About the Test
Purpose of the test
Opioid testing is used to detect evidence of opioid use or misuse. Opioid use identifies the consumption of a class of drugs that are chemically similar to psychoactive agents found in opium. Opioid misuse is used when consumption of these drugs does not match a drug schedule prescribed by a physician to that individual.. Testing for the use and misuse of opioids may be performed for a variety of purposes:
- Medical testing: Drug screening is commonly used in psychiatric care, substance use treatment programs, and as a way to monitor the use of prescription opioids Drug testing may be used in emergency settings to identify acute intoxication; however, the providers may rely solely on the patient’s symptoms to drive treatment.
- 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.
If you are 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 you 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, and opium. Heroin, which can be made from morphine easily, is often grouped with natural opioids.
- Synthetic opioids are created in the laboratory and act on the same receptors in the brain as natural opioids. They may not look chemically similar to natural opioids.. Synthetic opioids include tramadol and fentanyl.
- Semi-synthetic opioids are chemically similar to natural opioids but are also manufactured in the laboratory and act on the same receptors in the brain as natural opioids. Semi-synthetic opioids include oxycodone, hydrocodone, hydromorphone, and oxymorphone.
Any individual opioid test may 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.
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 may be confirmed by a second, more specific test.
Common 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. This varies based on many factors, including the type of opioid used, the amount and frequency of use, the type of test sample and factors specific to the patient such as body weight, ability to process the drug, nutrition and other medications.. 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:
| URINE DETECTION WINDOWS AFTER OPIOID USE | |
|---|---|
| OPIOID AND EXAMPLE TRADE NAMES | ESTIMATED DETECTION WINDOW |
| Buprenorphine (Buprenex, Suboxone) | Up to 14 days |
| Codeine | Up to 3 days |
| Fentanyl (Duragesic, Fentora) | Up to 3 days |
| Heroin | Less than 1 day |
| Hydrocodone (Lorcet, Vicodin) | Up to 3 days |
| Hydromorphone (Dilaudid, Exalgo) | Up to 3 days |
| Meperidine (Demerol, Mepergan) | Up to 4 days |
| Methadone (Dolophine, Methadose) | Up to 14 days |
| Morphine (Avinza, Duramorph) | Up to 3 days |
| Oxycodone (Oxycontin, Percocet) | Up to 3 days |
| Oxymorphone (Numorphan, Opana) | Up to 3 days |
| Propoxyphene (Darvon, Darvocet) | Up to 4 days |
| Tapentadol (Nucynta) | Up to 3 days |
| Tramadol (Ultram) | Up to 4 days |
The following table provides examples of detection windows in other types of test samples:
| OTHER ESTIMATED DETECTION WINDOWS | |||
|---|---|---|---|
| OPIOID | HAIR | SALIVA | SWEAT |
| Codeine | Up to 90 days | Up to 36 hours | Up to 14 days |
| Morphine | Up to 90 days | Up to 36 hours | Up to 14 days |
| Heroin | Up to 90 days | Up to 36 hours | Up to 14 days |
When should I get an opioid test?
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.
Your doctor might ask you to get an opioid test if you are prescribed the medication because of its highly addictive potential. Even if the drug itself is legal, its use may be controlled and so testing can be a precautionary measure.
Finding an Opioid Test
How can I get an opioid test?
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. Often, opioid tests can be ordered by your doctor or by an administrator of the program that requires drug testing.
You can buy a drug panel test online and visit the participating lab to get tested for opioids. For example, a 9-panel drug test can test for amphetamines, barbiturates, benzodiazepines, cannabinoid, cocaine, methadone, opiates, phencyclidine (PCP), and propoxyphene. Your doctor does not have to order this test.
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 saliva and urine drug tests allow you to conduct a rapid drug screening with results provided quickly in your own home, and you do not need a doctor’s order. At-home hair follicle testing involves collecting a hair sample at home before sending the sample to a laboratory for testing.
Rapid drug tests performed at-home are a type of initial drug screening. Positive results on drug screening tests require confirmation testing.
Aside from testing in a health care professional’s office, you can also order a drug panel test online and visit the participating lab. Keep in mind, online and at-home opioid tests are not a substitute for drug testing conducted by a doctor or other health care professional.
How much does the test cost?
If you purchase an over-the-counter drug test panel that includes screening for opioids, you’ll pay out of pocket and the cost can range from about $10 to $25. You can also order a drug panel test online and visit the participating lab for testing. The cost can range from $109 to $129, depending on how extensive the screening is.
Aside from self-pay, the cost of opioid testing might be covered by your health insurance provider, employer, or the organization requesting the test. If your doctor orders the test, the health care provider pays for it or you might be responsible, in which case you can submit it to insurance. Keep in mind, you might be billed for copays and deductibles.
Taking an Opioid Test
For laboratory-based testing, an initial drug screen is usually performed on a clean catch urine sample, which prevents germs from contaminating the sample. You can get tested for opioids in a lab, medical facility, or other testing site and the process can vary based on the sample required. For example, saliva, sweat, and hair samples are another way to test for drugs including opioids.
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, talk to your health care provider about what type of collection will be performed.
There are several ways testing locations prevent urine sample tampering. Some monitor you during the collection, others might require a technician to check the restroom before you enter.
Be sure to talk to your doctor or employer about medications you take because some over-the-counter and prescription drugs can affect opioid test results – and the same is true with some foods like poppy seeds. Do not eat them within three days of a urine test.
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. You’ll wash your hands thoroughly with soap and water and clean the area thoroughly with sterile wipes in the testing kit. Then, urinate into the toilet before stopping the flow of urine and moving the collection container a few inches from the urine stream. Fill the container about halfway. Once the urine sample is collected, you 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 health care provider using a small needle. Blood is drawn from a vein, usually from the arm.
- Hair samples are small amounts of hair cut from near your scalp using scissors. If you don’t have sufficient hair on your head, hair can be collected from another part of the body.
- Saliva samples are obtained by collecting your spit or by placing a swab between your 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 during sample collection, although some people having blood drawn might feel some pinching pain and experience temporary bruising where the needle is inserted. Samples used for drug testing can typically be obtained in less than 5 minutes.
If you’re using an at-home test kit, keep in mind the instructions vary. Be sure to read through the steps carefully before obtaining a sample.
After the test
After collecting a clean catch urine sample, simply close the sample container and return it to a staff member at the testing facility, or follow the instructions in the test kit to send to a lab. 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 nothing additional. There are no restrictions after testing.
Opioid Test Results
Receiving test results
Results from an opioid test are often available within a few hours to a few business days. Depending on how and where you take the test, you might receive results by a phone call from your doctor, on a secure patient portal, or electronic health record.
Interpreting test results
Keep in mind, drug screening tests are interpreted differently than laboratory-based testing that confirms initial screening results. So, if you are using an at-home test kit, you might very well need follow-up testing to confirm results.
- Drug screening tests: Results from drug screening tests are usually 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 results for confirmation testing are always performed in a certified laboratory.
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. As one example, 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 you have not 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.
Keep open lines of communication with your health care provider, and don’t hesitate to ask these important questions about opioid testing, the purpose, and how results are interpreted.
- 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?
