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Test Code TOPSU Targeted Opioid Screen, 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: 3 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative


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 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 19411-8
42324 Codeine-6-beta-glucuronide 89310-7
42325 Morphine 19597-4
42326 Morphine-6-beta-glucuronide 89308-1
42327 6-monoacetylmorphine 19321-9
42328 Hydrocodone 19482-9
42329 Norhydrocodone 89304-0
42330 Dihydrocodeine 19446-4
42331 Hydromorphone 19486-0
42332 Hydromorphone-3-beta-glucuronide 89309-9
42333 Oxycodone 19642-8
42334 Noroxycodone 89303-2
42335 Oxymorphone 19646-9
42336 Oxymorphone-3-beta-glucuronide 89301-6
42337 Noroxymorphone 89302-4
42338 Fentanyl 59673-4
42339 Norfentanyl 43199-9
42340 Meperidine 19532-1
42341 Normeperidine 27920-8
42342 Naloxone 42618-9
42343 Naloxone-3-beta-glucuronide 89307-3
42344 Methadone 19550-3
42345 EDDP 41858-2
42346 Propoxyphene 19429-0
42347 Norpropoxyphene 19632-9
42348 Tramadol 19710-3
42349 O-desmethyltramadol 86453-8
42350 Tapentadol 72485-6
42351 N-desmethyltapentadol 89306-5
42352 Tapentadol-beta-glucuronide 89300-8
42353 Buprenorphine 3414-0
42354 Norbuprenorphine 82371-6
42355 Norbuprenorphine glucuronide 89305-7
65059 Opioid Interpretation 69050-3