Changes are Coming
As part of the U.S. Department of Transportation (DOT) January 23, 2017’s Notice of Proposed Rulemaking (NPR), the standard Substance Abuse and Mental Health Services Administration (SAMHSA) panel for drug testing may be changing this October 1, 2017 if the rule is finalized.
Current SAMHSA panel:
| Initial Analyte | Screening Cut-off | Confirmatory Analyte | Confirmation Cut-off |
|---|---|---|---|
| Amphetamine | 500 ng/mL | 250 ng/mL | |
| Cocaine | 150 ng/mL | Benzoylecgonine | 100 ng/mL |
| Opiates | |||
| Codeine | 2000 ng/mL | 2000 ng/mL | |
| Morphine | 2000 ng/mL | 2000 ng/mL | |
| Heroin Metabolite | 10 ng/mL | 6-Acetylmorphine | 10 ng/mL |
| Marijuana | 50 ng/mL | 11-COOH-THC | 15 ng/mL |
| Methamphetamine | 500 ng/mL | 250 ng/mL | |
| MDMA | 500 ng/mL | MDEA, MDA | 250 ng/mL |
| Phencyclidine | 25 ng/mL | 25 ng/mL |
This is the proposed, new panel:
| Initial Analyte | Screening Cut-off | Confirmatory Analyte | Confirmation Cut-off |
|---|---|---|---|
| Amphetamine | 500 ng/mL | 250 ng/mL | |
| Cocaine | 150 ng/mL | Benzoylecgonine | 100 ng/mL |
| Opioids | |||
| Codeine | 2000 ng/mL | 2000 ng/mL | |
| Morphine | 2000 ng/mL | 2000 ng/mL | |
| Heroin Metabolite | 10 ng/mL | 6-Acetylmorphine | 10 ng/mL |
| Hydrocodone / Hydromorphone | 300 ng/mL | 100 ng/mL | |
| Oxycodone / Oxymorphone | 100 ng/mL | 100 ng/mL | |
| Marijuana | 50 ng/mL | 11-COOH-THC | 15 ng/mL |
| Methamphetamine | 500 ng/mL | 250 ng/mL | |
| MDMA | 500 ng/mL | 250 ng/mL | |
| MDA | 500 ng/mL | 250 ng/mL | |
| Phencyclidine | 25 ng/mL | 25 ng/mL |
Opiates or Opioids
The term opiates normally refers to non-synthetic opiates like heroin, codeine and morphine. The new language, using opioids, includes semi-synthetic opioids; hydrocodone, hydromorphone, oxymorphone and oxycodone. The reason for this change is that opioid testing is to be expanded in October to include semi-synthetics.
Drug Changes
Hydrocodone
Hydrocodone and oxycodone were both synthesized in Germany in the early 1900s. Hycodan® was the original trade name for hydrocodone, but has since been marketed under hundreds of trademarks including Vicodin®, Lortab® and Lorcet®. These are examples of compounded products comprised of acetaminophen and hydrocodone. Hydrocodone are available in tablet, capsule and syrup form, and is often prescribed in combination with less effective non-opioids.
Hydromorphone
Hydromorphone was synthesized in Germany in 1924 and was mass marketed shortly thereafter under the trade name Dilaudid®. As a member of the opioid class, hydromorphone is a potent semi-synthetic analgesic (pain reliever) and antitussive (cough suppressant) that has been compared to hydrocodone for the similarities between them, and morphine, its derivative. It is available in the form of tablets, rectal suppositories, oral solutions and injectable formulas.
Oxycodone
Oxycodone is very similar to hydrocodone as they are both narcotic analgesics and antitussives (cough suppressants). However, oxycodone is considerably more potent than hydrocodone. The main differences between the two main trade names of oxycodone, OxyContin® and Percocet®, are related to their potencies, effects and their chemical mixtures. Firstly, OxyContin® is far more potent than Percocet® for a number of reasons. Percocet® provides pain relief for approximately 5 hours, while the effects of OxyContin® last up to 12 hours. This is due to several factors. OxyContin®, unlike Percocet®, is a time-released narcotic analgesic and the dose of oxycodone found in one OxyContin® tablet is released periodically throughout a time period of approximately 12 hours. Furthermore, OxyContin® is comprised of pure oxycodone, while Percocet® contains acetaminophen. One OxyContin®tablet contains as much oxycodone as in 16 Percocet® tablets.
Oxymorphone
Oxymorphone is much like oxycodone it available in tablet and injectable forms and available as Numorphan® (suppository and injectable solution) and Opana® (tablet).
Screening Summary
Hydrocodone and hydromorphone are to be screened at 300 ng/mL and confirmed at 100 ng/mL while oxycodone and oxymorphone are to be both screened and confirmed at 100 ng/mL.
Amphetamines
Back in 2013, the amphetamine group was modified to include Methylenedioxymethamphetamine (MDMA) as an initial screening analyte with two additional drugs tested during confirmation, methylenedioxymethamphetamine (MDA) and methylenedioxy-N-ethylamphetamine (MDEA).
The change for 2017 removes MDEA all together from the confirmation panel and move MDA to a initial screening analyte much like MDMA is right now.
The Affect
It will be interesting to see how this change will affect Canadian non-DOT testing since it so heavily relies on the “gold standard” of DOT & SAMHSA testing practices. More to come on this topic through the year as we keep a close eye on this notice.
More information regarding these changes can be read here in section 40.85.
