Opiates are a class of compounds that includes morphine, codeine, and heroin. Morphine and codeine are naturally occurring alkaloids that are found in opium, a substance exuded from the unripe seed pod of the opium poppy Papaver somniferum. Heroin is a semisynthetic derivative of morphine.

Morphine is a potent analgesic. Codeine is used in analgesic preparations and as a cough suppressant. Heroin is an even more potent analgesic than morphine. Both morphine and codeine are legitimate drugs. Heroin is a drug of abuse that may be snorted, smoked, or dissolved and injected subcutaneously or intravenously.

Opiates are absorbed rapidly. Heroin is converted almost immediately to morphine, which is excreted in urine both unchanged and as a glucoronidated metabolite. Excretion takes place over a period of a couple of days. Codeine is excreted in urine as a glucoronidated conjugate, as free and conjugated norcodeine, and as morphine. The presence of opiates in the urine indicates the use of heroin, morphine and/or codeine.

6-Acetylmorphine (6-AM) is a metabolite of heroin; its presence is positive proof of heroin use. 6-AM has a very short half-life (ie, it is detectable for only a few hours after heroin use). Current literature shows that 10 ng/ml is the lowest testing level by GC/MS that can reasonably be used to consistently and accurately identify and quantitate the presence of 6-AM.

Oxycodone, a drug in the opiate family, is becoming an ever increasing problem within this area. The availability of a urine semi-quantitative drug screen may aide physician’s in monitoring patients who have been prescribed Oxycodone.

The Dade Behring Urine Opiates Screen Flex test is based on an enzyme reaction using morphine as the standard. Using morphine as the standard the cutoff levels are set at 300 ng/ml in our laboratory. The method provides a preliminary analytical test result, and must be confirmed with another method, preferably GC/MS. The table below gives the compounds this assay is designed to detect and the levels at which the compounds have been found to give a response approximately equivalent to that of 300 ng/ml morphine cutoff levels.

• Compound Conc (ng/ml)
  • Codeine 247
  • Dihydrocodeine 291
  • Hydrocodone 364
  • Hydromorphone 498
  • Levallorphan > 7,500*
  • Meperidine > 50,000**
  • 6-Acetylmorphine 1,088
  • Morphine-3-Glucoronide 626
  • Naorphine 9,862*
  • Naloxone 828,139
  • Oxycodone 5,388
  • Oxymorphone > 20,000

*Therapeutic levels or toxic levels of levallorphan and nalorphine are not reported in the literature.

**Meperidine urinary concentrations of 150,000 ng/ml have been measured in cases of fatal merperidine overdosage.

The semi Quantitative test has an assay range of 50—1800 ng/ml. Any result above the cutoff of 300 ng/ml is reported as positive (likely represents drug abuse); results less than 300 ng/ml are reported as negative (for drug abuse) with a numerical value. This numerical value may aide in determining whether or not an opiate(s) is/are present in a patients specimen. This numerical value may aide a physician in knowing whether or not a prescribed opiate is taken (i.e. could the patient be selling the drug). However, as in interpreting any drug screen results, the interpretation should include reasonable clinical judgment.

Please contact the laboratory department.