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25096 Opiates, Urine, Confirm Only by GCMS

Opiates, Urine, Confirm Only by GCMS
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​ 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​ 2-4 days​ Gas chromatography-mass spectrometry (GCMS) using selected ion monitoring​
Test Information
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
 
This test is a GCMS 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 GCMS. 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 GCMS 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 GCMS ​
​G0480 ​ ​1 ​Opiates Confirmation by GCMS ​For Medicare/Medicaid
Classification
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
​
Synonyms/Keywords
​Hydrocodone, Hydromorphone, Codeine, Morphine, Vicodin, Dilaudid, Lortab, Heroin
Ordering Applications
Ordering Application Description
​Centricity ​Opiates, Urine, Confirm Only by GCMS
​Cerner Opiates, Urine, Confirm Only
​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​ 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

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​ Gas chromatography-mass spectrometry (GCMS) using selected ion monitoring​
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​80361 ​ ​1 ​Opiates Confirmation by GCMS ​
​G0480 ​ ​1 ​Opiates Confirmation by GCMS ​For Medicare/Medicaid
Classification
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
​
For most current information refer to the Marshfield Laboratory online reference manual.