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24782 Opiates Mini, Urine

Opiates Mini, Urine
Test Code: OPIMIN
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​ 5 mL​ 3 mL​ 1.5 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 method group (i.e. only the drugs detected in the single opiate assay performed at Marshfield Labs: hydrocodone, codeine, hydromorphone and morphine) by immunoassay; if the screen is positive, this test automatically includes GCMS confirmation for the opiate method group. 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.).
Reference Range Information
Performing Location Reference Range
​Marshfield Negative.  Positives are reported with a quantitative GCMS result.​
Interpretation
 
• 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 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 Screen
80361​ ​1 ​Opiates, Urine Confirmation ​If needed
​G0480 ​1 Opiates, Urine 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
Ordering Applications
Ordering Application Description
​Centricity ​Opiates Mini
​Cerner None​
​COM ​Opiates Mini, 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​ 5 mL​ 3 mL​ 1.5 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 GCMS result.​
Interpretation
 
• 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 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.
For more information visit:
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 Screen
80361​ ​1 ​Opiates, Urine Confirmation ​If needed
​G0480 ​1 Opiates, Urine 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.