TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: 6MAMX    
6-Monoacetylmorphine, Chain of Custody, Random, Urine

Useful For Suggests clinical disorders or settings where the test may be helpful

Determination of heroin use in urine specimens handled through the chain-of-custody process

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing for adulterants will be performed on all chain of custody urine samples per regulatory requirements.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Heroin (diacetylmorphine) is a semisynthetic opiate that is closely related to morphine. It is no longer used clinically in the United States, though elsewhere it is used for rapid relief of pain.(1) Like morphine and other opiates, its relaxing and euphoric qualities make heroin a popular drug of abuse. Heroin is commonly injected intravenously, although it can be administered by other means such as snorting, smoking, or inhaling vapors.

 

Heroin shares the core structure of morphine, with the addition of 2 acetyl groups, which are thought to enhance its permeation into the central nervous system.(2,3) Heroin is metabolized by sequential removal of these acetyl groups; loss of first acetyl group converts heroin into 6-monoacetylmorphine (6-MAM) and loss of the second acetyl group converts 6-MAM to morphine, the dominant metabolite of heroin.(2,3) Heroin is rarely found intact in urine, since only 0.1% of a dose is excreted unchanged. 6-MAM is a unique metabolite of heroin, and its presence is a definitive indication of recent heroin use. Like heroin, 6-MAM has a very short half-life and detection window.

 

Chain of custody is required whenever the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was under the control of personnel involved with testing the specimen at all times; this control implies that the opportunity for specimen tampering would be limited. This includes a record of the disposition of a specimen to document the personnel who collected it, who handled it, and who performed the analysis. When a specimen is submitted in this manner, analysis will be performed in such a way that it will withstand regular court scrutiny.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Negative

Cutoff concentrations:

6-MAM

<5 ng/mL

Interpretation Provides information to assist in interpretation of the test results

The presence of 6-monoacetylmorphine (6-MAM) in urine is definitive for recent heroin use. However, the absence of 6-MAM does not rule out heroin use because of its short half-life. 6-MAM is typically only detectable within 24 hours of heroin use. 6-MAM is further metabolized into morphine, which may be detected 1 to 2 days after 6-MAM is no longer measurable. Morphine will typically be found in a specimen containing 6-MAM.(2,3)

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

While 6-monoacetylmorphine (6-MAM) is metabolized to morphine, the presence of morphine alone is not sufficient evidence to prove heroin use. 6-MAM is the only definitive metabolite of heroin.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Giovannelli M, Bedforth N, Aitkenhead A: Survey of intrathecal opioid usage in the UK. Eur J Anaesthesiol 2008;25:118-1122

2. Principles of Forensic Toxicology. Second edition. AACC Press, 2003, pp 187-205

3. Hardman JG, Limbird LE, Gilman AG: Goodman and Gilman's. The Pharmacological Basis of Therapeutics. 10th edition McGraw-Hill Book Company, 2001 pp 590-592

4. Principles of Forensic Toxicology. Fourth edition. AACC Press, 2013

5. Langman LJ, Bechtel LK, Meier BM, Holstege C: Chapter 41: Clinical Toxicology. In Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Edited by N Rifai, AR Horvath, CT Wittwer. Sixth edition. Elsevier, 2018 p 872