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What Is Opioid Testing?

Medically Reviewed by Sabrina Felson, MD on May 03, 2022

You might need an opioid test to start a new job or to complete an application for life or disability insurance. Your doctor may also order one if they suspect you’re misusing or dependent on prescription opioids you take for pain, or if you’re in treatment for addiction. This test checks for traces of opioids in your urine, blood, or saliva.

Opioids are powerful drugs designed to ease pain. Your doctor might prescribe this type of medicine for serious pain, illness, or injuries. Besides pain relief, opioids can also make you feel relaxed, happy, or high till the dose wears off.

Over time, it’s relatively easy to become addicted to them, even if your doctor prescribes them. Millions of people misuse prescription opioids each year. Some 8%-12% of people prescribed opioids for chronic pain go on to develop opioid use disorder. And every year, tens of thousands die from overdoses of opioids -- so many that health experts call this a health crisis. Testing can help detect, prevent, and treat addiction.

Which Drugs Do Opioid Tests Screen For?

Most opioid tests pick up both opioids and opiates. Most opiates are made from active ingredients found naturally in opium poppy plants. Most opioids are chemical imitations of the natural ones. Combined, they include both prescription painkillers and illegal drugs. Opioid tests can detect both.

Heroin is the only illegal opioid. Others, such as the very potent fentanyl, have legal uses but are often made illegally.

Prescription opioids include these drugs, which may be used alone or in combination with other medicines:

While doctors may order opioid tests separately, they usually order them as part of a larger drug panel to check for a variety of illegal and prescription drugs.

Urine Drug Test for Opioids

A urine test is the most common way to check for opioids. There are two types of urine tests:

Presumptive test (immunoassay screen). Presumptive tests are usually part of an initial drug screening and are often used to detect illicit drug use in the workplace. They’re fast, cheap, and can provide results within minutes or days, depending on where you get the test.

Confirmatory test (gas chromatography/mass spectrometry). If you test positive on a presumptive test, you may have to get a confirmatory test for a more specific result. It can also be used to detect misuse of prescription opioids that aren’t detected in the presumptive test. This test costs more, but your chances of a false positive are low. It can detect all opioids, including fentanyl.

Who Needs Opioid Testing?

You might need an opioid test in a few different situations.

In the workplace. Opioid testing may be part of drug tests you must take before you start a new job. Most federal jobs require drug tests as a condition for employment. Private companies may require them, too.

Employers can also require random testing. But in most cases, opioid screenings happen in specific situations, such as:

  • Before you start the job
  • During annual physical exams
  • After a workplace accident, to rule out “working under the influence” as a cause
  • When you return to work after drug rehab
  • If your employer has reasonable suspicion of drug misuse

For insurance applications. Opioid testing may be one of a series of drug tests you must get when you apply for life or disability insurance.

Insurers want to make sure your health is not in imminent danger, so they check for signs of drug dependence and other health problems.

Prescription opioid management. Opioid testing can also be part of long-term opioid therapy. That’s when your doctor prescribes opioids for an extended time to treat severe pain that’s not caused by cancer treatment or part of end-of-life care.

Anyone who takes prescription opioids is at risk for opioid use disorder (OUD). But the length of your treatment and your history with drug use can also play roles. The risk for OUD is high because opioids trigger feel-good signals in the brain (endorphins) that dull pain. If you take them for a long time, your body’s endorphin production dips, and you build tolerance to the drug. So you’ll need a higher dose for a similar effect.

Routine opioid tests help doctors find possible signs of OUD so they can address the problem before it gets worse.

During opioid therapy, doctors mostly use urine tests. The tests help:

  • Improve care and safety when you use opioids for a long time
  • Check to see if you stick to the treatment and dosage plan
  • Check for opioid misuse, abuse, or OUD

Doctors might also order opioid tests if you transfer to a new doctor for your long-term opioid treatment or need a referral to a pain specialist.

When your doctor prescribes opioids for a long time, they’ll likely suggest a routine testing schedule. It will be based on your drug use history and your risk for OUD. For example:

  • If you’re at low risk, you might be tested every 12 months.
  • For medium risk, you could get tests every 6 months.
  • For high risk, you may have tests every 3 months.

Your doctor may also order a drug test if they notice signs of opioid misuse. This might happen if you:

  • Request early refills
  • Switch doctors often
  • Report lost or stolen prescriptions
  • Make frequent emergency room visits

What Happens During an Opioid Test?

Most opioid tests are given at a doctor’s office, a lab, or a testing site. In some cases, a trained person may visit your home or workplace to collect specimens.

Urine drug test. You’ll get instructions and a container to collect your sample. Collect at least 1-2 ounces of urine or fill it past the line on the cup. Once you’re done, seal the container and return it to the technician.

In some cases, a medical technician or someone else may need to be present while you provide your sample.

Blood test. A health care professional uses a needle to take a blood sample from a vein in your arm. This usually takes less than 5 minutes. The blood then goes to a lab for drug testing.

Saliva test. During this test, a health care worker swabs the inside of your cheek to collect a sample. In some cases, you may have to spit into a tube.

How to Understand Opioid Test Results

If your results are negative, you don’t have opioids in your body. If your doctor thinks you might be misusing prescription pills, they may order more tests.

If the test is positive, it means you:

  • Have traces of opioids in your body
  • May be misusing drugs

It’s possible to get a false positive result. This means the test comes back as positive even though you haven’t taken opioids or misused them. Your doctor can order more tests to confirm the result.

Things You Need to Know About Opioid Tests

Before you take a test, tell your doctor about any over-the-counter medications or prescription drugs you take. This can help explain any false positive tests.

If you eat poppy seeds, often found in bagels and other baked goods, they may cause a positive test result. Avoid poppy seed-based foods and drinks for at least 3 days before the test.

If you test positive for unhealthy levels of opioids or struggle with an opioid use disorder, there are things you can do that can save your life. Talk to your doctor about medication-assisted treatment to keep you off opioids. You can also get naloxone nasal spray (Narcan) that someone could use to save your life in the case of an overdose.

Show Sources

SOURCES:

CDC: “Urine Drug Testing,” “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.”

MedlinePlus.gov: “Opioid Testing.”

UpToDate: “Urine drug testing for patients with chronic pain.”

Mayo Clinic: “How opioid addiction occurs.”

SAMHSA: “Drug Testing Resources.”

U.S. Department of Health and Human Services: “What is the U.S. Opioid Epidemic?”

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