Published: 22nd August 2024 - All information correct at time of publication.
Heroin in the workplace: Why and how we test for 6-MAM, Methadone and Buprenorphine.
A non-negative or positive result for opiates may ring alarm bells for some people due to the direct connotation to heroin. However, this should not be the case as there are many opiate based pain medications (such as co-codamol) available over the counter or on prescription, which may cause a completely legitimate explanation for the result. So, how do we determine if it is heroin or a pain medication? The answer is 6-Monoacetylmorphine (6-MAM).
To gain a better understanding of this, substances found under the subgroup opiates e.g. codeine and morphine are structurally similar and are derived from the poppy plant. These are not to be confused with opioid compounds (e.g. fentanyl), which are synthetically derived and do not come from the poppy plant but do have similar effects to opiates, although are typically much more potent.
The best and easiest way to identify heroin use is the presence of 6-MAM. Heroin (diacetylmorphine) is really unstable in the human body; heroin has a half-life of two minutes in blood and is rapidly converted to its other breakdown products. 6-MAM is the principal metabolite of heroin and unique to its use, remaining detectable in urine for between 12 – 24 hours after heroin consumption. We can test for 6-MAM using our accredited LC-MS/MS method, which is considered the ‘gold-standard technique’ for drug testing.
Can we identify heroin use without 6-MAM?
Yes, 6-MAM metabolises further to morphine, which we are also accredited to test for using our opiate LC-MS/MS method. We test for opiates using a confirmatory drug test which can identify multiple compounds, all relevant to workplace drug testing. This includes morphine, codeine, dihydrocodeine and 6-MAM, desmethylpapaverine and thebaine. Identifying these compounds and their relative concentrations allows us to determine the source of the drug i.e. did the morphine come from heroin or the administration of prescribed morphine? Morphine can remain detectable in urine for up to three to five days after use, which can help identify heroin use for a longer period of time than the use of 6-MAM alone.
How can you identify someone who is abusing heroin or their opiate prescription?
All opiate medications are addictive, both psychologically and physically. Heroin is deemed to be ‘more addictive’ than other opiates as it has a stronger effect on the receptors in the body. It has been reported that heroin users can take around a week to overcome the physical withdrawal effects of taking the drug (nausea etc.) whilst still psychologically feeling the need to use heroin. Typical opiate users will feel drowsy, pain free, euphoria, possible nausea and, in some cases, users will have small pupils. Heroin users will exhibit these symptoms worsened and, typically, they will exhibit paler skin, shallow breath and a weak pulse.
Persons addicted to heroin may go to extreme lengths to conceal their drug use, however, there could be some changes in behaviour that could indicate addiction; lack of interest in personal hygiene, worsening performance at work or wearing clothing that may conceal their skin, particularly in warmer months.
What treatments are on offer to help with opiate addiction?
It is important to note there must be plentiful evidence to suggest opiate addiction to obtain treatment. This may include, but is not limited to, a positive drug test, combined with a GP recommendation, self-referral etc. Those diagnosed with an opiate addiction may be prescribed methadone and buprenorphine, both of which SYNLAB Laboratory Services can also test for. Most people are aware of methadone, it is the most common prescribed opiate addiction treatment in the UK, and is usually administered daily, with most users on a dose between 60-120mg. It allows the user to feel relaxed and reduce pain, but does not exhibit the same ‘high’ as heroin, making it safer to use.
Buprenorphine works in a similar way to methadone, however, does not exhibit as great of an analgesic effect as methadone, has less potential for abuse and lasts longer in the body. The presence of buprenorphine and/ or methadone alongside a valid prescription may indicate that the donor has been provided help to treat opiate use disorders.
It is important to note that any opiate (heroin or not), methadone, and buprenorphine can exhibit psychological effects, SYNLAB Laboratory Services would recommend that a fitness for work test should be conducted by an occupational health practitioner prior to carrying out safety critical job roles. It is also a requirement of the DVLA that people on methadone or buprenorphine programs for opiate dependency notify the DVLA and have annual assessments to retain their driving licence.
Published 23/08/24. All information correct at time of publication.
Written by Fern Read
SYNLAB Laboratory Services
