Screening for Fentanyl in Routine Clinical Toxicology Testing

Why this strategy works

Because it is such a highly potent and fast acting opioid, and because it is often difficult-if not impossible-to identify prior to consumption, the presence of fentanyl in illicit drug supplies changes the landscape of opioid overdose dramatically. Harm reduction, risk reduction, and opioid overdose prevention efforts all need to be informed by an awareness of fentanyl exposure in the populations served in order to continue affording maximum safety and protection to community members who are navigating a fentanyl-contaminated drug supply.

The addition of fentanyl testing in routine clinical toxicology tests allows for early warnings of supply contamination and provides one of the best sources of routine surveillance for fentanyl-exposed individuals and for public health responses to opioid use and overdose.

Fentanyl testing in routine drug screens works best when:

• Adjustments are made to funding streams, standard lab procedures, and electronic medical records systems to accommodate and standardize this change in practice.
• Trends in the results of fentanyl screens are shared effectively across public institutions with the capacity to intervene amongst those who intentionally or unintentionally consume fentanyl and reduce the risk of overdose.

• A study conducted in Vancouver, British Columbia, that tested urine samples from 242 people who inject drugs found that 29% of all participants (only 59% of whom reported using heroin) tested positive for fentanyl. Of those who tested positive for fentanyl, nearly 75% did not report using fentanyl in the past three days, indicating that they were not aware they had been exposed. The same study also found that people who reported using methamphetamine had 6-times the odds of testing positive for fentanyl, compared to those who did not report using methamphetamine. At the time, this was a counter-intuitive finding, which would have likely not been discovered without adding fentanyl screening to these drug testing procedures. 

• A recent study conducted in the Detroit area found that 38% of clients receiving methadone-based MAT tested positive for fentanyl in standard monthly drug screenings at least once between January 2015 and May 2016. Clients who tested positive for fentanyl as well.
• Data collected from more than 700 medical records at a methadone-based MAT clinic in Rhode Island revealed that approximately one in seven methadone patients tests positive for fentanyl each month, and nearly two-thirds of new patients initiating methadone-based MAT tested positive for fentanyl at intake. Each of these factors may shape a patient's experience of treatment and individual needs while receiving care.