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Drug of Abuse Testing Trends and News
March 2024
Is a "fourth wave" of the opioid crisis here?
In December 2023, initial results from New Mexico’s high school wastewater testing initiative Wastewater Drug Monitoring Dashboard (NM) surprised officials.1
Cocaine use in nearly 82% of campus communities1
Methamphetamine detected in more than half of the schools1
Per testing last May, xylazine has entered the community1
In 2023, New Mexico Gov. Michelle Lujan Grisham declared drug abuse a public health emergency and issued an executive order.1,2 Other communities, including those in California, Delaware, and Virginia, have also used similar programs to test high school wastewater, a concept first used for Covid-19.3,4
Unprecedented challenges of the opioid crisis
The prevalence of fentanyl, xylazine, and stimulants is weakening the effectiveness of medication-assisted treatment (MAT) of opioid disorders (i.e.,buprenorphine and naloxone).5 Furthermore, the use of xylazine (aka, 'tranq' dope) is being increasingly linked to overdose deaths. Fentanyl mixed with xylazine presents a highly dangerous combination, recognized as a national threat by the White House's Office of National Drug Control Policy.6 The Vermont State Department of Health reported that as many as 1 in 3 overdose deaths involve xylazine.5
The 'fourth wave' of high mortality: the rise of stimulants
A 'fourth wave' of high mortality involving stimulant-related deaths appears entwined with the ongoing opioid crisis. A significant increase in co-use-related overdose deaths has resulted from a rise in the use of synthetic opioids in combination with cocaine and methamphetamine.7
The increased availability of methamphetamine coupled with a lack of certain opioids in the market has driven this heightened stimulant usage. One of the possible explanations for the rise in methamphetamine usage, according to user experience, is that it served as an opioid substitute, offered a synergistic high, and balanced out the effects of opioids in order to regain “normalcy.”7
"If you don't screen, you can't detect"
According to 2021 data from the U.S. Centers for Disease Control and Prevention, more than 71,000 people in the United States died from synthetic opioids, and nearly all of these deaths involved fentanyl. Despite this, testing of overdose patients in hospital emergency departments for fentanyl has remained low at only 5%. Furthermore, greater than 40% of patients tested for fentanyl test positive.8
In most cases, hospitals test for the "federal five": opiates, amphetamines, cocaine, THC, and PCP. Fentanyl tests must generally be ordered separately from routine toxicology screening. It is imperative that healthcare systems push for increased fentanyl screening as this synthetic opioid continues to kill at an unprecedented rate.8
Effective drug testing is vital for substance use disorder treatment and in healthcare settings
Drug testing in SUD treatment can serve as:9
- An initial assessment during evaluation for SUD diagnosis
- A screen for preventing potential adverse effects of pharmacotherapy
- A method of monitoring patient illicit substance use or adherence to pharmacotherapy treatment
- A way to assess treatment plan efficacy
In healthcare settings, drug testing is useful for:9
- Determining/refuting perinatal maternal drug use
- An addition to counseling and psychiatric care
- Monitoring compliance during treatment with opioids or other medications with the potential for abuse
- Detecting drug use or abuse that may negatively impact care of the patient in other medical specialties
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Archive
Kratom and reagent cross-reactivity
Kratom and NAS (Neonatal Abstinence Syndrome), quality controls failure causes
Troubleshooting quality controls calibration
CBD (Cannabidiol) and FDA, and substance abuse pregnancy screening
Opioid crisis exacerbates adolescent fentanyl-involved deaths
Polysubstance use, MAT defined, cannabis-impaired driving
Q&A for fentanyl and THC (Marijuana)
Pregnancy drug testing: new perspectives, Q&A EtG/EtS
Substance abuse disorders - prevention, treatment, and recovery
1. Wastewater Treatment Testing. Office of the Governor - Michelle Lujan Grisham. Accessed January 10, 2024. 
https://www.governor.state.nm.us/wastewater-testing/
2. Executive Orders | Office of the Governor - Michelle Lujan Grisham. https://www.governor.state.nm.us/about-the-governor/executive-orders/
3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division on Earth and Life Studies; Board on Population Health and Public Health Practice; Water Science and Technology Board; Committee on Community Wastewater-based Infectious Disease Surveillance. Wastewater-based Disease Surveillance for Public Health Action. Washington (DC): National Academies Press (US); 2023 Jan 19. 2, Wastewater Surveillance for COVID-19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK591716/
4. Wastewater - Delaware Health and Social Services - State of Delaware. www.dhss.delaware.gov. Accessed January 10, 2024. https://www.dhss.delaware.gov/dhss/dph/lab/wastewater.html
5. Sisk T. Evolving Overdose Crisis Shakes Previously Effective Treatments. Medpagetoday.com. Published November 25, 2023. Accessed January 10, 2024. https://www.medpagetoday.com/special-reports/features/107493
6. What You Should Know About Xylazine | Drug Overdose | CDC Injury Center. www.cdc.gov. Published May 5, 2023. https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html
7. Ahmed S, Sarfraz Z, Sarfraz A. Editorial: A Changing Epidemic and the Rise of Opioid-Stimulant Co-Use. Front Psychiatry. 2022 Jul 6;13:918197. doi: 10.3389/fpsyt.2022.918197. PMID: 35873238; PMCID: PMC9296817.
8. Even as fentanyl overdoses surge, few hospitals test for it. OncLive. Published October 28, 2022. Accessed January 10, 2024. https://www.chiefhealthcareexecutive.com/view/even-as-fentanyl-overdoses-surge-few-hospitals-test-for-it
9. (2012). Clinical Drug Testing in Primary Care (p. 5). SAMHSA. https://store.samhsa.gov/product/TAP-32-Clinical-Drug-Testing-Primary-Care/SMA12-4668