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COVID-19 Vaccination and Testing ETS

The ETS on Vaccination and Testing was officially filed in the Office of the Federal Register on November 4, 2021, and it became effective when it was published on November 5, 2021. Written comments on any aspect of the ETS must be submitted by December 6, 2021 in Docket number OSHA-2021-0007. Written comments on the information collection determination as described in V.K. of the ETS preamble [2021-23643] must be submitted by January 4, 2022 in Docket number OSHA-2021-0008.

Find information on the COVID-19 Healthcare ETS or on Coronavirus Disease (COVID-19).

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Should I be worried about fentanyl?

Cocaine vs Fentanyl
Two viles showing the amount of heroin and the amount of Fentanyl that can be fatal if ingested.

The opioid epidemic may be getting even more deadly, due to wider availability of the drug

Fentanyl is a highly addictive synthetic opioid 50 to 100 times more potent than morphine and 50 times more potent than heroin. The pharmaceutical drug is manufactured for pain management; however, clandestine laboratories also produce the drug and mix in heroin sometimes referred to as Apace, China Girl, Dance Fever, or He-Man, the deadly cocktail has infiltrated our streets, neighborhoods, and workplaces1.

According to a recently published report from the CDC’s National Vital Statistics System, between 2011 and 2016, fentanyl was among the top 10 drugs most frequently involved in deaths from drug overdose. According to the report:

  • Oxycodone held the top spot for fatal overdoses in 20112
  • Heroin reigned as the number one culprit for overdoses from 2011 to 20152
  • Overdose deaths from fentanyl surpassed both oxycodone and heroin starting in 20162

Today, fentanyl continues to play a significant role in drug overdose deaths in the US, with large-scales manufacturing and smuggling into the country of serious concern. On January 31of this year, the US Customs and Border Protection announced the biggest-ever fentanyl bust in history3. Officials in Arizona seized more than 254 pounds fentanyl coming across the border from Mexico in a produce truck.

Sadly, according to the CDC, more than 28,000 deaths were directly attributed to synthetic opioids in 20174. Additionally, deaths from synthetic opioids significantly increased in 23 states and Washington D.C. from 2016 – 2017, with West Virginia, Ohio, and New Hampshire with the highest synthetic opioid related death rates4.

More overdose deaths in the US are linked to fentanyl than any other drug1. As illicit manufacturing continues, increased public education and awareness will be increasingly important in stopping fentanyl’s deadly effects.

[ Article from Quest Diagnostics ]


1Fentanyl. National Institute on Drug Abuse

2National Vital Statistics Report

3US border officers make largest-ever fentanyl bust

4Centers for Disease Control and Prevention “Sythetic Opioid Overdose Data”

Colorado high: six years of recreational marijuana

On November 6, 2012, Colorado became the first state to legalize recreational marijuana use for anyone 21 years of age and older. After five years, researchers have compiled a substantial amount of data about the effects of recreational marijuana throughout the state. One example is the financial aspect of legalizing the drug for recreational use. Last year alone, the recreational marijuana industry brought in $1.5 billion in sales according to the Colorado Department of Revenue.

The Rocky Mountain High Intensity Drug Trafficking Area released a report detailing the impact of legalized marijuana in Colorado. The report showed that 15.9% of people were self-reported past-month marijuana users compared to the national average of 8.6%. Increased drug use has impacted traffic accidents and public health in the state. A few other statistics include:

  • People who visited a hospital due to marijuana use increased by 52% from 2012 to 2016.
  • Traffic accidents related to marijuana use jumped from 11.43% in 2013 to 21.3% in 2017.
  • Traffic deaths with drivers who tested positive for marijuana increased by 39% during the past four years, which equates to one person killed every 2 ½ days.

While it may not come as a surprise that people are using marijuana more frequently where recreational use is permitted, the parallels between increased drug use and increased dangerous activities are surprising. In a 2017 Westword poll, 48% of people who used marijuana recreationally reported going to work high and 39% said they went to work high on a weekly basis.

It is important to keep your employees and workplaces safe regardless of state marijuana legislation. Drug testing for marijuana can help to reduce injuries in the workplace, improve productivity, and reduce employee turnover.

For an interactive map with marijuana positivity by zip code, visit

-Article authored by Quest Diagnostics.

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Emerging Trends and Alerts

New drugs and drug use trends often burst on the scene rapidly. NIDA’s National Drug Early Warning System (NDEWS) reports on emerging trends and patterns in many metropolitan areas and states. NDEWS builds on the work of the former Community Epidemiology Work Group (CEWG).

Loperamide Misuse/Abuse

Posted on June 09, 2016

Loperamide is an over-the-counter anti-diarrheal medication that is available in tablet, capsule, or liquid form under brand names such as Imodium, Kaopectate 1-D, Maalox Anti-Diarrheal, and Pepto Diarrhea Control. Because it acts at mu-opioid receptors, which regulate movement in the intestinal tract, it is an opioid medication, and there are reports of its being misused by drug users to stave off opioid withdrawal or possibly even to get high.

Misuse of loperamide has been reported since 2003; it is not common, but it has been reported all over the country. Nationwide, the number of calls to poison centers involving the intentional abuse or misuse of loperamide increased from 87 in 2010 to 190 in 2014 (AAPCC annual reports; ).

Effects of Loperamide

When taken as recommended, loperamide is designed not to enter the brain; but instructions available on the Internet purport to show how taking loperamide in very high quantities and combining it with other substances may help it produce psychoactive effects that resemble the euphoric effects of other opioids or that mitigate cravings and withdrawal symptoms.

Users’ reports of these effects effects (if any) are conflicting, but physical consequences of loperamide misuse may be severe, including fainting, abdominal pain, constipation, cardiovascular toxicity (including racing heart and even cardiac arrest), pupil dilation, and kidney failure from urinary retention. Anecdotes and case reports indicated that the potential harm is high.

There were also reports of opioid withdrawal symptoms when users stopped taking loperamide, including severe anxiety, vomiting, and diarrhea.

FDA issued a Safety Alert about Loperamide on 6/7/16: Loperamide (Imodium): Drug Safety Communication – Serious Heart Problems With High Doses From Abuse and Misuse

More information on loperamide is also availabe from the National Drug Early Warning System (NDEWS) .

Fake Prescription Drugs Laced with Fentanyl

Updated May 05, 2016

Media reports and official alerts in several U.S. communities (including Sacramento, CA and most recently, Carroll County, MD) are warning of counterfeit pain and anxiety medications that actually contain fentanyl, an extremely powerful, potentially deadly opioid. The pills, which are disguised as common prescription drugs like Norco (hydrocodone), Percocet (oxycodone), and Xanax (alprazolam), are responsible for a growing number of overdose deaths and non-fatal overdoses around the country. Fentanyl is 25 to 50 times stronger than heroin, so even a small amount can cause an overdose. (The Drug Enforcement Administration reports that some of these pills are manufactured in China and smuggled into the U.S. via Mexican drug cartels.)

The fake pills are much cheaper than the real versions. The public should be aware that drugs obtained on the street, even though they look like a real prescription pharmaceutical, may be deadly. It is always unsafe to take a prescription drug unless it comes from your own prescription and is dispensed by a reputable pharmacy.

Surge in Fentanyl Overdose Deaths

Posted on July 09, 2015

A surge in overdose deaths related to fentanyl, an opioid 30 to 50 times more potent than heroin, has prompted Baltimore health officials to launch a public health campaign to raise awareness among drug users. Hundreds of people have overdosed on fentanyl across the nation since 2013, often as a result of using heroin that has been laced with the much stronger substance. A quarter of drug overdose deaths in Maryland now involve fentanyl, up from 4 percent in 2013. Opioid overdose can stop a person’s respiration, and fentanyl can have this effect very quickly. Other parts of the country such as Detroit and surrounding suburbs are also seeing major surges in fentanyl use and fentanyl-related deaths. In some cases users are unknowingly taking fentanyl in what they believe to be pure heroin, but a growing number of opioid users are deliberately taking fentanyl.

Fentanyl and other opioid overdoses can be reversed if the drug naloxone (Narcan) is administered promptly. In a growing number of states, naloxone is being distributed to injection drug users and other laypersons to use in the event of overdose. For example, Baltimore’s Staying Alive Drug Overdose Prevention and Response plan issues naloxone and training in its use.

Increasing Overdoses From Synthetic Cannabinoids (“Spice,” “K2,” etc.) in Several States

Updated May 08, 2015

Recent surges in hospitalizations and calls to poison control centers linked to consumption of synthetic cannabinoid products–sold under brand names like “Spice,” “K2,” “No More Mr. Nice Guy,” and others–are being reported in several southern and northeastern U.S. states and have prompted officials to issue health warnings. After a surge in synthetic cannabinoid exposures and poison center calls in April and May, 2015, the Maryland Poison Center issued an urgent notice about the dangers of these drugs . New York Governor Andrew Cuomo issued an alert after more than 160 patients were hospitalized following synthetic cannabinoid use in under two weeks in mid April, 2015.

Synthetic cannabinoids are chemically related to THC, the active ingredient in marijuana, and are sometimes called “synthetic marijuana” or “legal marijuana,” but actually the effects can be considerably more powerful and more dangerous than marijuana. Users can experience anxiety and agitation, nausea and vomiting, high blood pressure, shaking and seizures, hallucinations and paranoia, and they may act violently.

The Maryland notice lists several chemical compounds in materials from crime labs, including MAB-/AB-CHMINACA, FUBINACA, FUB-PB-22, and XLR11. Besides the brand names above, the New York State health alert lists other common names: Blonde, Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, Wicked X, AK-47; recent reports have involved products with the names Geeked Up, Ninja, Caution, Red Giant, and Keisha Kole.

For more information on synthetic cannabinoids, see DrugFacts: K2/Spice (“Synthetic Marijuana”)

U.S. and British Columbia Issue Alerts on Fentanyl

Updated March 18, 2015

The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the dangers of fentanyl and related compounds (fentanyl analogues). Fentanyl, an opioid that is 50-100 times more powerful than morphine, is both abused on its own and commonly added to heroin to increase its potency. Fentanyl and fentanyl-laced heroin have been a concern for over a decade and have caused numerous overdose deaths among injection drug users in several U.S. cities.

Heroin is not the only drug that can be laced with fentanyl, however. Officials in Vancouver, British Columbia, Canada, recently issued public warnings about a wide range of fentanyl-laced drugs causing overdose deaths among users. They warn that fentanyl is now being concealed in non-injection drugs, including oxycodone and various “party drugs” in powder or pill form, as well as in marijuana (although no deaths have been confirmed from fentanyl-laced marijuana). Because of this new threat, British Columbia officials are urging all recreational drug users to “know their source.”

HIV Outbreak in Indiana Linked to Abuse of Opana

Posted on February 27, 2015

Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases in the southeastern portion of the state that are linked to injection drug abuse of the powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in southeastern Indiana were transmitted sexually.

Officials advise that people in southeastern Indiana who have engaged in needle sharing or unprotected sex should get tested for HIV and then re-tested after 2-3 months, as HIV may not appear on tests immediately when the virus is contracted. To reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles, and having unprotected sex or sex with commercial sex workers.

Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

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