Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites

Rebecca Heltsley, Anne Zichterman, David L. Black, Beverly Cawthon, Tim Robert, Frank Moser, Yale H. Caplan, Edward J. Cone

Research output: Contribution to journalArticle

Abstract

This study of 20,089 urine specimens from chronic pain patients provided a unique opportunity to evaluate the prevalence of prescription opiates and metabolites, assess the usefulness of inclusion of normetabolites in the test panel, and compare opiate and oxycodone screening results to liquid chromatography with tandem mass spectrometry (LC-MS-MS) results. All specimens were screened by an opiate [enzyme-linked immunosorbent assay (ELISA), 100 ng/mL] and oxycodone assay [ELISA, 100 ng/mL or enzyme immunoassay (EIA), 50 ng/mL] and simultaneously tested by LC-MS-MS [limit of quantitation (LOQ) = 50 ng/mL] for 10 opiate analytes (codeine, norcodeine, morphine, hydrocodone, dihydrocodeine, norhydrocodone, hydromorphone, oxycodone, noroxycodone, and oxymorphone). Approximately two-thirds of the specimens were positive for one or more opiate analytes. The number of analytes detected in each specimen varied from 1 to 8 with 3 (34.8%) being most prevalent. Hydrocodone and oxycodone (in combination with metabolites) were most prevalent followed by morphine. Norcodeine was only infrequently detected whereas the prevalence of norhydrocodone and noroxycodone was approximately equal to the prevalence of the parent drug. A substantial number of specimens were identified that contained norhydrocodone (n = 943) or noroxycodone (n = 702) but not the parent drug, thereby establishing their interpretative value as biomarkers of parent drug use. Comparison of the two oxycodone screening assays revealed that the oxycodone ELISA had broader cross-reactivity with opiate analytes, and the oxycodone EIA was more specific for oxycodone. Specimens containing only norhydrocodone were best detected with the opiate ELISA whereas noroxycodone (only) specimens were best detected by the oxycodone EIA.

Original languageEnglish (US)
Pages (from-to)32-38
Number of pages7
JournalJournal of Analytical Toxicology
Volume34
Issue number1
StatePublished - Jan 2010

Fingerprint

Opiate Alkaloids
Oxycodone
Metabolites
Chronic Pain
urine
Prescriptions
metabolite
drug
Enzymes
Assays
Urine
enzyme
assay
Immunosorbents
Testing
immunoassay
Pharmaceutical Preparations
Hydrocodone
Enzyme-Linked Immunosorbent Assay
Immunoenzyme Techniques

ASJC Scopus subject areas

  • Analytical Chemistry
  • Toxicology
  • Health, Toxicology and Mutagenesis
  • Chemical Health and Safety
  • Environmental Chemistry

Cite this

Heltsley, R., Zichterman, A., Black, D. L., Cawthon, B., Robert, T., Moser, F., ... Cone, E. J. (2010). Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites. Journal of Analytical Toxicology, 34(1), 32-38.

Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites. / Heltsley, Rebecca; Zichterman, Anne; Black, David L.; Cawthon, Beverly; Robert, Tim; Moser, Frank; Caplan, Yale H.; Cone, Edward J.

In: Journal of Analytical Toxicology, Vol. 34, No. 1, 01.2010, p. 32-38.

Research output: Contribution to journalArticle

Heltsley, R, Zichterman, A, Black, DL, Cawthon, B, Robert, T, Moser, F, Caplan, YH & Cone, EJ 2010, 'Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites', Journal of Analytical Toxicology, vol. 34, no. 1, pp. 32-38.
Heltsley R, Zichterman A, Black DL, Cawthon B, Robert T, Moser F et al. Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites. Journal of Analytical Toxicology. 2010 Jan;34(1):32-38.
Heltsley, Rebecca ; Zichterman, Anne ; Black, David L. ; Cawthon, Beverly ; Robert, Tim ; Moser, Frank ; Caplan, Yale H. ; Cone, Edward J. / Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites. In: Journal of Analytical Toxicology. 2010 ; Vol. 34, No. 1. pp. 32-38.
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