Opioid Testing

What is opioid testing?

Opioid testing looks for opioids in a sample of your urine (pee), blood, saliva (spit), hair, or sweat.

Opioids include powerful medicines that health care providers may prescribe to relieve pain from serious injuries, illnesses, or surgery. Opioids also include illegal drugs, such as heroin.

The terms "opioids" and "opiates" are often used to mean the same thing, but they're slightly different. Opioids include:

• Opiates, which are natural opioids made from the opium poppy plant. Opiates include the medicines codeine and morphine, and the illegal drug heroin.
• Synthetic and semi-synthetic opioids, which are medicines made in labs, including:
  • Oxycodone.
  • Hydrocodone.
  • Hydromorphone.
  • Oxymorphone.
  • Methadone.
  • Fentanyl.

Prescription opioids are relatively safe for reducing pain if you take them for a short time according to your provider's instructions. But opioids can increase feelings of pleasure and well-being in some people. For these reasons, misuse of prescription opioids is common.

Prescription opioid misuse means taking the medicine in a different way or for a different purpose than your provider prescribed. It includes:

• Taking more than your prescribed dose or taking it more often.
• Getting and using prescription pills from friends or family members, even if you're using the pills for a medical condition.
• Taking prescription drugs to get high.
• Mixing prescription opioids with alcohol or other drugs.

Opioid misuse is dangerous because opioids are highly addictive. Misusing them can lead to opioid use disorder (OUD), which is sometimes called opioid addiction. OUD can cause difficulties with work, school, and homelife. It can even lead to overdose and death.

Opioid testing can't diagnose opioid misuse or OUD. But it can be used with questionnaires called drug use screening tests to help find out who may need help with a drug problem.

Other names: opioid screening, opiate screening, opiate testing

What is it used for?

Opioid testing may be used for different purposes, including:

• Therapeutic drug monitoring. Some opioids can be used during certain medical treatments. During these treatments, your provider may monitor opioid levels to make sure the medicine is working and that you don't have a dangerous amount of opioids in your blood.
• Monitoring misuse of prescription opioids. If your provider prescribed opioids for pain, opioid tests may be used to make sure you're taking the right amount of medicine. Your provider may also order this test if they suspect you are taking opioid medicines that they didn't prescribe for you.
• As part of an overall drug testing program to check for a variety of drugs, including marijuana, cocaine, and opioids. Drug testing may be used for:
  • Employment. Employers may test you for drugs before hiring you and/or after hiring to check for on-the-job drug use.
  • Legal evidence. Testing may be part of a criminal or motor vehicle accident investigation. Drug testing may also be ordered as part of a court case.
  • Drug treatment. Drug testing may be used to monitor treatment in programs for drug or alcohol use disorder.
  • Sports. Professional and other athletes are often tested for drugs.

Drug testing may be scheduled ahead of time or done randomly without notice.

Why do I need opioid testing?

Your provider may order opioid testing if you're taking prescription opioids to treat:

• Chronic pain.
• Post-surgical pain.
• A persistent cough.
• Severe pain due to trauma.
• Cancer-related pain.

Certain tests can tell if you are taking more medicine than prescribed, which can be a sign of misuse or addiction.

Your provider may also order opioid testing if you have other signs or symptoms of opioid misuse or addiction, which may include:

• Calling early for refills or asking for higher doses.
• Complaining of increasing pain even though your condition isn't getting worse.
• Showing signs of opioid use when you don't have a prescription for opioid medicines. Some common signs of opioid use include:
  • Constricted (abnormally small) pupils.
  • Trouble staying awake or falling asleep at inappropriate times.
  • Flushed, itchy skin.
  • Personality changes.
  • Social withdrawal.
  • Neglecting responsibilities.
• Having withdrawal symptoms when not taking opioids, which may include:
  • Frequent yawning.
  • Wide open pupils (the openings that let light into your eyes).
  • Uncontrollable leg movements.
  • Increased heart rate and blood pressure.
  • Nausea and vomiting.

In a hospital emergency room, a provider may order opioid testing if you have signs of a possible drug overdose, such as slow shallow breathing and very low blood pressure.

You may also be asked to take a drug test, which includes testing for opioids, for a job, to participate in certain organized sports, or as part of a police investigation or court case.

What happens during an opioid test?

Opioid testing may be done in a variety of locations, including labs, hospitals, drug treatment centers, and workplaces. Most opioid tests require a urine sample. Other opioid tests may use samples of your blood, saliva, sweat, or hair.

For a urine test, you will be given instructions for how to collect your urine sample. Follow them carefully. In certain cases, a health care professional or other person may need to be present while you provide your sample. This is to make sure the urine is yours and isn't contaminated with anything that might affect the test results.

For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

For a saliva test, a sample may be collected in one of two ways:

• A swab or pad will be placed inside of your cheek for a few minutes until it is soaked with saliva. OR
• You'll spit into a tube.

For a sweat test, you'll wear a patch on your skin for five to seven days. The patch will absorb your sweat.

For a hair test, scissors will be used to cut a small sample of hair from near your scalp. Hair may be cut from other parts of your body instead. Hair samples can show long-term opioid use.

Will I need to do anything to prepare for the test?

Be sure to tell the testing professional or your provider if you are taking any prescription or over-the-counter medicines. Some of these medicines may show up as opioids on your test results. Poppy seeds can also show up as opioids. So, you should avoid foods with poppy seeds for at least three days before your test.

Are there any risks to the test?

There are no known risks to having a urine, saliva, sweat or hair test. There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

Your test results depend on the type of opioid testing you had.

Tests to screen for drugs in your system only show whether opioids are in your sample. They can't show what kind or how much:

• Positive results mean that opioids were found. But positive test results may not be accurate (false positives), so follow-up testing is usually required to confirm the results.
• Negative results mean that either:
  • No opioids were found in your sample. That may be because you haven't taken any, or you took them but they are no longer in your body.
  • A very small amount of opioids was found, but too little to be called a positive test result. In certain cases, follow-up tests may be done to get more information.

Confirmation tests may be done if there is a question about the results of a screening test. These tests can show more detail about the amount and/or type of opioids found in your sample.

Opioid test results can be complicated to understand. They may be affected by how fast your body uses opioids, other medicines you take, and the different ways labs do the tests. So, it's best to ask your provider to explain what your results mean.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about opioid testing?

You can buy at-home tests for many opioids and other prescription and illegal drugs. These tests only check whether opioids show up in your sample. There are two types:

• At-home tests let you do the entire test at home and get rapid results. But if the test result finds opioids, you'll need to have a follow-up lab test to check the accuracy of the result. Some at-home tests include a kit for collecting a sample, usually urine or saliva, to send to a lab in case the home test result is positive.
• A self-collection test has a kit for gathering urine, saliva, or another type of sample to send to a lab for testing.

It's best to talk with your provider about using home drug testing so you can decide if it's right for your situation.