Opioid Testing

Opioid testing detects evidence of opioid use in a person’s body. Opioids may be prescribed by a doctor to manage moderate to severe pain, or they may be obtained and used illegally.

Opioid testing can be performed on a sample of a patient’s blood, hair, saliva, sweat, or urine. Testing for opioid use may be performed for a variety of reasons, including employment testing and when monitoring patients for prescription drug misuse.

While opioid tests can be ordered on their own, testing is often conducted as part of a broad screening panel. A drug screening panel, such as a 10-panel drug test, may be used to find evidence of a variety of illegal and prescription drugs. If a patient tests positive on an initial drug screening panel, results are confirmed by a second, more specific test.

Purpose of the test

Opioid testing is used to detect evidence of opioid use or misuse. Opioid use describes the use of illegal opioids, such as heroin and illegally manufactured fentanyl. Opioid misuse refers to using prescription opioids in a manner that differs from a doctor’s recommendation. Testing for the use and misuse of opioids may be performed for a variety of purposes:

• Medical screening: Drug testing is commonly used in psychiatric care, substance use treatment programs, and as a way to monitor the use of prescription opioids. It’s uncommon to screen hospitalized patients for opioid use, even in cases of a suspected overdose.
• Workplace testing: An employer may require drug testing for job applicants before being hired, regularly during employment, or after an accident. Workplace drug testing is required by federal law in certain safety- and security-sensitive industries, such as transportation.
• Military testing: The Department of Defense requires drug testing for members of the military. Urine drug tests are ordered randomly and at other times, such as when a superior believes that a service member is using drugs.
• Athletic testing: Professional athletes are often required to take part in drug testing programs. The U.S. Anti-Doping Agency prohibits the use of many opioids for athletes participating in competitions.
• Legal and forensic testing: Drug testing may be conducted during an investigation or court case. For example, drug testing may provide evidence after a motor vehicle accident or in a case involving child abuse or endangerment.

In patients prescribed opioids for pain, opioid testing allows doctors to monitor for opioid misuse. Opioid misuse includes taking opioids prescribed for another person, taking a larger dose than prescribed, or using an opioid in a way that differs from what is recommended by a doctor, such as snorting or injecting the drug. Monitoring patients can help doctors prevent or treat opioid misuse before it develops into an addiction.

Opioid testing can not detect current intoxication or an opioid addiction.

What does the test measure?

Opioid testing detects the presence of opioids or opioid metabolites in a test sample. Opioid metabolites are substances created when the body is processing and breaking down an opioid. Opioids include both natural and manufactured substances:

• Natural opioids are derived from the seeds of the opium poppy plant. Also called opiates, natural opioids include morphine, codeine, opium, and heroin.
• Synthetic opioids are fully machine-made substances. Synthetic opioids include tramadol and fentanyl.
• Semi-synthetic opioids are part natural and part synthetic. Semi-synthetic opioids include oxycodone, hydrocodone, hydromorphone, and oxymorphone.

Opioid tests do not detect all opioids and their metabolites. The types of opioids included in an opioid test varies by medical facility, laboratory, and geographical region. A routine drug screening panel often detects only natural opioids like heroin, morphine, and codeine.

Drug screening panels may not detect widely-used synthetic and semi-synthetic opioids, such as tramadol, methadone, and fentanyl. Testing for these opioids often requires a more extensive panel or a more targeted drug test. For example, the Department of Defense uses an expanded drug panel that includes several semi-synthetic opioids.

Opioids and their metabolites can only be detected in the body for a limited amount of time after use, called the detection window. The detection window varies based on many factors, including the type of opioid used, the amount and frequency of use, and the type of test sample. The detection window can also vary based on the cutoff values used by an individual laboratory to determine a positive result. The table below provides examples of detection windows for a urine sample:

The following table provides examples of detection windows in other types of test samples:

When should I get opioid testing?

Opioid testing may be used in a variety of settings, including monitoring of prescription opioid use, within a substance use treatment program, and during pre-employment testing.

Drug testing requirements are impacted by laws on the federal, state and local levels. Drug-free policies that require regular drug testing may be implemented in both federal and non-federal workplaces.

How to get tested

Opioid testing can be performed in a doctor’s office, laboratory, or other medical facility. Test samples can also be obtained on-site at a workplace or other location requiring drug testing.

An opioid test may be ordered by a person’s doctor or by an administrator of the program that requires drug testing.

Can I take the test at home?

At-home drug tests are available to screen for opioid use. At-home opioid testing can be performed on a sample of hair, saliva, or urine. At-home hair follicle testing involves collecting a hair sample at home before sending the sample to a laboratory for testing. At-home saliva and urine drug tests allow patients to conduct a rapid drug screening with results provided quickly in their own home.

Rapid drug tests performed at-home are a type of initial drug screening. Positive results on drug screening tests require confirmation testing. An at-home opioid test is not a substitute for drug testing conducted by a doctor or other health care professional.

How much does the test cost?

An opioid test may be paid for by a patient, their health insurance provider, their employer, or the organization requiring drug testing. A patient’s health insurance provider may cover the cost of drug testing when the test is ordered by a doctor. Patients may still be responsible for out-of-pocket costs such as copays and deductibles.

For laboratory-based testing, an initial drug screen is usually performed on a clean catch urine sample. Clean catch urine samples are collected in a way that prevents germs from contaminating the sample. A clean catch urine sample may be collected in a laboratory, medical facility, or other testing site.

The process of collecting other test samples varies based on the type of sample needed.

Before the test

The process of collecting urine can vary based on the reason for drug testing and the requirements of the testing location. Before a urine drug test, it may be helpful for patients to talk to their doctor or the staff at the testing location about how collection will be performed.

There are several ways in which testing locations prevent patients from tampering with a urine sample. For example, patients may be monitored or directly observed by a technician or trained staff member while collecting urine. During collection monitoring, the trained professional checks the restroom before the patient enters. If direct observation of collection is required, the trained professional will watch the patient collect the urine sample.

It’s important for patients to tell their doctor or employer about any medications they are taking, as there are several over-the-counter and prescription medications that can affect the results of opioid testing. Eating poppy seeds can also affect the result of an opioid test. Patients shouldn’t eat poppy seeds within three days of a urine test for opioid use. There are no other preparations necessary when collecting samples of blood, heair, saliva, or sweat.

During the test

Collecting a clean catch urine sample involves several steps. Patients begin by washing their hands thoroughly with soap and water and wiping the outside of their genitals with sterile wipes provided in the testing kit. Patients then begin urinating into the toilet before stopping the flow of urine and moving the collection container a few inches from their genitals. Patients then urinate into the collection container until it is about half full. Once the urine sample is collected, patients can move the collection container aside and finish urinating into the toilet.

The process of collecting other test samples depends on the type of sample needed:

• Blood samples are collected by a healthcare provider using a small needle. Blood is drawn from a vein, usually in a patient’s arm.
• Hair samples are small amounts of hair cut from near a person’s scalp using scissors. If patients don’t have sufficient hair on their head, hair can be collected from another part of the body.
• Saliva samples are obtained by collecting a patient’s spit or by placing a swab between a patient’s gums and cheek for several minutes.
• Sweat samples are collected by placing a patch on the skin for 5 to 7 days.

There is very little risk to patients during sample collection, although patients having blood drawn may feel pain and have temporary bruising where the needle is inserted. Samples used for drug testing can typically be obtained in less than 5 minutes.

After the test

After collecting a clean catch urine sample, patients close the sample container and return it to a staff member at the testing facility. The staff member may measure and record the temperature of the sample and secure it in tamper-proof packaging before sending it for analysis. Other test samples obtained by a health care professional require no additional actions from the patient. There are no restrictions on activity after opioid testing.

Receiving test results

Results from an opioid test are often available within a few hours to a few business days. Patients may receive their results through the testing site, a doctor, or an administrator of the organization requiring testing. Opioid test results may also be sent through the mail or a patient’s electronic health record.

Interpreting test results

Patients and their doctors should use caution when interpreting drug test results. Drug screening tests are interpreted differently than laboratory-based testing that confirms initial screening results.

• Drug screening tests: Results from drug screening tests are qualitative, which means that they offer a positive or negative result but don’t provide information on the amount or type of opioids detected in the sample. At-home drug tests are typically screening panels, requiring additional confirmation testing when results are positive.
• Confirmation testing: Confirmation testing uses different testing methods to offer more detailed information about the opioids or metabolites detected in the test sample.

The cutoff value for an opioid test means the minimum level of opioid or opioid metabolite in a sample that is considered to be a positive result. Cutoff values for opioid testing are not universal and depend on the laboratory or agency conducting the test. In federal drug-free workplace programs that test for morphine and codeine, the cutoff for both an initial test and for confirmation testing is 2000 ng/mL.

Negative results on an opioid test indicate that the opioids or metabolites measured were not detected in the test sample. This result may indicate that the patient hasn’t used opioids, that opioid use was outside of the test’s detection window, or that the level of opioid or its metabolite was below the cutoff level for a positive test result.

Positive results on an opioid test indicate that opioid or metabolites were detected in the test sample. If the initial test was a drug screening test, a positive result requires additional confirmation testing that is conducted in a laboratory.

Are test results accurate?

Although no drug test is 100% accurate, opioid testing is a common and standard method of detecting opioid use. In order to reduce the risk of inaccurate drug test results, health professionals take special precautions during sample collection, transportation, and testing. Confirmation testing with a more specific drug test is another way in which doctor’s minimize the risk of inaccurate or misleading drug test results.

When reviewing drug test results, patients can talk to their doctor or the test administrator about the reliability of testing and the cutoff value used to determine results.

Do I need follow-up tests?

Positive results on an opioid screening test require confirmation testing. Confirmation testing is especially important when a positive result on an opioid test may have a negative effect on a person’s employment, legal or forensic case, or medical treatment decisions.

If a patient tests positive on an opioid test, a health care provider may suggest or provide an evaluation for opioid use disorder, also called an opioid addiction. Even when prescribed by a doctor and taken appropriately, using opioids can lead to addiction in some people. In fact, as many as one in four patients prescribed long-term opioid therapy develop an opioid addiction.

During an evaluation for opioid use disorder, a patient is asked a series of questions to determine patterns and effects of opioid use, including what opioids are consumed, the frequency of use, and the consequences of opioid use in the patient’s life. Treatment is available for opioid use, misuse, and addiction.

Questions for your doctor about test results

Patients receiving drug testing may find it helpful to talk to their doctor about the testing process and the way that results are interpreted. Helpful questions may include:

• Why am I being tested for drug use or misuse?
• What is my test result?
• Will a follow-up confirmation test be required based on my result?
• Who will have access to my test result or medical record?
• Will I be retested for drug use in the future?

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