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Opiates

Interpretation

  • Opiates are the natural or synthetic drugs that have a morphine-like pharmacological action. Medically, opiates are used primarily for relief of pain. Opiates include morphine and drugs structurally similar to morphine (eg, codeine, hydrocodone, hydromorphone, oxycodone).
  • Heroin (diacetylmorphine) is a synthetic opiate made from morphine and is rarely detectable in body fluids. It has a half-life of a few minutes. Illicit heroin often contains small amounts of acetylcodeine. The presence of both codeine and morphine in urine does not rule out the use of heroin; however, the ratio of morphine to codeine can be helpful in discriminating between heroin and codeine use.
  • 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. Due to first-pass metabolism, no pharmacologic effect is experienced from poppy seed ingestion.
  • If there is a question as to a patient's therapeutic compliance, a serum test request for the specific drug of interest may be of help.
  • The presence of an opiate >LOQ indicates exposure to that opiate within 2 to 3 days prior to specimen collection.
  • The presence of 6-MAM is conclusive evidence of prior heroin use. However, due to its short half-life, it is only detectable in urine for about 8 hours after administration.

Metabolites

  • Heroin (diacetylmorphine) is metabolized to morphine. Heroin undergoes rapid deacetylation to 6-monoacetylmorphine (6-MAM), which is about 6 times more potent than morphine. 6-MAM is further deacetylated to morphine. The effects of heroin are attributed to the combined effect of heroin, 6-MAM, and morphine.

    Diacetylmorphine 6-monoacetylmorphine (6-MAM) Morphine

  • Codeine is metabolized to morphine. The presence of morphine in urine can indicate exposure to morphine, heroin, or codeine.

    Codeine Morphine

  • Hydromorphone is a minor metabolite of morphine and may be excreted in urine at concentrations up to 2.5% of the morphine concentration. Consequently, the detection of minor amounts of hydromorphone in urine containing high concentrations of codeine should not be interpreted as evidence of hydromorphone use.
  • Hydrocodone is a minor metabolite of codeine that is metabolized to hydromorphone and may be excreted in urine at concentrations up to 11% of the codeine concentration. Consequently, the detection of minor amounts of hydrocodone in urine containing high concentrations of codeine should not be interpreted as evidence of hydrocodone use.

    Hydrocodone Hydromorphone

  • Oxycodone is metabolized to oxymorphone.

    Oxycodone Oxymorphone

Approximate Detection Times

Opiates LOQ (ng/mL) Detection Time* up to
     6-MAM
5
<1 day
     Morphine
100
3 days
     Codeine
100
3 days
     Hydrocodone
100
3 days
     Hydromorphone
100
3 days
     Oxycodone
100
3 days
     Oxymorphone
100
3 days
*These are approximate detection times for the drug or metabolites in urine. The actual detection time depends on dose, frequency of use, and individual metabolism.

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