Federal Register Proposes Adding Fentanyl, Removing MDMA From Drug Testing Panels

A new article published in the Federal Register in February, which prefaced a digital Drug Testing Advisory Board (DTAB) meeting that was held on March 5. The topic of the article and the meeting covered the Department of Health & Human Services (HHS) drug testing panels and considered adding fentanyl, while also removing MDMA.

Section 8105 from the Fighting Opioid Abuse in Transportation Act (which is included in the SUPPORT for Patients and Communities Act) requires the Secretary to justify whether or not to include fentanyl or other Schedule I or II substances in the Mandatory Guidelines for Federal Workplace Drug Testing Programs.

The focus on fentanyl is driven by the high number of overdose deaths in the U.S., as well as the fact that fentanyl can be used on its own and not paired with heroin or other substances. “According to the National Forensic Laboratory Information System (NFLIS) 2022 report, fentanyl was the third most frequently identified drug and accounted for 13.81% of all drugs reported by forensic laboratories,” the article stated.

According to the proposal, both fentanyl and norfentanyl (a metabolite of fentanyl) would be tested at 1 nanogram per milliliter of blood.

The article also mentioned removing MDA and MDMA from the list of drugs tested in the panel “because the number of positive specimens reported by HHS-certified laboratories does not support testing all specimens for MDA and MDMA in Federal workplace drug testing programs.”

The National Laboratory Certification Program (NLCP) shows that in 2021-2022, the positive rates of MDMA sat between 0.001%-0.003%, with less than 25% of “positive specimens are likely agency blind samples.”

The Substance Abuse and Mental Health Services (SAMHSA), which manages the Center for Substance Abuse Prevention’s (CSAP) DTAB, also considered removing PCP from the drug testing panel. However, decided not to pursue that change. “While PCP has an overall positivity rate nearly as low as MDMA, there are regional differences in positivity, with some areas of the country having much higher rates, so PCP remains a regulated test analyte,” the article stated.

During the March 5 digital meeting, SAMHSA led a public presentation covering “Regulatory Program Updates and Mandatory Guidelines.” The goal of the meeting was to discuss a review of the current Federal Drug Testing Program, as well as the state of the Drug-Free Workplace Program.

The National Laboratory Certification Program (NLCP) also presented an analysis of the cost and benefits of testing for fentanyl and MDMA. The most prevalent substances tested by the NFLIS in 2022 according to most frequently identified drugs in seized drug exhibits, meth was ranked at number one, followed by cocaine at number two, fentanyl at three, cannabis/THC at four, heroin at five. The ranking substance skip slightly to oxycodone at seven, followed by amphetamine at 13, hydrocodone at 15, and finally MDMA at rank 19.

The NLCP also explained that fentanyl testing in urine samples costs $0.23 to $5.00 per specimen for initial testing and $8.00 to $25.00 per specimen for confirmation testing, while oral samples costs $0.80 to $1.00 per specimen for initial testing and $22.00 to $25.00 per specimen for confirmation testing. The total cost estimate to add fentanyl to the drug testing panel could cost anywhere between $ $9,139 to $192,850 per year.

However, removing MDMA from the panel would save an estimated $3,800 and $38,000 per year (based on initial testing between $0.10 to $1.00 per specimen, and confirmation testing between $8.00 to $25.00 per specimen). MDMA is ranked as the 19th most frequently identified drug, the NLCP said the cost was negligible.

The meeting also invited the public to submit comments regarding the proposed changes, with 115 commenters agreeing with the adding fentanyl to the drug panel and 20 agreed with the addition of norfentanyl. Only 3 disagreed with the addition of fentanyl, citing the expense, the fact that it’s a time consuming process, and also the ongoing truck driver shortages.

Many commenters supported removing MDMA and MDA because of the low positivity rate, and how the removal wouldn’t “affect workplace and public safety.” However, many commenters also disagreed with MDMA/MDA removal proposal, claiming that even with a low positivity rate “not testing for it could lead to higher abuse.”

SAMHSA provided a graph that showed the drug specimens reported between January 2013-December 2023. During the 10-year period, confirmed tests for 6-acetylmorphine (referred to as 6-am), PCP, and MDMA, all remained low.

These potential changes are not yet official, as the DTAB is set to review and publish responses to the public comments. After that, a federal review process will proceed, possibly with revisions, and eventually a formal federal register article will announce the finalization of the changes.

Earlier this month, the U.S. Department of Transportation’s Federal Motor Carrier Safety Administration released a report that show year-end data from 2023 regarding the annual decrease of truck drivers. Overall, the number of truck drivers has decreased significantly every year since 2020, with the 2023 number sitting at 858,000. More truck drivers tested positive in drug tests in 2023 than ever before, and a high number of drivers refused to be screened in 2023 as well.