HHS Revises Authorized Drug Testing Panels in Response to Growing Fentanyl Danger

The Department of Health and Human Services (HHS), in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), released a Rule on January 14, 2025, proposing various modifications to their Authorized Testing Panels. Among these changes was the inclusion of fentanyl and norfentanyl in their panels. These changes go into effect July 7, 2025.

What has changed?

Nomenclature Adjustments

The abbreviations for certain strands of THC have been updated to avoid confusion. Δ-9-tetrahydrocannabinol, previously abbreviated as simply THC, is now identified as Δ9THC in order to distinguish it from other compounds (particularly Δ-8-tetrahydrocannabinol, or Delta-8). Similarly, Δ-9-tetrahydrocannabinol-9-carboxylic acid, previously abbreviated as THCA, is now Δ9THCC.

Drug Testing Panel Updates

Proposed Removal of MDA and MDMA

The HHS proposed removing MDA and MDMA from the Authorized Drug Panel due to data indicating that the drugs were no longer used in a significant enough manner to be tested for; positivity for both drugs in the U.S. has been at or below 0.002% from 2021 to 2023.

Out of ten commenters, four agreed with the removal of the drug, while six disagreed. Due to a lack of majority agreement, the Department postponed the removal of the drugs to conduct further studies.

Addition of Fentanyl and Norfentanyl

The HHS also proposed the addition of fentanyl and norfentanyl to the Authorized Drug Testing Panel. Proposals to include fentanyl on the drug panel have been put forward from as early as 2015; however, it was largely believed that the drug only occurred in combination with other drugs, particularly heroin, and therefore did not need to be tested for alone on the drug panel. More recently, a gradual increase in positivity for Fentanyl in workplace drug testing has been observed, suggesting that it’s being used as a stand-alone substance with greater frequency.

115 out of 118 commenters advocated for the addition of fentanyl and norfentanyl to the panel, many of whom cited the recent rise in fentanyl overdoses as a key factor.

Why add Fentanyl?

Threat of Overdose

Fentanyl is widely regarded as one of the most dangerous and deadly drugs in the United States. A mere 2mg dose is enough to kill an average American, and an estimated 73,830 people in the U.S. lost their lives due to fentanyl overdose in 2023 alone.

Co-Occurrence with Other Drugs

Fentanyl’s danger only compounds in its occurrence alongside other drugs. “Lacing,” a common practice in the drug market, can lead to substance abusers overdosing on fentanyl they never intended to take in the first place. Other drugs such as amphetamines, marijuana, opiates, and more often have fentanyl added to them to decrease the cost of production and increase dependency of the drug users.

Increased Standalone Usage

Fentanyl was not included on the Authorized Drug Testing Panel in the past due to the commonly held belief that it only occurred alongside other drugs; ergo, testing for fentanyl would be moot, as the user would already be positive for whatever drug was laced with fentanyl. Recent data shows that this may no longer be the case.

Rising positivity rates indicate that fentanyl is increasingly being used as a standalone drug, not only being laced into other drugs. In addition, there has been a recent advent of pure fentanyl being distributed as “dupes” of commonly misused prescription drugs, such as opioids, stimulants, and anxiety medications.

Will this affect DOT Drug Testing Panels?

The Department of Health and Human Services (HHS) has no direct correlation or oversight with the Department of Transportation (DOT) or its policies; however, it has been observed in the past that occasionally, the DOT follows suit when the HHS makes a change. For example, in 2018, the DOT added several opioids to its drug testing panel at the behest of the HHS updating its Mandatory Guidelines for Federal Workplace Drug Testing Programs. Therefore, the DOT may choose to add fentanyl and norfentanyl to its panels to align with the HHS’ ruling.