• Michael Misialek, MD

Pathologists Play Key Role in Battling Opioid Addiction

The Opioid Epidemic

Each day, 7,000 are treated in emergency rooms for prescription painkiller overdose, with 44 dying as a result. In 2013, about two million Americans abused prescription painkillers. About 75% of opioid addiction patients switch to heroin as a cheaper alternative. About 8,200 Americans die from heroin overdose annually. Opioid addiction knows no boundaries, occurring in every state, socio-economic class and ethnic group.


Opioids are a class of drugs which bind to receptors in the central nervous system exerting a pain-reducing effect. Synthetic opioids are structurally different, but elicit the same response.


Pathologists are responsible for overseeing laboratory testing, including that of drug screens. Opioids are detected by testing either blood or urine. A commonly used panel for drugs of abuse includes immunoassays for amphetamines, barbiturates, benzodiazepines, cocaine, ethanol, methadone, opiates, phencyclidine, and marijuana (THC). Positive tests are confirmed by a more specific assay such as gas-chromatography mass spectrometry. Chain of custody may be required in medico-legal cases.

Commercially available screens primarily detect morphine and codeine and their derivatives. The synthetic opioids are not detected. This is an important fact to keep in mind, depending on the drug under consideration.

Some of the commonly prescribed opioids include the following:

Opiates Morphine (MS Contin) Codeine Thebaine Heroin Hydromorphone (Dilaudid) Hydrocodone (Vicodin) Oxymorphone (Numorphan) Oxycodone (Oxycontin, Percocet, Percodan)

Synthetic Opioids

Fentanyl (Duragesic) Meperidine (Demerol) Propoxyphene (Darvon) Tramadol (Ultram) Methadone Buprenorphine

Drug Monitoring

Pathologists provide valuable drug monitoring information for the safe and effective function of pain services.


Pathologists are not only involved in drug detection and monitoring, but they are also a valuable member of the care team working to curb opioid addiction.

Pathologists contribute to the following key areas:

Safe prescribing

State policies

Drug monitoring programs

Tackling opioid addiction requires a team effort. Pathologists are one of the valuable team members contributing to safe prescribing.

#pathology #drugscreening #opioid #codeine #heroin

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