Urine Fentanyl Immunoassays: How to choose?

Over the past decade, the opioid crisis in the United States has been exacerbated by the fentanyl epidemic. Fentanyl, a synthetic opioid, is approximately 100 times more potent than morphine and 50 times more potent than heroin. Due to its high potency, detecting fentanyl use has become increasingly critical. Laboratory testing for fentanyl provides essential information in various settings, including acute intoxications or overdoses in emergency centers, compliance monitoring for pain management, addiction treatment selection for substance-use disorders, and behavioral testing programs.
While mass spectrometry-based methods are considered the gold standard for confirmation, urine testing using immunoassays remains the most common and feasible screening method in many institutions. Several FDA-approved immunoassays are available for automated chemistry analyzers, targeting either fentanyl or its metabolite norfentanyl, with varying degrees of cross-reactivity with other fentany analogs. Rapid testing methods, such as lateral flow immunoassays, have also gained interest for fentanyl screening in specific clinical settings.
This presentation aims to review recent publications on the analytical and clinical performance of various fentanyl immunoassays and share our experience in evaluating these assays for cinical implementation.

Learning Objectives:

• List currently available fentany! immunoassays
• Describe the advantages and limitations of different fentanyl testing methodologies
• Evaluate fentanyl immunoassays for implementation based on clinical need