Drug testing covers a wide array of substances and methods. To better understand how opiates and synthetic opiates test positive on a POCT urine drug test, we must first take a look at the different classes that comprise the opiate family. Below is a list of opiate classes, their sub-classes, and common names for drugs that contain these substances. (Learn more in "Prescription Opioids and Safety Sensitive Work".) Opiates fall under both prescription and illicit classes. (Learn more in "Managing Opioids in the Workplace".)

Natural Opiates

Natural opiates are the three natural components that can be extracted from the opium plant.

• Morphine
• Codeine
• Thebaine
• oThebaine (oThebaine is not used for therapeutic or recreational purposes, but is converted industrially into a variety of compounds including oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, buprenorphine and etorphine. (Learn more in "A Look At Prescription Drug Abuse Statistics".)

Semi-Synthetic Opiates

Semi-synthetic opiates are substances partially derived from the opium plant.

• Hydrocodone
• oHycodan
• oVicodin
• Oxycodone
• oOxyContin
• oPercocet
• oPercodan
• Hydromorphone
• oDilaudid
• Oxymorphone
• oNumorphan
• Buprenorphine
• oSubutex
• Diacetylmorphine (Heroin)

Synthetic Opioids

Synthetic opioids/narcotics have opiate-like reactions within the body but are not derived from opium.

• Methadone
• Propoxyphene
• oDarvocet
• Fentanyl
• oDarvon
• oDuragesic
• oActiq
• Meperidine
• oDemerol

The most common drugs tested for in POCT tests are the ones most likely to be abused and affect workplace safety. These substances are:

• Morphine
• Codeine
• Hydrocodone
• Oxycodone
• Hydromorphone
• Oxymorphone
• Propoxyphene
• Heroin

Test Types

POCT tests include various sensitivities. Two of these are the 5 panel and the 12 panel test cards. Each test/card looks at different drug substances and are utilized in different situations, such as DOT testing. (Learn more in "DOT vs. Non DOT Testing: What's the Difference?")

5 Panel Test Cards

The only test available for opiates on this card is the Opiate 2000 ng/ml test. This card works well for Morphine and Codeine drug classes and can detect them at 2000 ng/ml. For semi-synthetic and synthetic opioids the detection levels are as follows:

• Hydrocodone — 12,500 ng/ml
• Hydromorphone — 5,000 ng/ml
• Oxycodone — 25,000 ng/ml
• Oxymorphone — 25,000 ng/ml
• Propoxyphene — not detected
• Heroin — see below

As you can see a standard Opiate test (5 panel) is relatively ineffective when trying to detect synthetic and semi-synthetic opioids as the detection levels are so high that it is very unlikely to detect them in a person unless the person ingested a very large dose recently. As for Heroin, 6-monoacetylmorphine is detected at 5000 ng/ml, which is an enormous level and just does not happen in real world testing situations. Heroin breaks down from the above compound quickly (within 45 minutes from ingestion) into codeine and morphine and will be easily picked up as that as the levels are typically very high. (Learn more in "What drugs are part of a non-DOT 5 panel drug test?")

12 Panel Test Cards

The tests available on a 12 panel test card for the opiate family are the standard Opiate test at 2000ng/ml, Oxycodone test at 100 ng/ml, and Propoxyphene test at 300 ng/ml. Comparing the detection levels of substances also checked by the 5 panel card, drastic differences are seen.

• Hydrocodone — 1,562 ng/ml (under the OXY test)
• Hydromorphone — 5,000 ng/ml (under the OPI test)
• Oxycodone — 100 ng/ml (under the OXY test)
• Oxymorphone — 1,562 ng/ml (under the OXY test)
• Propoxyphene — 300 ng/ml (under the PPX test)
• Heroin — same as above

As these numbers show, the 12 panel test card is far superior in detecting synthetic and semi-synthetic opioids. In 2013, prescription painkillers overtook Cocaine as the #2 most abused drug class (Marijuana is #1 as always). (Learn more in "Medical Marijuana Use and Concerns in the Workplace".) The most abused painkillers are the Hydrocodone and Oxycodone families. A 12 panel drug test does a much better job of detecting these substances at lower concentration levels. (Learn more in "Drug Test Types: 5, 7, and 12 Panel Urine Screening Differences and Reasons to Use".)

Drug Testing Recommendations

For any company that is concerned about painkiller drug abuse, it is highly recommended that they adopt a 12 panel POCT drug test to detect semi-synthetic and synthetic opioids rather than the 5 panel test. It is also recommended that their drug and alcohol policy be amended to reflect the cutoff concentrations for the additional tests. (Learn more in "Drug Detection Cutoffs: What You Need to Know".) Company drug and substance use/abuse policies should also include wording to require all employees let their supervisor or safety personnel know about any prescription painkillers that may have safety sensitive warnings with their use. (Learn more in "The Importance of a Good Drug and Alcohol Policy in the Workplace".)