Home
HelpTest Code 6MAMU 6-Monoacetylmorphine Confirmation, Random, Urine
Reporting Name
6-MAM Confirmation, UUseful For
Method Name
Gas Chromatography Mass Spectrometry (GC-MS)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
UrineOrdering Guidance
1. For situations where chain of custody is required, a Chain-of-Custody Kit (T282) is available. For chain-of-custody testing, order 6MAMX / 6-Monoacetylmorphine, Chain of Custody, Random, Urine.
2. If urine creatinine is required or adulteration of the sample is suspected, order ADULT / Adulterants Survey, Random, Urine.
3. Additional drug panels and specific requests are available. Call 800-533-1710 or 507-266-5700.
Specimen Required
Supplies: Urine Tubes, 10 mL (T068)
Container Tube: Plastic, 10-mL urine tube
Specimen Volume: 10 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
Additional Information:
1. No specimen substitutions.
2. STAT requests are not accepted for this test.
Specimen Minimum Volume
2.1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 14 days | ||
| Ambient | 72 hours |
Reject Due To
| Gross hemolysis | OK |
| Gross icterus | OK |
Reference Values
Negative
6-MAM cutoff concentration: <5 ng/mL
Day(s) Performed
Tuesday, Wednesday
CPT Code Information
80356
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| 6MAMU | 6-MAM Confirmation, U | 19593-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 30983 | 6-Monoacetylmorphine by GC/MS | 19593-3 |
| 29898 | 6-MAM Interpretation | 69050-3 |
| 29899 | Chain of Custody | 77202-0 |
Clinical Information
Heroin (diacetylmorphine) is a semisynthetic opiate that is closely related to morphine. It is no longer used clinically in the United States, though elsewhere it is used for rapid relief of pain.(1) Like morphine and other opiates, its relaxing and euphoric qualities make heroin a popular drug of abuse. Heroin is commonly injected intravenously, although it can be administered by other means, such as snorting, smoking, or inhaling vapors.
Heroin shares the core structure of morphine, with the addition of 2 acetyl groups, which are thought to enhance its permeation into the central nervous system.(2,3) Heroin is metabolized by sequential removal of these acetyl groups; loss of first acetyl group converts heroin into 6-monoacetylmorphine (6-MAM) and loss of the second acetyl group converts 6-MAM to morphine, the dominant metabolite of heroin.(2,3) Heroin is rarely found intact in urine since only 0.1% of a dose is excreted unchanged. 6-MAM is a unique metabolite of heroin, and its presence is a definitive indication of recent heroin use. Like heroin, 6-MAM has a very short half-life and detection window.
Interpretation
The presence of 6-monoacetylmorphine (6-MAM) in urine is definitive for recent heroin use. However, the absence of 6-MAM does not rule-out heroin use because of its short half-life. 6-MAM is typically only detectable within 24 hours of heroin use. 6-MAM is further metabolized into morphine, which may be detected 1 to 2 days after 6-MAM is no longer measurable. Morphine will typically be found in a specimen containing 6-MAM.(2,3)
Cautions
While 6-monoacetylmorphine (6-MAM) is metabolized to morphine, the presence of morphine alone is not sufficient evidence to prove heroin use. 6-MAM is the only definitive metabolite of heroin.
Method Description
6-Monoacetylmorphine is extracted using solid phase extraction techniques. The eluent is evaporated, reconstituted in organic solvent, and then derivatized. It is then analyzed by gas chromatography mass spectrometry using selected ion monitoring.(Unpublished Mayo method)