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Test Code OPATU Opiates Confirmation, Urine

Reporting Name

Opiate Confirmation, U

Useful For

Detection and quantification of codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, noroxycodone, noroxymorphone, norhydrocodone, dihydrocodeine, and naloxone in urine

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Urine


Specimen Required


Container/Tube: Plastic, 60-mL urine bottle

Specimen Volume: 20 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative.

Additional Information:

1. For situations where chain of custody is required, a Chain-of-Custody Kit (T282) is available. For chain-of-custody testing, order OPATX / Opiates Confirmation, Chain of Custody, Urine.

2. If urine creatinine is required or adulteration of the sample is suspected, the following test should be requested, ADULT / Adulterants Survey, Urine. For additional information, refer to ADULT / Adulterants Survey, Urine.

3. Submitting <20 mL will compromise our ability to perform all necessary testing.


Specimen Minimum Volume

2.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  14 days

Reference Values

Negative

Cutoff concentrations

Codeine by LC-MS/MS: 25 ng/mL

Dihydrocodeine-by LC-MS/MS: 25 ng/mL

Hydrocodone by LC-MS/MS: 25 ng/mL

Norhydrocodone-by LC-MS/MS: 25 ng/mL

Hydromorphone by LC-MS/MS: 25 ng/mL

Oxycodone by LC-MS/MS: 25 ng/mL

Noroxycodone-by LC-MS/MS: 25 ng/mL

Oxymorphone by LC-MS/MS: 25 ng/mL

Noroxymorphone-by LC-MS/MS: 25 ng/mL

Naloxone-by LC-MS/MS: 25 ng/mL

Morphine by LC-MS/MS: 25 ng/mL

Day(s) and Time(s) Performed

Monday through Friday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

80361

80365

G0480 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
OPATU Opiate Confirmation, U In Process

 

Result ID Test Result Name Result LOINC Value
6543 Codeine-by LC-MS/MS 3508-9
42000 Dihydrocodeine-by LC-MS/MS 19448-0
21177 Hydrocodone-by LC-MS/MS 3681-4
42001 Norhydrocodone-by LC-MS/MS 78868-7
21179 Hydromorphone-by LC-MS/MS 9835-0
21178 Oxycodone-by LC-MS/MS 11246-6
42002 Noroxycodone-by LC-MS/MS 77779-7
35023 Oxymorphone-by LC-MS/MS 17395-5
42003 Noroxymorphone-by LC-MS/MS No LOINC Needed
42004 Naloxone-by LC-MS/MS 77207-9
6542 Morphine-by LC-MS/MS 3831-5
21180 Opiates Interpretation 69050-3

Clinical Information

Codeine is converted by hepatic metabolism to morphine and norcodeine with a half-life of 2 to 4 hours. If codeine is ingested, the ratio of codeine to morphine generally exceeds 1.0 in urine during the first 24 hours. The ratio may fall below 1.0 after 24 hours, and after 30 hours, only morphine may be detected.

 

Morphine is a naturally occurring narcotic analgesic obtained from the poppy plant, Papaver somniferum. Morphine is converted by hepatic metabolism to normorphine with a half-life of 2 to 4 hours. The presence of morphine in urine can indicate exposure to morphine, heroin, or codeine within 2 to 3 days. Ingestion of bakery products containing poppy seeds can also cause morphine to be excreted in urine. If excessively large amounts are consumed, this can result in urine morphine concentrations up to 2,000 ng/mL for a period of 6 to 12 hours after ingestion.

 

Hydrocodone exhibits a complex pattern of metabolism including O-demethylation, N-demethylation, and 6-keto reduction to the 6-beta hydroxymetabolites. Hydromorphone and norhydrocodone are both metabolites of hydrocodone. Dihydrocodeine is also a minor metabolite. Trace amounts of hydrocodone can also be found in the presence of approximately 100-fold higher concentrations of oxycodone or hydromorphone since it can be a pharmaceutical impurity in these medications. The presence of hydrocodone >100 ng/mL indicates exposure within 2 to 3 days prior to specimen collection.

 

Hydromorphone is metabolized primarily in the liver and is excreted primarily as the glucuronidated conjugate, with small amounts of parent drug and minor amounts of 6-hydroxy reduction metabolites. The presence of hydromorphone >100 ng/mL indicates exposure within 2 to 3 days prior to specimen collection. Hydromorphone is also a metabolite of hydrocodone; therefore, the presence of hydromorphone could also indicate exposure to hydrocodone.

 

Dihydrocodeine is a semisynthetic narcotic analgesic prepared by the hydrogenation of codeine. It is also a minor metabolite of hydrocodone. It is metabolized to dihydromorphine and has a half-life of 3.4 to 4.5 hours. 

 

Oxycodone is metabolized to noroxycodone, oxymorphone, and their glucuronides, and is excreted primarily via the kidney. The presence of oxycodone >100 ng/mL indicates exposure to oxycodone within 2 to 3 days prior to specimen collection.

 

Oxymorphone is metabolized in the liver to noroxymorphone and excreted via the kidney primarily as the glucuronide conjugates. Oxymorphone is also a metabolite of oxycodone and, therefore, the presence of oxymorphone could also indicate exposure to oxycodone.

 

Naloxone is a synthetic narcotic antagonist and used for partial or complete reversal of opioid depression induced by natural or synthetic opioids. It has also been incorporated into oral tablets of opioids to discourage abuse. The duration of action is dependent on the dose and route of administration. The half-life in adults is approximately 30 to 81 minutes.

 

The detection interval for opiates is generally 2 to 3 days after last ingestion.

Interpretation

This procedure reports the total urine concentration; this is the sum of the unconjugated and conjugated forms of the parent drug.

Clinical Reference

1. Gutstein HB, Akil H: Chapter 21: Opioid Analgesics. In Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th edition. Edited by LL Brunton, JS Lazo, KL Parker. New York, McGraw-Hill Companies Inc, 2006. Available at: http://www.accessmedicine.com/content.aspx?aID=940653

2. Baselt RC: Dispositition of Toxic Drugs and Chemical in Man. Ninth edition. Edited by RC Baselt. Foster City, CA. Biomedical Publication, 2011

3. Hackett LPDusci LJIlett KFChiswell GM: Optimizing the hydrolysis of codeine and morphine glucuronides in urine. Ther Drug Monit 2002;24(5):652-657

Analytic Time

2 days

Reject Due To

Hemolysis

Mild OK; Gross OK

Lipemia

NA

Icterus

Mild OK; Gross OK

Other

NA

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)