Department of Transportation (DOT) regulations have finally caught up to the rest of the world with the addition of four semi-synthetic opioids to the DOT drug test panel. This move also brings DOT regulations into alignment with the growing focus on the opioid epidemic and the determination to end it.

In effect, the changes add a new opioid panel to the original opiate panel. But what does this really mean? What is the difference between the two and why should you care?

Two Distinct Classes

The terms opiate and opioid are often used interchangeably, but they actually refer to two distinct classes of drugs. While opiates can be opioids, the reverse isn't always true — opioids are not necessarily opiates. The new regulations, which took effect in January of 2018, now refer to opioids rather than opiates.

Opiates and opioids are both frequently prescribed medically for purposes that include pain relief, anesthesia, and cough suppression. They are also a common drug of choice for people with substance abuse problems. Opiates and opioids both work by affecting parts of the brain that control pain and emotions, increasing levels of the hormone dopamine, alleviating pain, or producing feelings of euphoria. However, as the brain becomes accustomed to the effects of these drugs, users require increasing amounts to produce the same effects. Subsequently, even medically prescribed opioids can lead to an addiction. (Learn more in Managing Opioids in the Workplace).

The distinction between opiates and opioids is a subtle but important one.

Opiates

Opiate is the term used to describe naturally occurring drugs, known as alkaloids, that are made from the opium poppy plant. Commonly used opiates include opium, codeine, and morphine. Heroin, another opiate, is an additionally refined version of morphine that was originally manufactured as a treatment for tuberculosis and as a remedy for morphine addiction. Neither heroin nor opium are used medically in the United States, although codeine and morphine are frequently prescribed as pain medications. Opiates work by binding themselves to specific receptors that affect the central nervous system. These drugs have both analgesic (painkilling) and narcotic effects, including inducing feelings of euphoria. (Learn more in An Introduction to Opiates and Drug Testing).

Opioids

The term opioid originally referred to synthesized or lab created compounds that mimic the drugs produced from the opium poppy. These drugs produce the same effect as opiates but are not necessarily derived from the opium poppy. The term opioid is now used, however, to describe both naturally occurring opiates as well as semi-synthetic and synthetic compounds. These drugs may, but do not necessarily have to have, the same structure as opium alkaloids. In short, opiates are one type of opioid.

Like opiates, opioids also have both analgesic and narcotic effects, and work by binding themselves to receptors governing the central nervous system.

Examples of opioids include:

Opiates – opium, codeine, morphine, heroin

Semi-synthetic compounds – oxycodone, oxymorphone, hydrocodone, hydromorphone

Synthetic compounds – fentanyl

New DOT rules

The DOT drug panel has always tested for opiates, more specifically for codeine, morphine, and heroin. As of January 2018, DOT added four semi-synthetic compounds to the test panel – oxycodone, oxymorphone, hydrocodone and hydromorphone. To accurately reflect these changes which now include both naturally occurring and semi-synthetic drugs, this part of the test panel has had its name changed from opiates to opioids.

Why the addition?

The nature of drug addiction and its effect on the workplace has changed significantly in recent years. These changes simply bring the test into line with these new realities. Of the over 20 million Americans believed to suffer from a substance abuse problem, over 500,000 had developed an addiction to heroin but a stunning two million were abusing prescription pain relievers. (Learn more in How Prescription Opioids Affect The Workplace). Even more significantly, experts believe that 23% of current heroin users will eventually become addicted to other opioids. And the problem shows few signs of going away anytime soon. Over one in three Americans are prescribed prescription pain relievers yearly and the National Institute of Drug Abuse says that 8-12% of the people with these prescriptions will eventually develop an addiction.

In the workplace, drug abuse has been linked to incidents, absenteeism and errors and increased risk for both employer and employee. In fact, absenteeism increases threefold for workers with substance abuse problems and the cost in lost productivity is estimated to exceed $42 billion each year. It can also put your workers at risk of additional health issues or even death.

Consider the following statistics. Drug addiction is the leading cause of accidental death in the United States and opioid addiction is the primary cause of this growing epidemic. Of the 54,404 lethal drug overdoses reported in 2015, 20,101 were attributed to prescription pain relievers and 12,990 to heroin.

Why these four drugs?

The four semi-synthetic compounds added to the drug panel – oxycodone, oxymorphone, hydrocodone and hydromorphone are all commonly available prescription pain medications. Here are a few of the more common brand names associated with these compounds:

Oxycodone — Oxycontin, Percocet

Oxymorphone — Opana

Hydrocodone — Vicodin

Hydromorphone — Dilaudid

DOT has also identified these compounds as commonly abused drugs according to recent research and data. The inclusion of these drugs in the new panel will further expand the protections offered by the mandatory DOT drug test panel and bring them more in line with national trends in substance abuse.

How it will affect your business?

For DOT regulated workplaces and employees working in safety-sensitive positions, the addition of opioids to the test panel affects very little. Employees, who test positively for opioids, will be required to produce proof to a Medical Review Officer (MRO) that they have a legitimate medical prescription. They may also be required to have their prescribing physician provide a written statement attesting to the fact that even with the prescription they are still able to perform their job safely.

While workplaces will be safer and more productive with this new testing, the inclusion of opioids in the test panel will likely lead to additional positive test results. It may also result in additional safety concerns raised by the MRO. Employers can prepare by ensuring their policies reflect both the new changes and their procedures for dealing with both positive test results and safety concerns.