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 them 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
|
