Test ID: MORP
Morphine, Unconjugated, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring morphine therapy
Routine drug monitoring is not indicated in all patients. Compliance monitoring is indicated in patients who are being treated for acute pain requiring excessive dose.
Assessing toxicity
Method Name A short description of the method used to perform the test
Gas Chromatography-Mass Spectrometry Using Selected Ion Monitoring (GC-MS SIM)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Duramorph
Infumorph
Kadian
Morphine Sulfate
MS Contin
MSIR
Oramorph
RMS
Roxanol
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Red top
Specimen Volume: 5 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days |
| Ambient | 14 days | |
| Frozen | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Morphine interacts primarily with mu-opioid receptor to mediate its effects, but also shows some affinity for kappa-opioid receptor.(1) Its major metabolites are glucuronide conjugates including: inactive morphine-3-glucuronide (M3G, approximately 60%), active morphine-6-glucuronide (M6G, approximately 10%), and a small amount of morphine-3,6-diglucuronide.(2,3) The enzyme UDP-glucuronosyltransferase-2B7 (UGT2B7) is primarily responsible for morphine glucuronidation.(2)
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.
Therapeutic: 70-450 ng/mL
Tolerant patients: <1,500 ng/mL
Toxicity: >700 ng/mL
Interpretation Provides information to assist in interpretation of the test results
The minimal effective peak serum concentration of unconjugated morphine for analgesia is 20 ng/mL. Peak therapeutic serum concentrations of 70 to 450 ng/mL occur 30 minutes after intravenous dose, 1 hour after intramuscular or subcutaneous dose, or 2 hours after oral dose.
Patients continuously administered morphine develop tolerance; they can tolerate serum concentrations up to 1,500 ng/mL.
Death may be associated with serum total morphine >700 ng/mL in the nontolerant subject.(4)
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test quantifies unconjugated morphine. This test does not quantify morphine-3-glucuronide and morphine-6-glucuronide. This test cannot distinguish the source of morphine from heroin, codeine, or prescription morphine.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Gutstein HB, Akil H: Opioid analgesics. In Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th edition. Edited by LL Brunton, JS Lazo, KL Parker. New York, McGraw-Hill Book Company, 2006, pp 547-590; available from URL: http://www.accessmedicine.com/content.aspx?aID=940653
2. Coffman BL, Rios GR, King CD, et al: Human UGT2B7 catalyzes morphine glucuronidation. Drug Metab Dispos 1997;25:1-4
3. Wittwer E, Kern SE: Role of morphine's metabolites in analgesia: concepts and controversies. AAPS J 2006 May 26;8(2):E348-352
4. Baselt RC: Morphine. In Disposition of Toxic Drugs and Chemical in Man. Eighth edition. Edited by RC Baselt, Foster City, CA, Biomedical Publications, 2008, pp 1057-1061
Method Description Describes how the test is performed and provides a method-specific reference
Morphine is extracted from serum by solid-phase chromatography, derivitized, and then analyzed by gas chromatography-mass spectrometry using selected ion monitoring.(Burt M, Kloss J, Apple F: Postmortem blood free and total morphine concentration in medical examiner cases. J Forensic Sci 2001;46:1138-1142)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Thursday; 8 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83925
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 83132 | Morphine, Unconjugated, S | 3827-3 |
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