Opiates, Screen and Confirmation, Urine (Codeine/Morphine)

CPT: 80307
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Test Details

Test Includes

Codeine and morphine only; confirmation is performed at an additional charge.

Use

Evaluate drug abuse

Limitations

In most immunoassays a number of narcotic drugs can cross react to give a positive result. Every effort should be made to confirm, by an analytically different and more sensitive method, all presumptive, positive opiate tests.

Methodology

Immunoassay (IA); confirmation: mass spectrometry (MS)

Additional Information

A qualitative urine test for opiates is performed in suspected overdose cases or as part of a drug of abuse program. The test is most sensitive for morphine and codeine, but other drugs will cross react in an immunoassay and give positive results (eg, hydrocodone, hydromorphone). All presumptive positive assays should be confirmed, preferably by MS. Morphine is a prescribed drug for pain relief, a metabolite of heroin, a metabolite of codeine, and a constituent of poppy seeds. Its presence in urine, even after confirmation, must be interpreted very carefully. Ingestion of poppy seeds (bagels, Danish) can cause positive opiate tests at a 300 ng/mL cutoff.1 The intake of heroin by the user can only be proved by the detection of 6-O-acetyl morphine.

Opiates in general are a group of drugs (commonly referred to as narcotics) that are used medically to relieve pain, but that also have a high potential for abuse. Morphine and codeine are found in the resin collected from the opium poppy. Other opiates are synthesized or manufactured (eg, heroin). Opium appears as dark brown chunks or as a powder and is usually smoked or eaten. Heroin can be a white or brownish powder that is usually dissolved in water and injected.

Opiates tend to relax the user. When the opiates are injected, the user feels an immediate “rush.” Other initial and unpleasant effects include restlessness, nausea, and vomiting. The user may go “on the nod,” going back and forth from feeling alert to drowsy. With very large doses, the user cannot be awakened, pupils become smaller, and the skin becomes cold, moist, and bluish in color. Furthermore, breathing slows down and death may occur. Clearance may be slower in geriatric patients.

Specimen Requirements

Specimen

Urine

Volume

20 mL

Container

Use plastic urine drug bottle and evidence tape or tamper-evident container for forensic specimen. Collection kits are available by request from the laboratory.

Collection

Urine temperature monitoring is recommended for samples to be tested for medicolegal purposes.

Storage Instructions

Maintain specimen at room temperature. If arrival extends beyond seven days, then refrigerate.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Clinical Information

Special Instructions

Chain-of-custody documentation is required for samples submitted for preëmployment, random employee testing, and forensic purposes. For other applications, use the standard test request form. Please mark chain-of-custody test number on the test request form.

Footnotes

1. Selavka CM. Poppy seed ingestion as a contributing factor to opiate-positive urinalysis results. J Forensic Sci. 1991 May; 36(3):685-696. 1856638

References

Barsan WG. Narcotic agents. Ann Emerg Med. 1986; 15:1019-1020.
Bjerver K, Jonsson A, Nilsson A, et al. Morphine intake from poppy seed food. J Pharm Pharmacol. 1982, 34:798-801.
Gillogley KM, Evans AT, Hansen RL, Samuels SJ, Batra KK. The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening. Am J Obstet Gynecol. 1990 Nov; 163(5 Pt 1):1535-1542. 2240103
Kulberg A. Substance abuse: Clinical identification and management. Pediatr Clin North Am. 1986 Apr; 33(2):325-361. 2870461
Ling GS, MacLeod JM, Lee S, Lockhart SH, Pasternak GW. Separation of morphine analgesia from physical dependence. Science. 1984 Oct 26; 226(4673):462-464. 6541807
Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. N Engl J Med. 1989 Aug 3; 321(5):303-309. 2664519
Pettitt BC Jr, Dyszel SM, Hood LV. Opiates in poppy seed: Effect on urinalysis results after consumption of poppy seed cake-filling. Clin Chem. 1987 Jul; 33(7):1251-1252. 3297423

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
074476 Opiate Screen, Urine 714865 Opiates ng/mL 3879-4
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 777037 Opiates 3879-4
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 777185 Codeine 3507-1
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 071811 Codeine GC/MS Conf ng/mL 16250-3
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 777193 Morphine 3830-7
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 714428 Morphine GC/MS Conf ng/mL 16251-1
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 070474 Documentation N/A
Reflex Table for Opiates
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 071456 Opiate Confirmation, Urine 739219 Opiates Holding N/A

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