OVERVIEW

Purpose: Detection and quantification of morphine, codeine, hydrocodone, oxycodone, hydromorphone, oxymorphone, heroin and the metabolites in urine. Preferred test to follow-up presumptive results for general drug screening or opiates urine screening. The essay detects both delta-9 and delta-8 THC-COOH.

CLINICAL INFORMATION

This panel represents the natural opiates (codeine and morphine) and the major semi-synthetic opioid drugs: hydromorphone, hydrocodone, oxycodone and oxymorphone. The panel may be ordered as is or modified to include additional opioids, such as fentanyl, heroin or many others listed on our website. The detection interval for opiates is generally two to three days after their last ingestion.

Codeine

Codeine is converted by hepatic metabolism to morphine and norcodeine with a half-life of 2 to 4 hours. Following codeine ingestion, the urine typically displays a codeine-to-morphine ratio surpassing 1.0 within the initial 24 hours. However, this ratio might fall below 1.0 after the initial 24 hours, and by the 30-hour mark, exclusively morphine might be detected.

Morphine

Morphine is a naturally occurring narcotic analgesic obtained from the poppy plant, Papaver somniferum. Through hepatic metabolism, morphine undergoes conversion into normorphine, with a half-life spanning 2 to 4 hours. The presence of morphine within urine can serve as an indicator of recent exposure to morphine, heroin or codeine over a span of 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

Hydrocodone exhibits a complex pattern of metabolism including O-demethylation, N-demethylation and 6-keto, ultimately leading to the formation of 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 due to the potential inclusion of hydrocodone as a pharmaceutical impurity within these medications. The presence of hydrocodone greater than 100 ng/mL indicates exposure within 2 to 3 days prior to specimen collection.

Hydromorphone

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 greater than 100 ng/mL indicates exposure during the 2 to 3 days prior to the specimen collection. Hydromorphone is also a metabolite of hydrocodone; therefore, the presence of hydromorphone could also indicate exposure to hydrocodone.

Oxycodone

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

Oxymorphone

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

Naloxone

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.

Heroin

Heroin (diacetylmorphine), a semi-synthetic opiate closely related to morphine, bears historical significance in the medical realm. Its clinical use has been discontinued in the United States, although it continues to serve as a means of rapid pain relief in other parts of the world. (1) Much like morphine and other opiates, the sedative and euphoric properties of heroin contribute to its widespread recreational abuse. Intravenous injection remains the common method of administration, although alternative routes include snorting, smoking, and inhaling vapors.

Heroin shares the foundational structure of morphine, augmented by the incorporation of two acetyl groups. These groups are believed to augment its ability to permeate the central nervous system. (2,3) The metabolism of heroin occurs in a sequential manner, involving the gradual removal of these acetyl groups. The initial loss of an acetyl group transforms heroin into 6-monoacetylmorphine (6-MAM), and the subsequent removal of the second acetyl group converts 6-MAM into morphine, which emerges as the primary metabolite of heroin. (2,3) Notably, heroin is seldom found unchanged in urine due to its minimal excretion of around 0.1% of the administered dose. An exceptional marker of recent heroin usage, 6-MAM stands as a unique metabolite of heroin. Its presence serves as a definitive indication of recent heroin consumption. Much like heroin, 6-MAM boasts a brief half-life and a limited window of detection.

Heroin (diacetylmorphine), a semi-synthetic opiate akin to morphine, holds historical medical significance. Although discontinued for clinical use in the United States, it remains employed in other regions for swift pain relief. Similar to morphine, heroin's tranquil and euphoric effects contribute to its recreational misuse. Intravenous injection is common, while alternate methods include snorting, smoking and vapor inhalation. Heroin's structure closely resembles morphine, with two added acetyl groups thought to enhance its central nervous system permeability. Metabolism involves gradual acetyl group removal, converting heroin first into 6-monoacetylmorphine (6-MAM), and then into morphine, the primary heroin metabolite. Heroin is rarely detected unchanged in urine, with just 0.1% excreted as such. A distinctive marker of recent heroin use, 6-MAM signifies recent consumption, echoing heroin's short detection window and half-life.

SPECIMEN COLLECTION

Specimen Type: Random Urine
Preferred Collection Container: Non-sterile specimen container
Specimen Required: 3 mL urine; minimum 1 mL

TEST DETAILS

Methodology: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Compliance Category: Laboratory Developed Test (LDT)
This test was developed and assessed by DMD in compliance with CLIA requirements for its analytical performance characteristics and clinical application. This test has not been cleared or approved by the US Food and Drug Administration.
Reference Interval: Negative
Drug/Metabolite Tested: morphine, codeine, hydrocodone, oxycodone, hydromorphone, oxymorphone, noroxycodone, norhydrocodone and 6-monoacetylmorphine
Drug/Metabolite Cutoff Concentration 500 ng/mL
Codeine 50 ng/mL
Morphine 25 ng/mL
Hydrocodone 25 ng/mL
Hydromorphone 25 ng/mL
Oxycodone 25 ng/mL
Oxymorphone 25 ng/mL
Norhydrocodone 25 ng/mL
Noroxycodone 50 ng/nL
6-monoacetylmorphine 10 ng/mL
CPT code(s): 80361, 80356 and 80365
Turn Around Time: 90% < 48 hours, 50% < 24 hours

SPECIMEN PROCESSING

Transport Temperature: Refrigerated (preferred) or room temperature overnight shipping.
Specimen Stability: 3 days at room temperature and 14 days at refrigerated and frozen temperatures (to be further confirmed with our validation).
Rejection Criteria: Stability limits exceeded.

Director: Cheryl Hanau, MD; Donald Hall, Jr., PhD; Garth Ehrlich, PhD; Yinghua Qiu, PhD, DABCC

Review Date: 08/28/2023

Note: The billing party has sole responsibility for CPT coding. Any questions regarding coding should be directed to the payer being billed. The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

 
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