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22911 Opiates Survey, Urine

Opiates Survey, Urine
Test Code: OPI
Synonyms/Keywords
​Hydrocodone, Hydromorphone, Codeine, Morphine, Vicodin, Dilaudid, Lortab, Heroin, Oxycodone, Oxymorphone, Oxycontin, Percodan, Percocet
Test Components
​Test includes immunoassay screen followed by quantitative confirmation by GCMS (when needed) of two drug groups:  opiates (hydrocodone, hydromorphone, codeine, morphine) and oxycodone (oxycodone and oxymorphone)
Useful For
​Detecting the presence of hydrocodone, hydromorphone, codeine, morphine, oxycodone and oxymorphone 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​ 10 mL​ 7 mL​ 3.5 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​
If no confirmatory work is required:1 day​
 
If confirmatory work is required: 4 days
Beckman AU680 Clinical Chemistry System with Emit immunoassay and gas chromatography-mass spectrometry (GCMS) using selected ion monitoring (if needed for confirmation)​
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 screen for the opiate and oxycodone method groups (drugs included are:  hydrocodone, codeine, hydromorphone morphine, oxycodone and oxymorphone) by immunoassay; if the screen is positive, this test automatically includes GCMS confirmation for the opiate and oxycodone method groups. Quantitation/confirmation charged separately if needed.  It is intended for use only in patients where an initial drug screening test has not already been performed (i.e. Point-of-Care drug screening cup, dipstick, etc.).  
 
This test can be used to assess patient compliance in taking opiates administered as part of pain management programs.​
Reference Range Information
Performing Location Reference Range
Marshfield​ Negative.  Positives are reported with a quantitative GCMS result.​
Interpretation
Interpreting Opiate Group Results
 
• 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.

Interpreting Oxycodone Group Results
1. Oxycodone metabolizes to oxymorphone.
2. Hydrocodone can be 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. Oxycodone and Hydromorphone can be pharmaceutical impurities of the Oxymorphone production process.  If either are present at levels less than or equal to 0.5% of the Oxymorphone level, it is likely an impurity and not evidence of use of Oxycodone and/or Hydromorphone.
 
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 separately if 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
80307​ 1​ Single Drug Class​
​80361 ​1 ​Opiates Confirmation ​If needed
​G0480 ​1 ​Opiates Confirmation ​For Medicare/Medicaid, If needed
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, Oxycodone, Oxymorphone, Oxycontin, Percodan, Percocet
Test Components
​Test includes immunoassay screen followed by quantitative confirmation by GCMS (when needed) of two drug groups:  opiates (hydrocodone, hydromorphone, codeine, morphine) and oxycodone (oxycodone and oxymorphone)
Ordering Applications
Ordering Application Description
​Centricity ​Opiate Survey, Urine
​Cerner ​Opiate Screen Urine
​COM ​Opiates Survey, Urine
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​ 10 mL​ 7 mL​ 3.5 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, morphine, oxycodone and oxymorphone in urine to confirm abuse or to monitor pain management compliance
Test Components
​Test includes immunoassay screen followed by quantitative confirmation by GCMS (when needed) of two drug groups:  opiates (hydrocodone, hydromorphone, codeine, morphine) and oxycodone (oxycodone and oxymorphone)
Reference Range Information
Performing Location Reference Range
Marshfield​ Negative.  Positives are reported with a quantitative GCMS result.​
Interpretation
Interpreting Opiate Group Results
 
• 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.

Interpreting Oxycodone Group Results
1. Oxycodone metabolizes to oxymorphone.
2. Hydrocodone can be 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. Oxycodone and Hydromorphone can be pharmaceutical impurities of the Oxymorphone production process.  If either are present at levels less than or equal to 0.5% of the Oxymorphone level, it is likely an impurity and not evidence of use of Oxycodone and/or Hydromorphone.
 
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 separately if suspected.  A positive result for 6-MAM is firm evidence of heroin use. Failure to detect 6-MAM does not rule out heroin.
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Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​
If no confirmatory work is required:1 day​
 
If confirmatory work is required: 4 days
Beckman AU680 Clinical Chemistry System with Emit immunoassay and gas chromatography-mass spectrometry (GCMS) using selected ion monitoring (if needed for confirmation)​
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
80307​ 1​ Single Drug Class​
​80361 ​1 ​Opiates Confirmation ​If needed
​G0480 ​1 ​Opiates Confirmation ​For Medicare/Medicaid, If needed
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.