[BLOG] Fentanyl – A Growing Concern

June 28, 2016

[AYR, ON]

Fentanyl usage is exploding across the country and is now considered an epidemic.

This is a concerning trend that is spiralling out of control, especially in Alberta, British Columbia, Quebec and Ontario. Overdoses. Fatalities. Gang involvement. Black market demand.  In Alberta and British Columbia, fatal overdoses linked to fentanyl soared from 42 in 2012 to 418 in 2015. The widespread use of prescription opioids is engulfing Canadians everywhere.

The picture isn’t pretty, and seemingly fentanyl’s notoriety is growing daily because of the vast media coverage that it produces. OxyContin was a big problem. Then manufactures stopped producing it and formulated a method that made it more difficult to crush it in to a powder.

There is also a growing concern in the workplace, specifically about the ‘Fitness for Duty’ of workers in safety sensitive positions.

Dr. Melissa Snider-Adler, DriverCheck’s Chief Medical Review Officer explains, “When not testing for what is commonly abused in the community, the company may be at risk for hiring an individual who is not fit or able to work in a safety sensitive position, however without testing, they will never know!”

Fentanyl Testing Now Available

Until recently testing for fentanyl was limited. DriverCheck recently announced that it was introducing two convenient ways to test for fentanyl in urine.

• Laboratory based screening is performed by immunoassay at a cut-off threshold of 2 ng/mL. All non-negative specimens are confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS) yielding quantitative results at a cut-off threshold of 1 ng/mL. Confirmation testing includes fentanyl and metabolites norfentanyl, sufentanil and norsufentanil.

• Urine onsite devices are available to detect the presence of norfentanyl at a cut-off threshold of 20 ng/mL in urine. Quantitative confirmation is available by LC/MS/MS at a cut-off threshold of 1 ng/mL to confirm non-negative results.

Dr. Snider-Adler suggests that, “This changes the game and the playing field in combating the fentanyl problem. Before companies were limited, but by making fentanyl testing available the momentum has changed directions.”

Until recently, there was only screening test at the lab available, and no confirmation urine test for fentanyl. Labs now have the ability to test for fentanyl and its metabolite norfentanyl. It is a highly sensitive and specific test – meaning that it picks up fentanyl use well and can differentiate it from other substances.

Many companies follow DOT-like procedures as they have been viewed as the gold standard in drug testing for the past fifty years. Since fentanyl is not currently part of the DOT testing panel, many companies have not yet started to add this to their testing panel. .

Dr. Snider-Adler explains, “It is important to keep in mind that non-DOT testing companies are able to set up a program in which they are testing for both the DOT panel of substances as well as other substances like fentanyl that are commonly abused in their community.”

What is Fentanyl?

Fentanyl is a synthetic opioid pain reliever used in the treatment of severe pain. Fentanyl is 10 times more powerful than OxyContin, 50 to 100 times more potent than morphine and has a shorter duration of action. There is potential of overdose from using an amount as small as two salt grains. It is prescribed in transdermal patch forms and for liquid via injection. It is also known to be snorted, injected or the individual will suck on the patch and then smoke it. Fentanyl use is known to have a high risk of misuse or abuse.

Fentanyl is a class of painkiller that also includes oxycodone and morphine. Developed in 1959 by a Belgian chemist, it was originally introduced as a pain reliever and anesthetic in medical settings. It wasn’t until the mid-1990’s that it became widespread in use.

“Fentanyl use is widespread. It is a powerful drug that can severely impact one’s performance, particularly for those in safety sensitive positions,” says Dr. Snider-Adler.

Illegally made, non-pharmaceutical fentanyl has become available. It can be mixed with heroin and/or cocaine to enhance its euphoric effects. This fentanyl-containing combination product may be sold to users through illegal drug markets, with or without their knowledge of its presence.

Aiding this epidemic is the availability to purchase from other countries, such as China. Packages that weigh less than 30 grams are not checked without the consent of the recipient at border security, so fentanyl is not always detected unless in large quantities, as per a recent article in the Globe and Mail “How Canada Got Addicted to Fentanyl”.

A primary issue is when the drug is processed in a clandestine lab, there are no quality control systems in place, making it difficult to get the proper dosage, therefore potentially making the synthetic drug that much more powerful at toxic levels. Chemical companies and clandestine labs in China are known to customize ingredients of pharmaceutical-grade fentanyl by tweaking a molecule slightly. Even a few hundred micrograms are enough to trigger euphoric bliss or a fatal overdose.

The truth is Canada is amongst the highest consumers of prescription opioids on a per-capita basis when compared to other countries, according to a recent study performed by University of Wisconsin-Madison.

Opiates versus Opium

To understand fentanyl, you must understand the difference between opiates and opium.

Opiates are drugs derived from opium. Opioids refer to synthetic opiates only, and were originally created to emulate opium, but done differently with synthetic chemicals. Opium is a powerful pain relieving medication that a number of drugs are also made from.

Types of Opiates

• Codeine

• Heroin

• Morphine

• Opium

Opioids are synthetic drugs that were created to work in a similar way to opiates through active ingredients made via chemical synthesis. Opioids act like opiates when taken for pain because they have comparable molecules.

Types of Opioids

• Buprenorphine

• Demerol

• Fentanyl

• Hydrocodone

• Hydromorphone

• Methadone

• Oxycodone

• Percocet

• Percodan

• Vicodin

Want to learn more about fentanyl and testing? Let us know by emailing us at PR@DriverCheck.ca.

About Dr. Melissa Snider-Adler, M.D., C.C.F.P., M.R.O. (AAMRO), D.A.B.A.M.:

Chief Medical Review Officer, DriverCheck Inc.

Dr. Melissa Snider-Adler is the Chief Medical Review Officer for DriverCheck. Her background is in Family Medicine, but now works primarily in the field of addiction medicine. She has been providing Opioid Agonist Therapy in multiple practice settings throughout Ontario for the last 16 years. Dr. Snider-Adler is Certified as a Medical Review Officer, and by the American Board of Addiction Medicine. She is an Assistant Professor at Queen’s University Department of Family Medicine.  She was one of the authors of the 2011 Methadone Maintenance Treatment Program Standards and Clinical Guidelines and continues to work as a Peer Assessor for the College of Physician and Surgeons of Ontario where she also sits on the Methadone Assessors Committee. Dr. Snider-Adler gives talks across Canada to companies, physicians and the community about workplace substance abuse and addiction prevention and treatment.

About DriverCheck Inc.:

Since its inception in 1996, DriverCheck Inc. (DC) has been the leading provider of medical testing and assessments in Canada.  Physician-owned and operated, DC has grown to become the largest national provider of workplace medical testing, and was one of the first Third Party Administrators in Canada to offer DOT-regulated alcohol and drug testing. DC’s head office is located in the village of Ayr, the heart of Ontario’s transportation hub. DC currently serves over 5,000 employers, with access to over 1,000 testing facilities strategically located across the country, providing easy access to all medical services. Our diverse service offerings include alcohol and drug testing, fatigue management, occupational health and injury management programs (including remote medical services). DC services a wide array of industries including transportation, oil & gas, mining, forestry and medical.

As Canada’s ‘Fitness for Duty’ leader, DC’s top priority is the safety of your staff and workplace.

To learn more about DriverCheck, visit www.DriverCheck.ca or call 1 (800) 463-4310.