Examples
Opiates (naturally occuring): heroin, morphine, codeine
Opioids (synthetic & semi-synthetic): fentanyl (and associated analogs), tramadol, oxycodone, hydromorphone, oxymorphone, buprenorphine, methadone
Routes of Use
ingestion, intranasal, injection, inhalation
Observed Symptoms
Adult: miosis, bradycardia, hypotension, sedation, constipation, respiratory depression
Prenatal Exposure
Prenatal opioid exposure may lead a newborn to experience withdrawal symptoms known as neonatal abstinence syndrome. Symptoms of withdrawal include: feeding difficulties, diaper rash, excessive suck, difficulty sleeping, irritability, muscle tightness or tremors, increased temperature, fast breathing. NAS occurs within a week of birth, usually within 48 hours and symptoms may last weeks to months. Prenatal opioid exposure includes risk for miscarriage, preterm delivery, still birth, and low birth weight.
Breastfeeding
Amount in breastmilk and breastfeeding recommendations can vary depending on the specific opioid. Heroin can be transferred in breastmilk and is considered a contraindication to breastfeeding. Prescribed opioids or medication assisted treatment may be considered safe. Consult a physician to understand each unique situation and circumstances.
Opiates (naturally occuring): heroin, morphine, codeine
Opioids (synthetic & semi-synthetic): fentanyl (and associated analogs), tramadol, oxycodone, hydromorphone, oxymorphone, buprenorphine, methadone
Routes of Use
ingestion, intranasal, injection, inhalation
Observed Symptoms
Adult: miosis, bradycardia, hypotension, sedation, constipation, respiratory depression
- Withdrawal: diaphoresis, agitation, diarrhea, vomiting, tachycardia, yawning, body aches, abdominal pain, flu-like illness
- Child: same
Prenatal Exposure
Prenatal opioid exposure may lead a newborn to experience withdrawal symptoms known as neonatal abstinence syndrome. Symptoms of withdrawal include: feeding difficulties, diaper rash, excessive suck, difficulty sleeping, irritability, muscle tightness or tremors, increased temperature, fast breathing. NAS occurs within a week of birth, usually within 48 hours and symptoms may last weeks to months. Prenatal opioid exposure includes risk for miscarriage, preterm delivery, still birth, and low birth weight.
Breastfeeding
Amount in breastmilk and breastfeeding recommendations can vary depending on the specific opioid. Heroin can be transferred in breastmilk and is considered a contraindication to breastfeeding. Prescribed opioids or medication assisted treatment may be considered safe. Consult a physician to understand each unique situation and circumstances.
What if opiates are prescribed to a caregiver? Consultation with a medical professional can be helpful when considering if there is a concern. If your “gut” tells you something is off, dig deeper and ask questions. Is the caregiver taking the medications as prescribed? Are medications being mixed with other medications or other substances?
The prescribing medical professional should be able to help you determine how the medication should affect the patient and how this may impact their caregiving abilities.
The prescribing medical professional should be able to help you determine how the medication should affect the patient and how this may impact their caregiving abilities.
Urine
Blood
Blood tests are typically not sent as clinical examination and observation of behavior, along with targeted urine tests, are sufficient for exposure.
Concentrations can be difficult to correlate with intoxication depending on the tolerance of the user, however, specific opioids / opiates concentrates can be obtained from reference labs.
Meconium
Assays for opiates, opioids and their respective metabolites can be tested to evaluate for maternal use.
Umbilical Cord
Arguably preferred for fentanyl. Otherwise assays for opiates, opioids and their respective metabolites can be tested to evaluate for maternal use.
Hair
Assays for opiates, opioids and their respective metabolites can be sent to evaluate for exposure.
- Urine drug screens test well for common metabolite of codeine, heroin and morphine, but will be unable to distinguish between the three. Depending on the UDS, it may react with synthetic opioids such as oxycodone, but not routinely, therefore many UDS have oxycodone as separate drug screen. Likewise, fentanyl will not be detected by Urine drug screens for opiates - such as heroin - due to its synthetic nature. It is necessary to specify opioids when testing for fentanyl. Depending on the opioid or opiate, tests can be positive up to 4 days after acute use.
- Confirmatory tests can distinguish between specific opiates (including heroin from morphine) and synthetic opioids (oxycodone, hydrocodone, fentanyl, etc). A confirmatory test is recommended if specific opioid exposure evaluation is needed.
Blood
Blood tests are typically not sent as clinical examination and observation of behavior, along with targeted urine tests, are sufficient for exposure.
Concentrations can be difficult to correlate with intoxication depending on the tolerance of the user, however, specific opioids / opiates concentrates can be obtained from reference labs.
Meconium
Assays for opiates, opioids and their respective metabolites can be tested to evaluate for maternal use.
Umbilical Cord
Arguably preferred for fentanyl. Otherwise assays for opiates, opioids and their respective metabolites can be tested to evaluate for maternal use.
Hair
Assays for opiates, opioids and their respective metabolites can be sent to evaluate for exposure.
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When strategizing interventions for fentanyl users, remember that people use fentanyl for largely the same reasons that people use other substances. Some use it to experience an associated feeling of euphoria, others use it without knowing that it has been introduced to other substances they use, and still others may use it knowingly in order to meet the physical needs associated with opioid use disorder. As with all substance use disorder interventions, be sure to take a holistic approach that addresses underlying issues that may be driving substance use, as well as the substance use itself. |
