Detecting Fentanyl on Urine Drug Screen?

This is an awesome tip that I learned from Dr. Carlos Dumois (who is also faculty here at Florida Hospital Family Medicine Residency)... 

Like oxycodone, fentanyl will not typically be detectable on a standard urine drug screen (i.e. opioids will likely be negative). According to the Mayo Clinic Proceedings: it is undetectable not because it has no metabolites (it does), but because the chemical structures of fentanyl and its metabolites differ radically from those of opiates (ie, morphine and codeine).

To screen for diversion, specific confirmatory testing needs to be orders. Confirmatory testing needs to be ordered for oxycodone also.