Sorted By Test Name - Mayo Medical Laboratories

OPATU
8473
semisynthetic narcotic derived from thebaine. It is metabolized by O-demethylation, forming
oxymorphone.(2) -Oxymorphone is a semisynthetic opioid derivative of thebaine and is indicated for
moderate-to-severe pain.(2) -Heroin, a semisynthetic derivative of morphine, is rapidly deacetylated in
vivo to the active metabolite 6-monoacetlymorphine (6-MAM), which is further hydrolyzed to
morphine.(2) Opiates have been shown to readily cross the placenta and distribute widely into many fetal
tissues. Opiate use by the mother during pregnancy increases the risk of prematurity and small size for
gestational age. Furthermore, heroin-exposed infants exhibit an early onset of withdrawal symptoms
compared to methadone-exposed infants. These infants demonstrate a variety of symptoms including
irritability, hypertonia, wakefulness, diarrhea, yawning, sneezing, increased hiccups, jitteriness, excessive
sucking, and seizures. Long-term intrauterine drug exposure may lead to abnormal neurocognitive and
behavioral development as well as an increased risk of sudden infant death syndrome. The disposition of
opiates and opioids in meconium, the first fecal material passed by the neonate, is not well understood.
The proposed mechanism is that the fetus excretes drug into bile and amniotic fluid. Drug accumulates in
meconium either by direct deposition from bile or through swallowing of amniotic fluid. The first
evidence of meconium in the fetal intestine appears at approximately the 10th to 12th week of gestation,
and slowly moves into the colon by the 16th week of gestation. Therefore, the presence of drugs in
meconium has been proposed to be indicative of in utero drug exposure up to 5 months before birth, a
longer historical measure than is possible by urinalysis.
Useful For: Detection of maternal prenatal opiate/opioid use up to 5 months before birth
Interpretation: The presence of any of the following opiates (codeine, morphine, hydrocodone,
hydromorphone, oxycodone, oxymorphone) at > or =50 ng/g or 6-monoacetlymorphine at > or =10 ng/g
indicates the newborn was exposed to opiates/opioids during gestation.
Reference Values:
Negative
Positives are reported with a quantitative LC-MS/MS result.
Cutoff concentrations
Codeine by LC-MS/MS: >50 ng/mL
Hydrocodone by LC-MS/MS: >50 ng/mL
Hydromorphone by LC-MS/MS: >50 ng/mL
Morphine by LC-MS/MS: >50 ng/mL
Oxycodone by LC-MS/MS: >50 ng/mL
Oxymorphone by LC-MS/MS: >50 ng/mL
Clinical References: 1. Gutstein HB, Akil H: Opioid analgesics. In Goodman and Gilman's The
Pharmacological Basis of Therapeutics. Edited by LL Brunton, JS Lazo, KL Parker. 11th edition.
McGraw-Hill Companies Inc, 2006. Available at URL:
www.accessmedicine.com/content.aspx?aID=940653 2. Baselt RC: Disposition of Toxic Drugs and
Chemical in Man. Edited by RC Baselt. Foster City, CA. Biomedical Publications, 2008, pp 355-360;
730-735; 745-747; 750-752; 1057-1064; 1166-1168; 1470-1171 3. Ostrea EM Jr, Lynn SM, Wayne RN,
Stryker JC: Tissue distribution of morphine in the newborns of addicted monkeys and humans. Clinical
implications. Dev Pharmacol Ther 1980;1:163-170 4. Szeto HH: Kinetics of drug transfer to the fetus.
Clin Obstet Gynecol 1993;36:246-254 5. Kwon TC, Ryan RM: Detection of intrauterine illicit drug
exposure by newborn drug testing. National Academy of Clinical Biochemistry. Clin Chem
1997;43:235-242 6. Ostrea EM Jr, Brady MJ, Parks PM, et al: Drug screening of meconium in infants of
drug-dependent mothers: an alternative to urine testing. J Pediatr 1989;115:474-477 7. Ahanya SN,
Lakshmanan J, Morgan BL, Ross MG: Meconium passage in utero: mechanisms, consequences, and
management. Obstet Gynecol Surv 2005;60:45-56
Opiates, Urine
Clinical Information: Opiates are the natural or synthetic drugs that have a morphine-like
pharmacological action. Medically, opiates are used primarily for relief of pain. Opiates include morphine
and drugs structurally similar to morphine (eg, codeine, hydrocodone, hydromorphone, oxycodone).(1)
Useful For: Detecting the presence of opiates in the urine
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