Opiates, Quantitative LC-MS/MS, Urine

Code
000.0000
Name
Opiates, Quantitative LC-MS/MS, Urine
Category
None
Department
Send-Out
Start Date
Expiration Date
Synonyms
CODEINE AND MORPHINE CONFIRMATION/QUANTITATION BY GC/MS, URINE
CPT Codes
83925
Site
SBMF
Reference Test
47017
ATLAS Test Code

Specimen Information

Type

Urine, random

Volume

4.0 ml

Transport Info

Refrigerated

Fasting Required?
False
Patient Instructions

Reference Range

Negative

Positive cutoff: 20 ng/mL

Methodology

Quantitative Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Clinical Significance

Confirm positive screen results by an alternate, specific method; detect use. Opium is obtained from the unripe pods of the opium poppy Papaver somniferum. Morphine and codeine are naturally occurring alkaloids of opium. Heroin is a compound synthesized from morphine and is the most commonly abused opiate. It is a U.S. Schedule 1 substance and therefore has no currently accepted medical use. Opiates are rapidly metabolized by the body, and the main site of metabolism is the liver. Morphine is excreted in urine as conjugated morphine (comprising about 60-80% of morphine’s urine disposition), free morphine (about 10%), and other trace metabolites. Codeine is excreted in urine as free and conjugated codeine (totaling about 80% of codeine’s urine disposition) and free and conjugated morphine (comprising about 15%). After codeine administration, total codeine may be eliminated faster than total morphine so that some urine specimens of codeine users may show only the presence of total morphine or a ratio of total morphine to total codeine of greater than one. Heroin is rapidly metabolized in whole blood to 6-acetylmorphine, which is then hydrolyzed to conjugated morphine in the liver. It is excreted in urine principally as conjugated morphine, but also in small amounts as free morphine and 6-acetylmorphine. Codeine is not a metabolite of heroin or morphine as previously reported by some investigators. However, codeine has been found in some heroin preparations as an impurity, accounting for its presence in the urine of some heroin abusers. Depending on the dose and the sensitivity of the analytical method, total morphine may be detected in urine up to 72 hours after last administration of morphine, codeine, or heroin. Positive result indicates exposure to drug and does not necessarily indicate impairment.

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