Earlier in January, the U.S. Department of Health and Human Services (HHS) published its updated guidelines for drug testing in federal workplaces. According to the Federal Register, fentanyl and its metabolite norfentanyl have been added to the federal workplace drug testing panel. The new guidelines will become effective in July 2025 and outline the authorized panels of Schedule I and II drugs and biomarkers for urine and oral fluid testing. Moreover, the new guidelines also aim to standardize the nomenclature that laboratories and Medical Review Officers will be required to use when reporting test results.

The Department initially proposed adding fentanyl to the list of analytes for federal workplace drug testing programs during the Drug Testing Advisory Board (DTAB) meeting held in December 2023. The decision to add fentanyl to the federal workplace drug testing panel was taken after reviewing the supporting information and public comments.

Fentanyl was added to oral fluid drug testing panels for screen at 4 ng/mL and confirmation threshold of 1 ng/mL, while for urine fentanyl will be the screen at 1ng/mL and for confirmation its metabolite norfentanyl is added and both thresholds for confirmation are at 1ng/mL. Until the new drug testing panel rules take effect, fentanyl and norfentanyl can be analyzed under the Mandatory Guidelines only upon request of a Federal agency for reasonable suspicion or post-accident specimen or routinely with a waiver from the Secretary (in accordance with Section 3.2 of the guidelines).

The Department also had considered removing the drugs methylenedioxyamphetamine (MDA) and methylenedioxymethamphetamine (MDMA) from the drug testing  program due to very low positivity rates. According to data from 2021-2023, positive results for MDMA were recorded at the rate of 0.002% of all samples, with over 25% of the positive specimens likely being agency blind samples. In addition, nearly 40% of MDMA-positive urine samples also tested positive for other drugs, while MDA had an even lower positivity rate of 0.00008%.

However, it was determined that the removal of MDMA and MDA from the urine and oral fluid drug testing panels requires further study, and it was decided that MDMA/MDA will not be removed from the drug testing panels at this time. The Department does plan to continue monitoring the prevalence of MDMA/MDA, however, and to work with DTAB to continue assessing the costs and benefits of removing one or both analytes in the future.

The notice also discusses the inclusion of biomarker testing for both urine and oral fluid in federal workplace drug testing. While Section 3.4 of the guidelines suggests adding biomarkers to the testing panel, none have been approved yet for federal workplace drug testing. Specific biomarkers will be reviewed based on laboratory data and scientific literature before inclusion in future updates. Currently the biomarker of creatinine is used in concert with specific gravity to confirm the validity of a urine specimen.