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Fentanyl use considered a public health crisis in Alberta

A few months after we first addressed the use of fentanyl in our blog, a wave of deaths caused by this deadly drug has health and police authorities in Alberta calling it a public health crisis.

An article published in the Globe and Mail on November 8 reported that 145 Albertans died from fentanyl in the first half of 2015 and police in Calgary and Edmonton say the rate of overdoses they are responding to is not slowing down.

Fentanyl is a popular and more potent substitute for the now defunct OxyContin. Yet only in rare or special circumstances are workplaces testing for Fentanyl, a synthetic opioid readily available through legitimate and false prescriptions, as well as on the street.

Fentanyl in the Workplace

From a workplace perspective, it can be tough to assess just how prevalent the use, misuse or abuse of Fentanyl is among workers in safety sensitive positions. Although OxyContin had been the driving trend for illicit drug users in recent years before it was removed from the Canadian pharmaceutical market, experts say Fentanyl became the preferred high in 2012 when governments forced the manufacturer of OxyContin to introduce a replacement preparation called OxyNeo, a medication that is formulated in a way that makes it much more difficult to abuse.

It’s not just the illicit form of the drug that could be a concern for employers. As an analgesic, Fentanyl is a commonly prescribed medication used to manage moderate to severe pain, usually in people with chronic pain. It is often used when other pain medicines no longer work. The drug is said to be 20 times stronger than heroin and up to 100 times more potent than morphine. Prescriptions for high potency painkillers like Fentanyl have skyrocketed over the past 15 years, and Canadians are now the world’s biggest per capita consumers of legal opioids.

Testing for Fentanyl

Despite growing concerns about the use of this drug, testing for Fentanyl in the workplace is typically only requested in exceptional or special circumstances and is not a drug currently tested for under standard workplace drug testing panels. To test for it, employers would need to include Fentanyl as a special add-on at an extra cost. Until standalone testing is available, Fentanyl would currently be tested for using a total pharmacological toxicology screen to provide an initial result, but although such initial immunoassay screen testing is available, no laboratories in Canada offer mass spectrometry confirmation testing nor provide its precise quantitative levels. As such, non-negative initial screening test samples would have to be sent to the United States for the confirmation test until such time confirmation testing becomes available in Canada.

Some policy experts in Canada suggest consideration should be given to expanding standard workplace panels to mandatorily include special drugs of concern as was suggested several years ago with oxycodone (the generic active opioid ingredient found in certain medications such as OxyNeo, Percodan, Percocet, and the now no longer available OxyContin).  Although the synthetic opioids oxycodone, oxymorphone, hydrocodone, and hydromorphone are very close to being added to standard testing panels, Fentanyl is not.  The U.S. Department of Health and Human Services (the branch of government that establishes the scientific and technical guidelines for federal workplace drug testing in the U.S., including the Department of Transportation) did make mention of Fentanyl in its proposed oral fluid lab-based drug testing guidelines recently released for public comment. This document noted that emergency department visits involving opiates/opioids increased by 183 percent between 2004 and 2011, with increases of over 100 percent for Fentanyl as well as morphine.

Despite this mention, Fentanyl does not appear to be on the DHHS radar for standard workplace testing programs. Nevertheless, policy experts recommend building into a company policy that additional drugs may be added on the advice of a Substance Abuse Professional in a post-treatment situation.

Employers may also want to consider testing for Fentanyl in situations where valid concerns that Fentanyl use, misuse, or abuse may exist having impact on safety sensitive work, or where it may have contributed to a workplace accident or incident.

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