 2021. Accessed October 25, 2022.
https://ncapda.org/fentanyl/ ?gclid=EAIaIQobChMIssyzlprW-gIVF47ICh1KBg-PEAAYAiAAEgKggvD_BwE.
3. Products - vital statistics rapid release - provisional drug overdose data.
Cdc.gov. Published October 12, 2022. Accessed October 25, 2022. https://
www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.
4. Facher L. Fentanyl test strips could help save lives. In many states, they’re still illegal. STAT. Published September 8, 2022. Accessed October 25, 2022.
https://www.statnews.com/2022/09/08/fentanyl-test-strips-could-help- save-lives-in-many-states-theyre-still-illegal/.
5. Huhn AS, Hobelmann JG, Oyler GA, Strain EC. Protracted renal clear- ance of fentanyl in persons with opioid use disorder. Drug Alcohol Depend. 2020;214(108147):108147. doi:10.1016/j.drugalcdep.2020.108147.
Rorie Madigan is currently a Global Drug Testing Marketing and Product Manager for Siemens Healthineers. She has a B.S. in Medical Technology from the University of Delaware and began her career in the microbiology laboratory at Christiana Hospital in Newark, DE. In 2007, she joined Siemens Healthineers where she has held multiple roles in Technical Support, Education, Consulting, and Marketing.
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