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HelpTest Code OPIC Opiates Confirmation, Random, Urine
Additional Codes
| Mayo Test ID |
|---|
| OPATU |
Reporting Name
Opiate Confirmation, UUseful For
Detection and quantification of codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, noroxycodone, noroxymorphone, norhydrocodone, dihydrocodeine, and naloxone in urine
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
UrineOrdering Guidance
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, Random, Urine.
Additional drug panels and specific requests are available; call 800-533-1710.
Additional Testing Requirements
If urine creatinine is required or adulteration of the sample is suspected, the following test should also be ordered, ADULT / Adulterants Survey, Random, Urine.
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 5-mL tube
Specimen Volume: 3 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.
3. Submitting less than 1 mL will compromise our ability to perform all necessary testing.
Specimen Minimum Volume
2.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 14 days |
Reject Due To
| Gross hemolysis | OK |
| Gross icterus | OK |
Reference Values
Negative
Cutoff concentrations by liquid chromatography tandem mass spectroscopy:
Codeine: 25 ng/mL
Dihydrocodeine: 25 ng/mL
Hydrocodone: 25 ng/mL
Norhydrocodone: 25 ng/mL
Hydromorphone: 25 ng/mL
Oxycodone: 25 ng/mL
Noroxycodone: 25 ng/mL
Oxymorphone: 25 ng/mL
Noroxymorphone: 25 ng/mL
Naloxone: 25 ng/mL
Morphine: 25 ng/mL
Day(s) Performed
Monday through Friday
CPT Code Information
80361
80365
80362
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 | 16250-3 |
| 42000 | Dihydrocodeine-by LC-MS/MS | 19448-0 |
| 21177 | Hydrocodone-by LC-MS/MS | 16252-9 |
| 42001 | Norhydrocodone-by LC-MS/MS | 61422-2 |
| 21179 | Hydromorphone-by LC-MS/MS | 16998-7 |
| 21178 | Oxycodone-by LC-MS/MS | 16249-5 |
| 42002 | Noroxycodone-by LC-MS/MS | 61425-5 |
| 35023 | Oxymorphone-by LC-MS/MS | 17395-5 |
| 42003 | Noroxymorphone-by LC-MS/MS | 90894-7 |
| 42004 | Naloxone-by LC-MS/MS | 77207-9 |
| 6542 | Morphine-by LC-MS/MS | 16251-1 |
| 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 2000 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 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 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 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 test reports the total urine concentration; this is the sum of the unconjugated and conjugated forms of the parent drug.
Cautions
This test detects drugs structurally similar to morphine. Other drugs in the opioid class, such as fentanyl, meperidine, and methadone are not detected.
Method Description
Opiates exist in patient urine as both free and either sulfate or glucuronide conjugates. Enzyme hydrolysis is used to liberate the conjugated drug. Specimens are then centrifuged, diluted, and filtered and the analytes are separated by liquid chromatography tandem mass spectroscopy and analyzed by multiple reaction monitoring.(Unpublished Mayo method)