This is a news article about fentanyl overdoses. In the event of an actual overdose, stop reading, call 911, and seek immediate medical assistance.
Part I of a 4-part series.
Opiates v. Opioids
Both opioids and opiates can be used to treat pain, but they can also have negative side effects, including addiction, tolerance, and overdose. Due to the high risk of addiction, these drugs are generally used only for short-term pain management and under strict medical supervision. Opioids and opiates can be highly addictive, and should only be used under the direction of a healthcare professional.
Opioids are drugs manufactured using a natural source (poppy), a synthetic source, or a combination thereof. While an opiate is a naturally occurring compound found in poppy plants, an opioid refers to any substance, whether natural or synthetic, that binds to the opioid receptors in the brain to create opiate-like effects.
Opiates are a subset of Opioids.
Derivation and Types of Opioids
- Opiates include opium, morphine, and codeine
- Semisynthetic Opioids include heroin, hydrocodone, hydromorphone, and oxycodone
- Synthetic Opioids include methadone, propoxyphene, meperidine, and fentanyl
Toxicology Screens for Drugs
A typical toxicology screen, also known as a drug test, is used to detect the presence of various drugs in a person’s bodily fluids, such as blood, urine, or saliva. The specific drugs that are tested for in a typical toxicology screen can vary depending on the purpose of the test and the type of test being performed.
Specific drugs that are tested for may vary depending on the test and the setting in which it is performed. Some tests may be more comprehensive and test for a wider range of drugs, while others may only test for a specific set of drugs.
The Federal Five Toxicology Screens for Drugs
The Federal Five toxicology screen is a type of drug test that is used to detect the presence of five specific drugs in a person’s bodily fluids, usually urine. The Substance Abuse and Mental Health Services Administration’s division of workplace programs established five categories of toxicology screens.
The Federal Five toxicology screen is mandated by the U.S. Department of Transportation for certain safety-sensitive positions, such as commercial truck drivers, train operators, and pilots.
The Federal Five toxicology screen includes amphetamines, cocaine, marijuana (THC), opiates, and phencyclidine (PCP).
Semisynthetic opioids like heroin, hydrocodone, hydromorphone, and oxycodone do show up in a Federal Five toxicology screen. Synthetic opioids like methadone, propoxyphene, meperidine, and fentanyl do not show up in an opiate drug screen and require a separate test.
The Federal Five toxicology screen will result in a report like the one below:
The specific testing method and cutoff levels for each drug in the Federal Five may vary depending on the lab and the testing company.
The Federal Five toxicology screen is not the same as other drug tests like the expanded opioid panel, which tests for a broader range of opioids.
Some hospitals run an expanded toxicology screen as standard procedure, including an expanded opioid panel that includes the Federal Five and may include additional drugs such as MDMA; Oxycodone; Barbiturates including Phenobarbital, Seconal, and Nembutal; Benzodiazepines including Clonazepam, Diazepam, and Lorazepam.
An expanded toxicology screen that includes the Federal Five toxicology screen will result in a report like the one below:
Immunoassay v. Mass spectrometry
There are two types of chemical analyzers used to perform a toxicology screen: Immunoassay and Mass Spectrometry.
Immunoassay is a biochemical test that measures the presence or concentration of molecules in a solution through the use of an antibody or an antigen. It is inexpensive, fast, and reasonably accurate.
Mass Spectrometry is used for, among other things, to determine the isotopic composition of elements in a molecule, and to determine the structure of a compound by observing its fragmentation. It is expensive, time-consuming, but can be far more accurate than a biochemical test.
For a deep dive into testing methodologies, visit the LabCorp website here.
The short version is a hospital ER will typically run an Immunoassay biochemical test, often on a urine sample, as part of a standard toxicology screen but may use Mass Spectrometry for a toxicology screen beyond a standard toxicology screen in certain circumstances.
Drug Testing is Used by the Federal Government to Screen Truck Drivers
As an example of how the government uses toxicology screens, the U.S. Department of Transportation’s Federal Motor Carrier Safety Administration created the Drug and Alcohol Clearinghouse in 2019, a database of drug test results for all Commercial driver’s license (CDL) or commercial learner’s permit (CLP) holders which contains records on over 3 million drivers.
The DOT tests for an expanded toxicology screen for drugs beyond the Federal Five. You can read the latest monthly report here.
The National Highway Traffic Safety Administration has found THC is the second-most common psychoactive substance found in drivers, after alcohol. The average THC concentration in marijuana is 1 to 5 percent; in hashish, it is 5 to 15 percent, and in hashish oil, it averages 20 percent.
What is THC?
THC (tetrahydrocannabinol), one of the drugs in the Federal Five, is the chemical responsible for marijuana’s psychological effects. THC attaches to cannabinoid receptors in the brain to cause the effects sought by those consuming THC by smoking marijuana or THC-infused extract.
THC concentration in cannabis depends on the cultivation of the marijuana plant; concentrations of THC ranges from 0.3 percent THC by weight to 20 percent by weight. When THC is exposed to air, it degrades into cannabinol, a cannabinoid that has its own psychological effects.
THC can be extracted from marijuana to make cannabis-infused oils and cannabutter used in making Edibles, food, and drinks (baked goods, candies and chocolates, beverages. lozenges, cooking oils and butter) infused with THC from marijuana extracts.
THC and Oil Pens
THC Oil is highly concentrated cannabinoids; at 80% it is close to a pure THC concentration. A pre-packaged Oil Pen contains .5 g of THC Oil, so one hit or puff is about 4 mg THC. Oil pens vaporize the THC Oil.
The New York State Marijuana Regulation and Taxation Act (2021) legalized the purchase, possession, and transport of up to 24 grams of cannabis concentrate like THC Oil for adults 21 and older.
THC Overdoses
THC overdoses have become more common with the rise in use of Edibles and more concentrated THC in marijuana extracts like THC Oil. Edibles can be extremely high in potency and can lead to overdose as people ingest a full serving of an Edible rather than a diagnosed amount. THC Oil is extremely high in potency and can lead to overdose by inhaling too much from a THC Oil pen.
A THC overdose, on its own, is not likely to be fatal but may cause psychosis that can lead to behavior that causes serious physical injury or death. In most cases, a THC overdose can cause extreme discomfort including feeling dizzy, nauseated, and disoriented.
Common symptoms of a THC overdose can include:
- Poor cognitive functioning
- Motor impairment
- Panic, fear, anxiety, agitation
- Extreme sedation
- Cardiac stress
- Nausea, vomiting
- Psychosis
