Opiate Test Interpretation
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.
Type of Opioids
- Natural opioids (opiates)
- Morphine
- Codeine
- Thebaine
- Semisynthetic opioids
- Heroin
- Hydromorphone
- Hydrocodone
- Fully synthetic opioids
- Methadone
- Fentanyl
- Tramadol
- Pethidine
- Levorphanol
- Dextropropoxyphene
- Opioid antagonists & agonist/antagonist
- Buprenorphine
- Naloxone
The American Society of Interventional Pain Physicians guideline states that urine drug testing must be implemented at initiation and during chronic pain management therapy. CDC issued new recommendations for prescribing opioid medications for chronic pain in March 2016 that include urine drug testing before starting opioid therapy and at least annually. The purpose of urine drug testing is to verify adherence to prescribed medications, identify undisclosed drugs, and discourage drug misuse, abuse, and diversion.
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. The detection window for most opioids in urine is approximately 1 to 3 days with longer detection times for some compounds such as methadone.
The Emit II Plus Opiate Assay tests for morphine, morphine-3-glucuronide, and codeine in human urine and gives a positive result if any of these opiates are present. It also detects synthetic opiates related to morphine, such as hydromorphone, and high concentrations of the analgesic meperidine and the narcotic antagonist nalorphine. Positive results for specimens containing other compounds structurally unrelated to opiates have not been observed. EMIT opiate cutoff for pain medicine compliance is 300 ng/mL.
Interpretation Guidelines
| Drug Class |
Brand Name | Expected Metabolites | Noncompliant results | Comments |
Detection Window |
|
Oxycodone |
Oxycontin Percocet Percodan Roxicodone Endocet |
Oxycodone Oxymorphone |
Negative or any metabolites not listed | Oxycodone & oxymorphone detected. Hydrocodone is a pharmaceutical contaminant of oxycodone and may be present. | 1– 3 days |
| Hydrocodone |
Lortab Lorcet Vicodan Hycodan Tussionex Norco |
Hydrocodone Hydromorphone Dihydrocodeine |
Negative or any metabolites not listed | Hydrocodone is metabolized to hydrodromorphone & dihydrocodeine | 1 –3 days |
| Hydromorphone |
Dilaudid Exalgo |
Hydromorphone Hydromorphone-3-glucuronide |
Negative or any metabolites not listed | 1-3 days | |
| Oxymorphone |
Numorphan Opana |
Oxymorphone Oxymorphone-3-glucuronide 6-hydroxy-oxymorphone |
Negative or any metabolites not listed | ||
|
Codeine |
Tylenol #3 |
Codeine Codeine-6-beta-glucuronide Norcodeine Morphine Normorphine Morphine 6 glucuronide Hydrocodone |
Negative or any metabolites not listed | Codeine is metabolized to morphine so both may be present | 1 –3 days |
| Methadone |
Dolophine Methadose Amidone |
Methadone EDPP EMDP |
Methadone only without metabolite, Negative or any metabolites not listed | Patients occasionally pour liquid methadone into their urine in order to test positive. However, the methadone metabolite will be absent. | 2- 3 days |
| Morphine |
MS Contin Duramorph Avinza Kadian |
Morphine, Normorphine, Morphine 6 glucuronide hydromorphone |
Negative or any metabolites not listed | Detection of morphine can be due to morphine use, heroin use, or poppy seed consumption. MS Contin patients usually develop very high urine morphine levels. Codeine is a pharmaceutical contaminant of morphine. | 2 –3 days |
|
Heroin (illegal in US) |
Does not apply |
Heroin Morphine Morphine-6-glucuronide Normorphine 6-Monoacetylmorphine |
6-acetyl- morphine is diagnostic for heroin abuse | Heroin may be contaminated with acetylcodeine so codeine may be detected. Only morphine may be detected after 8 hours | 12–24 hours |
| Fentanyl |
Duragesic Fentora Sublimaze Actiq |
Fentanyl Norfentanyl Despropfentanyl |
Negative or any metabolites not listed | Special GC/MS test is required for detection | 1-2 days |
| Propoxyphene |
Darvon Darvocet |
Propoxyphene Norpropoxyphene |
Negative or any metabolites not listed | 2 days | |
| Meperidine |
Demerol Mepergan Pethidine |
Meperidine Normperidine |
Negative or any metabolites not listed | 2-3 days | |
| Naloxone | Narcan |
Naloxone Naloxone-3-beta-glucuronide |
Negative or any metabolites not listed | ||
| Buprenorphine |
Buprenex Suboxone |
Norbuprenorphine Norbuprenorphine glucuronide |
Negative or any metabolites not listed |
Nagpal G, etal. Interpretation of Urine Drug Screens: Metabolites and Impurities. JAMA 2017;318:1704-5.
