Mayo Test Catalog, (Sorted By Test Name) - Mayo Medical ...

OPATU
8473
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
Interpretation: This procedure reports the total urine concentration; this is the sum of the
unconjugated and conjugated forms of the parent drug. Heroin (diacetylmorphine) is rarely detectable in
body fluids. It has a half-life of a few minutes. Heroin undergoes rapid deacetylation to
6-monoacetylmorphine (6-MAM), which is about 6 times more potent than morphine. 6-MAM is
further deacetylated to morphine; the effects of heroin are attributed to the combined effect of heroin,
6-MAM, and morphine. The presence of 6-MAM is conclusive evidence of prior heroin use. However,
due to its short half-life, it is only detectable in urine for about 8 hours after administration.(2) Codeine
is also metabolized to morphine. The presence of morphine in urine can indicate exposure to morphine,
heroin, or codeine within 2 to 3 days.(2) Illicit heroin often contains small amounts of codeine. The
presence of both codeine and morphine in urine does not rule out the use of heroin; however, the ratio of
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