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The page below is a sample from the LabCE course The Toxicology Laboratory's Role in Pain Management: Testing for Opiates. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Opiate Metabolites

In Pain Management (PM), a confirmation should be performed if a screening result is positive. Since confirmatory methods use mass spectrometry, specific compounds can be identified and quantitated. However, we need to be able to make sense of the specific compounds that are found.
The accompanying diagram and table contain the essentials for opiate metabolism that are needed for routine PM interpretation. Posting this information in the laboratory is very useful. Laboratory testing personnel will find that they can quickly memorize the parent and metabolite relationships and use it to make sense of opiate confirmation results.
The information contained in the table may be included with opiate confirmation results to help clinicians understand the results.

Detected Drug
Possible Parent Drug
Detection Window
Codeine
Codeine
2-3 days
Hydrocodone
Hydrocodone, codeine, dihydrocodeine
2-3 days
Hydromorphone
Hydromorphone, hydrocodone, morphine
2-3 days
Morphine
Morphine, codeine, heroin
2-3 days
Oxycodone
Oxycodone
2-3 days
Oxymorphone
Oxymorphone, oxycodone
2-3 days