Detecting the presence of opiates in the urine

 Opiates are the natural or synthetic drugs that have a morphine-like

pharmacological action, expressed predominantly at the u (mu)-opioid

receptor. They are used primarily for relief of pain and often produce

physical and psychological dependence. Opiates are readily

absorbed from the gastrointestinal tract, nasal mucosa, lung, and

after subcutaneous or intramuscular (IM) injection. They are excreted

from the kidney primarily by glomerular filtration in both free and

conjugated forms. Opiates are metabolized by cytochrome P450

enzymes, predominantly CyP 2D6 and 3A4, and uridine diphosphate

(UDP) glucuronosyltransferase. Patients deficient in these enzyme

activities will experience adverse drug events if prescribed standard

doses.

Negative

Positives are reported with a quantitative GC-MS result.

Cutoff concentrations:

IMMUNOASSAY SCREEN

      <300 ng/mL

CODEINE BY GC-MS

      <100 ng/mL

HYDROCODONE BY GC-MS

      <100 ng/mL

HYDROMORPHONE BY GC-MS

      <100 ng/mL

MORPHINE BY GC-MS 

      <100 ng/mL

OXYCODONE BY GC-MS

      <100 ng/mL

This procedure reports the total urine concentration; this is the sum

of the unconjugated and conjugated forms of the parent drug. The

parent drug is the unmetabolized form of the prescribed drug.

Codeine: An adult of typical body weight (70 Kg) with normal renal

and hepatic function receiving a 60 mg oral dose of codeine will excrete

approximately 40% of the daily dose in urine as free codeine or the

glucuronide or sulfate ester of codeine. Assuming a typical daily urine

output of 1 L, the steady-state urine concentration of codeine will be in

the range of 3,000 ng/mL to 15,000 ng/mL. Morphine is a normal metabolite

of codeine:  morphine will be present at concentration <2 to 10 times 

codeine as a result of codeine ingestion. Urine concentrations will be

proportionally higher with higher doses. Abstinence for >4 days will

result in a nondetectable concentration (<100 ng/mL).

Morphine:  An adult of typical body weight (70 Kg) with normal renal

and hepatic function receiving a 10 mg IM dose of morphine will excrete

<20% of the daily dose in urine as free morphine or the glucuronide or

sulfate ester of morphine. Assuming a typical daily urine output of 1 L,

the steady-state urine concentration of morphine will be in the range of

5,000 ng/mL to 20,000 ng/mL. A patient receiving a 5 mg intravenous

(IV) dose of morphine every 4 hours will excrete urine morphine

Concentration in the range of 10,000 ng/mL to 40,000 ng/mL. Urine

concentrations will be proportionally higher with higher doses. Abstinence

for >4 days will result in a nondetectable concentration (<100 ng/mL).

Note:  The active forms of morphine in blood include morphine and

               morphine-3-glucuronide. These forms of morphine, plus

               morphine-6-glucuronide, are excreted in urine and are quantified

               as a single result (total morphine) in this test.

Hydrocodone:  An adult of typical body weight (70 Kg) with normal renal

and hepatic function receiving a 10 mg oral dose of hydrocodone will

excrete approximately 20% of the daily dose in urine as hydrocodone,

hydromorphone, or  the glucuronide or sulfate ester of hydromorphone. 

Assuming a typical daily urine output of 1 L, the steady-state urine

concentration of hydrocodone will be in the range of 500 ng/mL to 3,000

ng/mL. Hydromorphone is a normal metabolite of hydrocodone:

hydromorphone will be present at concentration approximately <2 times

hydrocodone as a result of hydrocodone ingestion. Urine concentrations

will be proportionally higher with higher doses. Abstinence for >4 days

will result in a nondetectable concentration (<100 ng/mL).

Hydromorphone:  An adult of typical body weight (70 Kg) with normal

renal and hepatic function receiving a 5 mg oral dose of hydromorphone

will excrete approximately 10% of the daily dose in urine as the

glucuronide or sulfate ester of the parent drug. Assuming a typical daily

urine output of 1 L, the steady-state urine concentration of hydromorphone

will be in the range of 800 ng/mL to 3,000 ng/mL. Hydrocodone is not a

normal metabolite of hydromorphone; hydrocodone will not be present

as a result of hydromorphone ingestion. Urine concentrations will be

proportionally higher with higher doses. Abstinence for >4 days will

result in a nondetectable concentration (<100 ng/mL).

Oxycodone:  An adult of typical body weight (70 Kg) with normal renal and

hepatic function receiving a 10 mg oral dose of oxycodone (Percodan)

will excrete approximately 40% of the daily dose in urine as oxycodone

or the glucuronide or sulfate ester of oxycodone. Assuming a typical

daily urine output of 1 L, the steady-state urine concentration of oxycodone

will be in the range of 2,000 ng/mL to 5,000 ng/mL. An adult receiving a 20

mg oral dose of oxycodone (OxyContin) will excrete oxycodone in the range

of 5,000 ng/mL to 15,000 ng/mL. An adult receiving a 40 mg oral dose of

oxycodone (OxyContin) will excrete oxycodone in the range of 10,000

ng/mL to 35,000 ng/mL. An adult receiving a 80 mg oral dose of oxycodone

(OxyContin) will excrete oxycodone in the range of 30,000 ng/mL to 65,000

ng/mL. Urine concentrations will be proportionally higher with higher doses.

Abstinence for >4 days will result in a nondetectable concentration

(<100 ng/mL).

This test detects drugs structurally similar to morphine. Other drugs

in the opioid class, such as fentanyl, meperidine, methadone, and

opiate antagonists such as naloxone, are not detected.

The presence of meperidine in a very high concentration (overdose

proportions) will result in a positive screen report. The gas

chromatography/mass spectrometry (GC-MS) report will be negative for

opiates.

1.   Hardman JG and Limbird LE:  Goodman & Gilman's The

      Pharmacological Basis of Therapeutics. 10th edition. New York,

      Macmillan Company, 2001, pp 569-619

2.   Baselt RC:  Disposition of Toxic Drugs and Chemicals in Man.

                6th edition. Foster City, CA, Biomedical Publications, 2002