Written by Roneet Lev, MD
Executive Director, IEPC

SB-864 was introduced by Senator Melissa Melendez on January 20, 2022. It is named after Tyler, a boy who went to a California emergency department with his mother after an overdose and was reported to have no opioids in his system. Tyler’s mom Juli was assured that he had no fentanyl in his system. She made a point to ask about fentanyl and was given well-intentioned, but wrong reassurance. Based on this information Tyler was treated with a lower supervised addiction plan when he overdosed from fentanyl a few days later. Juli turned her grief into action advocating for change. She helped me find an author for this fentanyl testing legislation.

Tyler’s Law is advocating for changing the “Federal 5” to the “Federal 6” in California. The drugs included in a standard rapid urine drug screen include the “federal five”: Amphetamines, Cocaine, Marijuana, Opiates, and Phencyclidine (PCP). These five categories were established by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Division of Workplace Programs. Synthetic opioids such as fentanyl, oxycodone and methadone do not show up in a standard opiate drug screen and require a separate test. It is time for the “Federal 5” to become the “Federal 6”, including fentanyl to key drugs in a panel.

In San Diego, we launched a campaign to increase fentanyl testing capability. Within 10 months the number of hospitals that include fentanyl in the urine drug screens went from 4 to 15, making it the community standard of care. The fentanyl reagent costs on average 75 cents per testing, giving little excuse to adding this testing capacity.

The law is not a mandate for testing. If you don’t want to order a drug test, don’t order it. Fentanyl accounts for 64% of all drug overdoses and is the leading cause of death in age 18 -45, more than COVID. If you are going to get a drug screen that includes PCP and cocaine, why would you not want it to include fentanyl?

How does a positive fentanyl test make a difference?

• Informs the doctor
• Informs the patient
• The patient may inform friends and other users
• Encourages a prescription for naloxone to the patient, friends, or family
• Motivates the patient to change
• Encourages connection to addiction treatment
• Provides data to MAT clinics and outpatient settings that do not have capacity for rapid fentanyl testing

To learn more, view the Fentanyl Tool Kit on the California ACEP website or on the San Diego Prescription Drug Abuse Web Site which includes a Fact Sheet on SB-864.

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