Determining compliance or identifying illicit opioid drug use using urine specimens
This test is not intended for employment-related testing.
This test uses high-resolution accurate mass spectrometry to identify 33 different opioids and/or metabolites where immunoassays are not adequate.
This test offers lower detection limits than previous Mayo Clinic Laboratories-offered screens.
This test has the ability to detect "spiked" samples.
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
LPPO | List prescribed opioids | No | Yes |
TOPSU | Targeted Opioid Screen, U | No | Yes |
Liquid Chromatography-Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
6-monoacetylmorphine (heroin metabolite)
Buprenorphine (Buprenex, Suboxone)
Codeine (Tylenol #3)
Codeine-6-beta-glucuronide (codeine metabolite)
Dihydrocodeine(hydrocodone metabolite)
EDDP (Methadone metabolite)
Fentanyl (Actiq, Duragesic, Fentora)
Heroin
Hydrocodone (Lortab, Norco, Vicodin)
Hydromorphone (Dilaudid, Exalgo)
Hydromorphone-3-beta-glucuronide (hydromorphone metabolite)
Meperidine (Demerol)
Methadone (Dolophine)
Methadone metabolite (EDDP)
Morphine (Avinza, Kadian, MS Contin)
Morphine-6-beta-glucuronide (morphine metabolite
N-desmethyltapentadol (Tapentadol metabolite)
Naloxone (Narcan)
Naloxone-3-beta-glucuronide (Naloxone metabolite)
Norbuprenorphine (Buprenorphine metabolite)
Norbuprenorphine glucuronide (Buprenorphine metabolite)
Norfentanyl (fentanyl metabolite)
Norhydrocodone (hydrocodone metabolite)
Normeperidine (Meperidine metabolite)
Noroxycodone (oxycodone metabolite)
Noroxymorphone (Oxymorphone metabolite)
Norpropoxyphene (propoxyphene metabolite)
O-desmethyltramadol (Tramadol metabolite)
Opiates
Oxycodone (Endocet, Percocet, Oxycontin)
Oxymorphone (Numorphan, Opana)
Oxymorphone-3-beta-glucuronide (Oxymorphone metabolite)
Propoxyphene (Darvon, Darvocet)
Tapentadol (Nucynta)
Tapentadol-beta-glucuronide (Tapentadol metabolite)
Tramadol (Tradol, Ultram, Ultracet)
Urine
In most cases, no additional testing is needed after the qualitative targeted opioid test is performed if the parent/metabolites found are consistent with the patients prescribed medications. However, if unexpected opioid parent/metabolites are found, confirmatory testing can be requested at an additional charge.
Question ID | Description | Answers |
---|---|---|
LPPO | List prescribed opioids |
Supplies: Sarstedt 5 mL Aliquot Tube (T914)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 5-mL tube
Specimen Volume: 1 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
0.5 mL
Gross hemolysis | Reject |
Gross icterus | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Urine | Refrigerated (preferred) | 14 days | |
Frozen | 28 days | ||
Ambient | 72 hours |
Determining compliance or identifying illicit opioid drug use using urine specimens
This test is not intended for employment-related testing.
Opioids are a large class of medications commonly used to relieve acute and chronic pain or help manage opioid abuse and dependence. Medications that fall into this class include: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol, and others. Opioids work by binding to the opioid receptors that are found in the brain, spinal cord, gastrointestinal tract, and other organs.
Common side effects include drowsiness, confusion, nausea, constipation, and, in severe cases, respiratory depression depending on the dose. These medications can also produce physical and psychological dependence and have a high risk for abuse and diversion, which is one of the main reasons many professional practice guidelines recommend compliance testing in patients prescribed these medications.
Opioids are readily absorbed from the gastrointestinal tract, nasal mucosa, lungs, and after subcutaneous or intermuscular injection. Opioids are primarily excreted from the kidney in both free and conjugated forms. This assay doesn't hydrolyze the urine sample and looks for both parent drugs and metabolites (including glucuronide forms). The detection window for most opioids in urine is approximately 1 to 3 days with longer detection times for some compounds (ie, methadone).
Not Detected
Cutoff concentrations:
Codeine: 25 ng/mL
Codeine-6-beta-glucuronide: 100 ng/mL
Morphine: 25 ng/mL
Morphine-6-beta-glucuronide: 100 ng/mL
6-monoacetylmorphine: 25 ng/mL
Hydrocodone: 25 ng/mL
Norhydrocodone: 25 ng/mL
Dihydrocodeine: 25 ng/mL
Hydromorphone: 25 ng/mL
Hydromorphone-3-beta-glucuronide: 100 ng/mL
Oxycodone: 25 ng/mL
Noroxycodone: 25 ng/mL
Oxymorphone: 25 ng/mL
Oxymorphone-3-beta-glucuronide: 100 ng/mL
Noroxymorphone: 25 ng/mL
Fentanyl: 2 ng/mL
Norfentanyl: 2 ng/mL
Meperidine: 25 ng/mL
Normeperidine: 25 ng/mL
Naloxone: 25 ng/mL
Naloxone-3-beta-glucuronide: 100 ng/mL
Methadone: 25 ng/mL
EDDP: 25 ng/mL
Propoxyphene: 25 ng/mL
Norpropoxyphene: 25 ng/mL
Tramadol: 25 ng/mL
O-desmethyltramadol: 25 ng/mL
Tapentadol: 25 ng/mL
N-desmethyltapentadol: 50 ng/mL
Tapentadol-beta-glucuronide: 100 ng/mL
Buprenorphine: 5 ng/mL
Norbuprenorphine: 5 ng/mL
Norbuprenorphine glucuronide: 20 ng/mL
If an opioid or its corresponding metabolites is identified (present), it indicates that the patient has used the respective opioid in the recent past. The absence of expected opioids or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge.
No significant cautionary statements
1. Gutstein HB, Akil H: Opioid analgesics. In: Brunton LL, Lazo JS, Parker KL, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill; 2006:chap 21
2. Chronic Pain in America: Roadblocks to Relief, survey conducted for the American Pain Society, The American Academy of the Pain Medicine and Janssen. Pharmaceutica; 1999
3. Magnani B, Kwong T: Urine drug testing for pain management. Clin Lab Med. 2012 Sep;32(32):379-390
The urine sample is diluted with internal standard and then analyzed by liquid chromatography- tandem mass spectrometry using a high resolution-accurate mass orbi-trap detector.(Unpublished Mayo method)
Monday through Saturday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
80364
G0481 (if appropriate)
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
TOSU | Targeted Opioid Screen, U | 95796-9 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
42323 | Codeine | 19411-8 |
42324 | Codeine-6-beta-glucuronide | 89310-7 |
42325 | Morphine | 19597-4 |
42326 | Morphine-6-beta-glucuronide | 89308-1 |
42327 | 6-monoacetylmorphine | 19321-9 |
42328 | Hydrocodone | 19482-9 |
42329 | Norhydrocodone | 89304-0 |
42330 | Dihydrocodeine | 19446-4 |
42331 | Hydromorphone | 19486-0 |
42332 | Hydromorphone-3-beta-glucuronide | 89309-9 |
42333 | Oxycodone | 19642-8 |
42334 | Noroxycodone | 89303-2 |
42335 | Oxymorphone | 19646-9 |
42336 | Oxymorphone-3-beta-glucuronide | 89301-6 |
42337 | Noroxymorphone | 89302-4 |
42338 | Fentanyl | 59673-4 |
42339 | Norfentanyl | 43199-9 |
42340 | Meperidine | 19532-1 |
42341 | Normeperidine | 27920-8 |
42342 | Naloxone | 42618-9 |
42343 | Naloxone-3-beta-glucuronide | 89307-3 |
42344 | Methadone | 19550-3 |
42345 | EDDP | 93495-0 |
42346 | Propoxyphene | 19429-0 |
42347 | Norpropoxyphene | 19632-9 |
42348 | Tramadol | 19710-3 |
42349 | O-desmethyltramadol | 86453-8 |
42350 | Tapentadol | 72485-6 |
42351 | N-desmethyltapentadol | 89306-5 |
42352 | Tapentadol-beta-glucuronide | 89300-8 |
42353 | Buprenorphine | 93494-3 |
42354 | Norbuprenorphine | 82371-6 |
42355 | Norbuprenorphine glucuronide | 89305-7 |
65059 | Opioid Interpretation | 69050-3 |
LPPO | List prescribed opioids | 29305-0 |