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Opioids Confirmation Panel Urine

Important Note

This test will temporarily be sent to Mayo Clinic Laboratories (Test ID TOSU) for their mass spectrometry-based assay that detects codeine, codeine-6-beta-glucuronide, morphine, morphine-6-beta-glucuronide, 6-monoacetylmorphine, hydrocodone, norhydrocodone, dihydrocodeine, hydromorphone, hydromorphone, oxycodone, noroxycodone, oxymorphone, oxymorphone-3-beta-glucuronide, noroxymorphone, fentanyl, norfentanyl, meperidine, normeperidine, naloxone, naloxone-3-beta-glucuronide, methadone, EDDP, propoxyphene, porpropoxyphene, tramadol, O-desmethyltramadol, tapentadol, N-desmethyltapentadol, tapentadol-beta-glucuronide, buprenorphine, norbuprenorphine, and norbuprenorphine glucuronide.

eD-H Order Code

LAB4248

Specimen Collection Information

Specimen Minimum Test Volume Container Special Handling
Urine 1.0 ML chem

Specimen Transport Temperature

Refrigerated

Reference Ranges / Critical Values

Assay Gender Age Range Normal Range Critical Values Units
U 6-MAM Lvl All 0 Minutes – 150 Years ≤4.9   ng/ml
U Buprenorphine Lvl All 0 Minutes – 150 Years ≤4.9   ng/ml
U Codeine Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U Dihydrocodeine Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U EDDP+ Lvl All 0 Minutes – 150 Years ≤24.9   ng/ml
U Fentanyl Lvl All 0 Minutes – 150 Years ≤0.9   ng/ml
U Hydrocodone Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U Hydromorphone Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U Methadone Lvl All 0 Minutes – 150 Years ≤24.9   ng/ml
U Morphine Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U Naloxone Lvl All 0 Minutes – 150 Years ≤4.9   ng/ml
U Norbuprenorphine Lvl All 0 Minutes – 150 Years ≤4.9   ng/ml
U Norfentanyl Lvl All 0 Minutes – 150 Years ≤0.9   ng/ml
U Norhydrocodone Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U Noroxycodone Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U O-Desmethyltramadol Lvl All 0 Minutes – 150 Years ≤24.9   ng/ml
U Oxycodone Lvl All 0 Minutes – 150 Years ≤4.9   ng/ml
U Oxymorphone Lvl All 0 Minutes – 150 Years ≤9.9   ng/ml
U Tramadol Lvl All 0 Minutes – 150 Years ≤24.9   ng/ml

Specimen Stability

7 days

Interpretive Data

Assay Display Interpretive Data
U 6-MAM Lvl 6-MAM: The presence of 6-monoacetylmorphine (6-MAM) indicates heroin use. 6-MAM is metabolized to morphine. Cutoff = 5 ng/mL.
U Buprenorphine Lvl Buprenorphine is not recognized as a metabolite of other opioids and its presence indicates the use of buprenorphine or combination products such as Suboxone®. Patients taking a low dose of buprenorphine may be compliant despite a buprenorphine result below the limit of detection. Cutoff = 5 ng/mL.
U Codeine Lvl Codeine is not a recognized metabolite of other opioids and its presence indicates use of a codeine-containing drug. Codeine metabolites include morphine and hydrocodone (minor metabolite). The presence of codeine in the absence of its metabolites (morphine and hydrocodone) suggests placement of codeine directly into the urine specimen rather than ingestion. Cutoff = 10 ng/mL.
U Dihydrocodeine Lvl Dihydrocodeine may arise from the use of dihydrocodeine-containing drugs or by metabolism of hydrocodone (minor metabolite). Cutoff = 10 ng/mL.
U EDDP+ Lvl EDDP+ is a metabolite of methadone. The presence of EDDP+ indicates use of methadone. Cutoff = 25 ng/mL.
U Fentanyl Lvl Fentanyl is not recognized as a metabolite of other opioids and its presence indicates the use of fentanyl-containing drugs. The presence of fentanyl in the absence of norfentanyl suggests placement of fentanyl directly into the urine specimen rather than ingestion. Cutoff = 1 ng/mL.
U Hydrocodone Lvl Hydrocodone may arise from the use of hydrocodone-containing drugs or by metabolism of codeine. When generated by the metabolism of codeine the concentration of hydrocodone is typically less than the concentration of codeine. Hydrocodone is metabolized to norhydrocodone dihydrocodeine and hydromorphone (minor metabolite). Cutoff = 10 ng/mL.
U Hydromorphone Lvl Hydromorphone may arise from the use of hydromorphone-containing drugs or by metabolism of morphine. Cutoff = 10 ng/mL.
U Methadone Lvl Methadone is not recognized as a metabolite of other opioids and its presence indicates the use of methadone-containing drugs. The presence of methadone in the absence of EDDP+ suggests placement of methadone directly into the urine specimen rather than ingestion. Cutoff = 25 ng/mL.
U Morphine Lvl The presence of morphine may arise from the use of morphine-containing drugs poppy seeds or via metabolism of either codeine or heroin. When generated by the metabolism of codeine the concentration of morphine is typically less than the concentration of codeine. When generated by the metabolism of heroin morphine is usually present at a concentration greater than the 6-MAM concentration. Hydromorphone is a minor metabolite of morphine. Cutoff = 10 ng/mL.
U Naloxone Lvl Naloxone is not recognized as a metabolite of other opioids and its presence indicates the use of naloxone or naloxone-containing products such as Suboxone®. Patients taking a low dose of naloxone may be compliant despite a naloxone result below the limit of detection. Cutoff = 5 ng/mL.
U Norbuprenorphine Lvl Norbuprenorphine is a metabolite of buprenorphine and its presence indicates use of buprenorphine or combination products such as Suboxone®. Cutoff = 5 ng/mL.
U Norfentanyl Lvl Norfentanyl is a metabolite of fentanyl and its presence indicates fentanyl use. Cutoff = 1 ng/mL.
U Norhydrocodone Lvl Norhydrocodone is the major metabolite of hydrocodone. Cutoff = 10 ng/mL.
U Noroxycodone Lvl Noroxycodone is a metabolite of oxycodone and its presence indicates oxycodone use. Cutoff = 10 ng/mL.
U O-Desmethyltramadol Lvl O-desmethyltramadol is a metabolite of tramadol and its presence indicates tramadol use. Cutoff = 25 ng/mL.
U Opioid Panel Interp This test was performed using liquid chromatography tandem mass spectrometry (LC-MS/MS). This test was developed and its performance characteristics determined by the Department of Pathology and Laboratory Medicine at Dartmouth-Hitchcock Medical Center. It has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing. This test is used for clinical purposes and should not be used for investigational or research purposes. For any interpretation questions please contact the laboratory at 603-650-2200.
U Oxycodone Lvl Oxycodone is not a recognized metabolite of other opioids and its presence indicates use of an oxycodone-containing drug. Oxycodone is metabolized to oxymorphone and noroxycodone. The presence of oxycodone in the absence of its metabolites (noroxycodone oxymorphone) suggests placement of oxycodone directly into the urine specimen rather than ingestion. Cutoff = 5 ng/mL.
U Oxymorphone Lvl Oxymorphone may arise from the use of oxymorphone-containing drugs or by metabolism of oxycodone. Cutoff = 10 ng/mL.
U Tramadol Lvl Tramadol is not recognized as a metabolite of other opioids and its presence indicates the use of tramadol-containing drugs. The presence of tramadol in the absence of O-desmethyltramadol suggests placement of tramadol directly into the urine specimen rather than ingestion. Cutoff = 25 ng/mL.

Day(s) Performed

Varies.

2 runs done weekly (Monday through Friday)

CPT(s)

_

Performing Lab Section

Chemistry