6-Monoacetylmorphine (6-MAM), Urine
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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.
Determination of heroin use
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 Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
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.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Positives are reported with a quantitative GC-MS result.
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Giovannelli M, Bedforth N, Aitkenhead A: Survey of intrathecal opioid usage in the UK. Eur J Anaesthesiol 2008;25:118-1122
2. Principles of Forensic Toxicology. 2nd edition. Washington DC. AACC Press, 2003, pp 187-205
3. Hardman JG, Limbird LE, Gilman AG: Goodman & Gilman's. The Pharmacological Basis of Therapeutics. 10th edition New York, McGraw-Hill Book Company, 2001 pp 590-592