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Lab Manual for UCSF Clinical Laboratories

Lab Manual for SFGH

Internal Resources


Item Value
Available Stat? Yes
Test code OPIAP
Performed by? Chemistry
Sendout? no
Price range $$
In House Availability Stat or routine, 24 hours/7days
Principle Competitive immunoassay using CEDIA technology
Interpretation CLINICAL SIGNIFICANCE: The opiates are narcotics that are used to treat pain. Abuse of these drugs can produce respiratory depression and coma. These toxic effects can be quickly reversed with administration of an opiate antagonist such as naloxone. Opiates can produce a significant chemical dependency.

CUTOFF: 300 ng/mL

Drug Detection Period (approximate guideline) = 2-3 days.

Positive results are confirmed by LC-MS/MS for most locations; exceptions are the Emergency Department and most inpatient locations. Drugs detected are codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, and 6-monoacetylmorphine. Extremely high oxycodone concentrations may cause a positive opiate screen. Note that morphine is the principal metabolite of codeine and of heroin. Hydrocodone has been proposed as a trace metabolite of codeine (see Reference 2). Hydromorphone is a metabolite of hydrocodone, and has been proposed as a trace metabolite of morphine (see Reference 3). See the Opiate Metabolism Chart for a diagram of opiate metabolism and interpretation of confirmation results.

Synthetic and some semi-synthetic opioids/opiates cannot be ruled out by opiate assays, and "false negative" results are likely. Oxycodone has poor cross-reactivity in the opiate assay. A separate screening test specifically for oxycodone is performed at SFGH. Drugs that are not detected at all by the opiate assay include: Buprenorphine, fentanyl, meperidine, methadone, propoxyphene, and tramadol. Page the Chemistry/Toxicology Fellow on call at 719-5166 to discuss testing for synthetic opiates. At SFGH, 97 % of opiate positive screens are confirmed.
Amount to Collect 10 mL
Normal range negative
Stability Minimum 1 week at 2-8°C
Turn around times Screening results are reported within 1 to 8 hours. Confirmation results will be reported as a separate test when they are completed (1-4 days).
Additional information (see OXYCODONE, URINE to monitor for compliance with oxycodone/Oxycontin¨ therapy)
References 1. Wu AHB, Broussard LA, Hoffman RS, Kwong TC, McKay C, Moyer TP, Otten EM, Welch SL, Wax P. National Academy of Clinical Biochemistry. Laboratory Medicine Practice Guidelines. Recommendations for the Use of Laboratory Tests to Support the Impaired and Overdosed Patients from the Emergency Department. Clin Chem 2003;49:357-79.

2. Oyler JM, Cone EJ, Hoseph RE Jr., Huestis MA. Identification of Hydrocodone in Human Urine Following Controlled Codeine Administration. J Anal Toxicol. 2000 Oct; 24(7):530-5.

3. Cone EJ, Heit HA, Yale HC, Gourlay D. Evidence of Morphine Metabolism to Hydromorphone in Pain Patients Chronically Treated with Morphine. J Anal Toxicol. 2006 Jan/Feb 30(1):1-6.

Last Updated 7/24/2015 5:44:53 PM
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