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Test Code TOPSU Targeted Opioid Screen, Urine

Secondary ID

65059

Useful For

This high-resolution accurate mass method qualitatively (present vs. not detected) identifies 33 opioid compounds (parent drug and metabolites) in urine to help determine compliance or identify illicit opioid drug use

Method Name

Liquid Chromatography-Tandem Mass Spectrometry, High Resolution Accurate Mass (LC-MS/MS HRAM)

Reporting Name

Targeted Opioid Screen, U

Specimen Type

Urine


Specimen Required


Supplies: Plastic 5-mL tube (T465)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 5-mL tube (T465)

Specimen Volume: 5 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative


Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 14 days
  Frozen  28 days
  Ambient  72 hours

Reject Due To

Hemolysis

Mild reject; Gross reject

Lipemia

NA

Icterus

Mild reject; Gross reject

Other

NA

Clinical Information

Opioids are a large class of medications commonly used to relieve acute and chronic pain or help manage opioid abuse and dependence. Medications that fall into this class include: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol, and others. Opioids work by binding to the opioid receptors that are found in the brain, spinal cord, gastrointestinal tract, and other organs.

 

Common side effects include drowsiness, confusion, nausea, constipation, and in severe cases respiratory depression depending on the dose. These medications can also produce physical and psychological dependence and have a high risk for abuse and diversion, which is one of the main reasons many professional practice guidelines recommend compliance testing in patients’ prescribed these medications.

 

Opioids are readily absorbed from the gastrointestinal tract, nasal mucosa, lungs, and after subcutaneous or intermuscular injection. Opioids are primarily excreted from the kidney in both free and conjugated forms. This assay doesn’t hydrolyze the urine sample and looks for both parent drugs and metabolites (including glucuronide forms). The detection window for most opioids in urine is approximately 1 to 3 days with longer detection times for some compounds (ie, methadone).

Reference Values

Not Detected

 

Cutoff concentrations:

Codeine: 25 ng/mL

Codeine-6-beta-glucuronide: 100 ng/mL

Morphine: 25 ng/mL

Morphine-6-beta-glucuronide: 100 ng/mL

6-monoacetylmorphine: 25 ng/mL

Hydrocodone: 25 ng/mL

Norhydrocodone: 25 ng/mL

Dihydrocodeine: 25 ng/mL

Hydromorphone: 25 ng/mL

Hydromorphone-3-beta-glucuronide: 100 ng/mL

Oxycodone: 25 ng/mL

Noroxycodone: 25 ng/mL

Oxymorphone: 25 ng/mL

Oxymorphone-3-beta-glucuronide: 100 ng/mL

Noroxymorphone: 25 ng/mL

Fentanyl: 2 ng/mL

Norfentanyl: 2 ng/mL

Meperidine: 25 ng/mL

Normeperidine: 25 ng/mL

Naloxone: 25 ng/mL

Naloxone-3-beta-glucuronide: 100 ng/mL

Methadone: 25 ng/mL

EDDP: 25 ng/mL

Propoxyphene: 25 ng/mL

Norpropoxyphene: 25 ng/mL

Tramadol: 25 ng/mL

O-desmethyltramadol: 25 ng/mL

Tapentadol: 25 ng/mL

N-desmethyltapentadol: 50 ng/mL

Tapentadol-beta-glucuronide: 100 ng/mL

Buprenorphine: 5 ng/mL

Norbuprenorphine: 5 ng/mL

Norbuprenorphine glucuronide: 20 ng/mL

Interpretation

If an opioid or its corresponding metabolites are identified (present), it indicates that the patient has used the respective opioids in the recent past. The absence of expected opioids or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge.

Clinical Reference

1. Gutstein HB, Akil H: Opioid analgesics. In The Pharmacological Basis of Therapeutics. 11th edition. Edited by LL Brunton, JS Lazo, KL Parker. Goodman and  Gilman's: McGraw-Hill Companies, Inc, 2006

2. Rovine T, Ferrero CL, American Pain Society: Chronic Pain in America: Roadblocks to Relief. The American Academy of the Pain Medicine. 1999 Feb 17. Available at www.doctordeluca.com/Library/Pain/ChronicPainRoadblocks.htm

3. Magnani B, Kwong T: Urine drug testing for pain management. Clin Lab Med 2012;32(32):379-390

Day(s) and Time(s) Performed

Monday through Friday; Varies

Analytic Time

2 days

Performing Laboratory

Mayo Medical Laboratories in Rochester

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

80364, G0480 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
TOPSU Targeted Opioid Screen, U In Process

 

Result ID Test Result Name Result LOINC Value
42323 Codeine In Process
42324 Codeine-6-beta-glucuronide In Process
42325 Morphine In Process
42326 Morphine-6-beta-glucuronide In Process
42327 6-monoacetylmorphine In Process
42328 Hydrocodone In Process
42329 Norhydrocodone In Process
42330 Dihydrocodeine In Process
42331 Hydromorphone In Process
42332 Hydromorphone-3-beta-glucuronide In Process
42333 Oxycodone In Process
42334 Noroxycodone In Process
42335 Oxymorphone In Process
42336 Oxymorphone-3-beta-glucuronide In Process
42337 Noroxymorphone In Process
42338 Fentanyl In Process
42339 Norfentanyl In Process
42340 Meperidine In Process
42341 Normeperidine In Process
42342 Naloxone In Process
42343 Naloxone-3-beta-glucuronide In Process
42344 Methadone In Process
42345 EDDP In Process
42346 Propoxyphene In Process
42347 Norpropoxyphene In Process
42348 Tramadol In Process
42349 O-desmethyltramadol In Process
42350 Tapentadol In Process
42351 N-desmethyltapentadol In Process
42352 Tapentadol-beta-glucuronide In Process
42353 Buprenorphine In Process
42354 Norbuprenorphine In Process
42355 Norbuprenorphine glucuronide In Process
65059 Opioid Interpretation 69050-3