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25096 Opiates, Urine, Confirm Only by LCMSMS

Opiates, Urine, Confirm Only by LCMSMS
Test Code: CO-OPIM
Synonyms/Keywords
​​Hydrocodone, Hydromorphone, Codeine, Morphine, Vicodin, Dilaudid, Lortab, Heroin
Useful For
​Detecting the presence of hydrocodone, hydromorphone, codeine or morphine in urine to confirm abuse or to monitor pain management compliance
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 2 mL​ 1 mL​ 0.5 mL​
Specimen Stability Information
Specimen Type Temperature Time
Urine​ Ambient​ 72 hours​
Refrigerate (Preferred)​ 30 days​
Frozen​ 30 days​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield Monday through Friday​ 2-4 days​ Liquid Chromatography/Tandem Mass Spectrometry (LCMS/MS) using Multiple Reaction Monitoring
Test Information
This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.
 
This test is a LC/MS/MS confirmation only for the opiate method group (i.e. only the drugs detected in the single opiate assay performed at Marshfield Labs: hydrocodone, codeine, hydromorphone and morphine). It is intended for use only in patients where an initial drug screening test has already been performed at the time of specimen collection (i.e. Point-of-Care drug screening cup, dipstick, etc.). The specimen will not be screened by immunoassay in the laboratory; it will only be tested by LC/MS/MS. If an initial drug screen has not been performed at the specimen collection site, it is more appropriate to order the "Opiates Mini, Urine" (OPIMIN) test code which includes an initial screen.
Reference Range Information
Performing Location Reference Range
Marshfield​ Negative.  Positives are reported with a quantitative LCMS/MS result.​
Interpretation

Current Cutoff Levels for Toxicology

• Codeine
1. Codeine metabolizes mainly to morphine, but hydrocodone is a minor metabolite as well (up to 11% of the codeine concentration).
 
• Morphine
1. Hydromorphone is a minor metabolite of morphine (up to 2.5% of the morphine concentration).   
2. Morphine is manufactured from codeine (demethylation).  Codeine levels less than 1% of the morphine concentration are most likely an impurity present from the manufacturing process and should not be considered evidence of Codeine use. 
3. Morphine is a metabolite of heroin and is found in the urine of heroin users.  In the illicit manufacturing of heroin, small amounts of codeine is often present as an impurity.  Presence of codeine does not rule out heroin use; however, the ratio of morphine to codeine can be helpful in discriminating between heroin and codeine use.  See discussion on Poppy Seeds below.
 
• Hydrocodone
1. Hydrocodone metabolizes to Hydromorphone.
2. Hydrocodone is a pharmaceutical impurity of the Oxycodone production process.  It may be present in very small amounts with high levels of Oxycodone (less than 4% of the oxycodone level).
3. Hydrocodone is a minor metabolite of codeine (see Codeine section above).
 
• Hydromorphone
1. Metabolite of hydrocodone.
2. Minor metabolite of morphine.
 
 Opiates and Poppy Seeds Summary
• The pattern most consistent with poppy seed consumption is: morphine and codeine both present, morphine < 5000 ng/mL, codeine about one tenth the morphine concentration, and 6-MAM (heroin metabolite) not detected.
• If both morphine and codeine are present, but the codeine concentration is greater than half the morphine concentration, the positive result is probably due to codeine use, and is almost certainly not due to poppy seeds.
• If morphine is present at less than 5000 ng/mL but codeine is undetectable, the positive result is probably not caused by poppy seeds.
• If morphine is very high (> 5000 ng/mL), the positive result is probably not caused by poppy seeds.
• 6-MAM is a heroin metabolite that is found only in the urine of heroin users and is not found in urine of a person who has eaten poppy seeds. It can be ordered as a separate test if heroin use is suspected.  A positive result for 6-MAM is firm evidence of heroin use. Failure to detect 6-MAM does not rule out heroin.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​80361 ​ ​1 ​Opiates Confirmation by LC/MS/MS ​
​G0480 ​ ​1 ​Opiates Confirmation by LC/MS/MS ​For Medicare/Medicaid
Classification
This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.
Synonyms/Keywords
​​Hydrocodone, Hydromorphone, Codeine, Morphine, Vicodin, Dilaudid, Lortab, Heroin
Ordering Applications
Ordering Application Description
​Cerner Opiates, Urine, Confirm Only by LCMSMS
​COM Opiates, Urine, Confirm
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 2 mL​ 1 mL​ 0.5 mL​
Specimen Stability Information
Specimen Type Temperature Time
Urine​ Ambient​ 72 hours​
Refrigerate (Preferred)​ 30 days​
Frozen​ 30 days​
Useful For
​Detecting the presence of hydrocodone, hydromorphone, codeine or morphine in urine to confirm abuse or to monitor pain management compliance
Reference Range Information
Performing Location Reference Range
Marshfield​ Negative.  Positives are reported with a quantitative LCMS/MS result.​
Interpretation

Current Cutoff Levels for Toxicology

• Codeine
1. Codeine metabolizes mainly to morphine, but hydrocodone is a minor metabolite as well (up to 11% of the codeine concentration).
 
• Morphine
1. Hydromorphone is a minor metabolite of morphine (up to 2.5% of the morphine concentration).   
2. Morphine is manufactured from codeine (demethylation).  Codeine levels less than 1% of the morphine concentration are most likely an impurity present from the manufacturing process and should not be considered evidence of Codeine use. 
3. Morphine is a metabolite of heroin and is found in the urine of heroin users.  In the illicit manufacturing of heroin, small amounts of codeine is often present as an impurity.  Presence of codeine does not rule out heroin use; however, the ratio of morphine to codeine can be helpful in discriminating between heroin and codeine use.  See discussion on Poppy Seeds below.
 
• Hydrocodone
1. Hydrocodone metabolizes to Hydromorphone.
2. Hydrocodone is a pharmaceutical impurity of the Oxycodone production process.  It may be present in very small amounts with high levels of Oxycodone (less than 4% of the oxycodone level).
3. Hydrocodone is a minor metabolite of codeine (see Codeine section above).
 
• Hydromorphone
1. Metabolite of hydrocodone.
2. Minor metabolite of morphine.
 
 Opiates and Poppy Seeds Summary
• The pattern most consistent with poppy seed consumption is: morphine and codeine both present, morphine < 5000 ng/mL, codeine about one tenth the morphine concentration, and 6-MAM (heroin metabolite) not detected.
• If both morphine and codeine are present, but the codeine concentration is greater than half the morphine concentration, the positive result is probably due to codeine use, and is almost certainly not due to poppy seeds.
• If morphine is present at less than 5000 ng/mL but codeine is undetectable, the positive result is probably not caused by poppy seeds.
• If morphine is very high (> 5000 ng/mL), the positive result is probably not caused by poppy seeds.
• 6-MAM is a heroin metabolite that is found only in the urine of heroin users and is not found in urine of a person who has eaten poppy seeds. It can be ordered as a separate test if heroin use is suspected.  A positive result for 6-MAM is firm evidence of heroin use. Failure to detect 6-MAM does not rule out heroin.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield Monday through Friday​ 2-4 days​ Liquid Chromatography/Tandem Mass Spectrometry (LCMS/MS) using Multiple Reaction Monitoring
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​80361 ​ ​1 ​Opiates Confirmation by LC/MS/MS ​
​G0480 ​ ​1 ​Opiates Confirmation by LC/MS/MS ​For Medicare/Medicaid
Classification
This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.
For most current information refer to the Marshfield Laboratory online reference manual.