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Test Code OPATX Opiates Confirmation, Chain of Custody, Urine

Useful For

Detection and quantification of codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, noroxycodone, noroxymorphone, norhydrocodone, dihydrocodeine, and naloxone in urine


Chain of custody is required whenever the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was under the control of personnel involved with testing the specimen at all times; this control implies that the opportunity for specimen tampering would be limited.

Additional Tests

Test ID Reporting Name Available Separately Always Performed
COCH Chain of Custody Processing No Yes
ADLTX Adulterants Survey, CoC, U Yes Yes

Testing Algorithm

Adulterants testing will be performed on all chain of custody urine samples as per regulatory requirements.

Reporting Name

Opiate Confirmation, CoC, U

Specimen Type


Specimen Required

Specimen Type: Urine

Container/Tube: Chain-of-Custody Kit (T282) containing the specimen containers, seals, and documentation required.

Specimen Volume: 20 mL

Collection Instructions: Collect specimen in the container provided, seal, and submit with the associated documentation to satisfy the legal requirements for chain-of-custody testing. 

Additional Information

1. If urine creatinine is required or adulteration of the sample is suspected, the following test should be requested, ADLTX / Adulterants Survey, Chain of Custody, Urine. For additional information, please refer to ADLTX / Adulterants Survey, Chain of Custody, Urine.

2. Submitting <20 mL will compromise our ability to perform all necessary testing.

Specimen Minimum Volume

2.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  14 days

Reject Due To


Mild OK; Gross OK




Mild OK; Gross OK



Clinical Information

Codeine is converted by hepatic metabolism to morphine and norcodeine with a half-life of 2 to 4 hours. If codeine is ingested, the ratio of codeine to morphine generally exceeds 1.0 in urine during the first 24 hours. The ratio may fall below 1.0 after 24 hours; and after 30 hours, only morphine may be detected.


Morphine is a naturally occurring narcotic analgesic obtained from the poppy plant, Papaver somniferum. Morphine is converted by hepatic metabolism to normorphine with a half-life of 2 to 4 hours. The presence of morphine in urine can indicate exposure to morphine, heroin, or codeine within 2 to 3 days. Ingestion of bakery products containing poppy seeds can also cause morphine to be excreted in urine. If excessively large amounts are consumed, this can result in urine morphine concentrations up to 2,000 ng/mL for a period of 6 to 12 hours after ingestion.


Hydrocodone exhibits a complex pattern of metabolism including O-demethylation, N-demethylation, and 6-keto reduction to the 6-beta hydroxymetabolites. Hydromorphone and norhydrocodone are both metabolites of hydrocodone. Dihydrocodeine is also a minor metabolite. Trace amounts of hydrocodone can also be found in the presence of approximately 100-fold higher concentrations of oxycodone or hydromorphone since it can be a pharmaceutical impurity in these medications. The presence of hydrocodone >100 ng/mL indicates exposure within 2 to 3 days prior to specimen collection.


Hydromorphone is metabolized primarily in the liver and is excreted primarily as the glucuronidated conjugate, with small amounts of parent drug and minor amounts of 6-hydroxy reduction metabolites. The presence of hydromorphone >100 ng/mL indicates exposure within 2 to 3 days prior to specimen collection. Hydromorphone is also a metabolite of hydrocodone; therefore, the presence of hydromorphone could also indicate exposure to hydrocodone.


Dihydrocodeine is a semisynthetic narcotic analgesic prepared by the hydrogenation of codeine. It is also a minor metabolite of hydrocodone. It is metabolized to dihydromorphine and has a half-life of 3.4 to 4.5 hours. 


Oxycodone is metabolized to noroxycodone, oxymorphone, and their glucuronides and is excreted primarily via the kidney. The presence of oxycodone >100 ng/mL indicates exposure to oxycodone within 2 to 3 days prior to specimen collection.


Oxymorphone is metabolized in the liver to noroxymorphone and excreted via the kidney primarily as the glucuronide conjugates. Oxymorphone is also a metabolite of oxycodone and, therefore, the presence of oxymorphone could also indicate exposure to oxycodone.


Naloxone is a synthetic narcotic antagonist and used for partial or complete reversal of opioid depression induced by natural or synthetic opioids. It has also been incorporated into oral tablets of opioids to discourage abuse. The duration of action is dependent on the dose and route of administration. The half-life in adults is approximately 30 to 81 minutes.


The detection interval for the opiates is generally 2 to 3 days after last ingestion.


Chain of custody is a record of the disposition of a specimen to document who collected it, who handled it, and who performed the analysis. When a specimen is submitted in this manner, analysis will be performed in such a way that it will withstand regular court scrutiny.

Reference Values


Cutoff concentrations



300 ng/mL


Codeine by LC-MS/MS: 25 ng/mL

Dihydrocodeine-by LC-MS/MS: 25 ng/mL

Hydrocodone by LC-MS/MS: 25 ng/mL-

Norhydrocodone-by LC-MS/MS: 25 ng/mL

Hydromorphone by LC-MS/MS: 25 ng/mL

Oxycodone by LC-MS/MS: 25 ng/mL

Noroxycodone-by LC-MS/MS: 25 ng/mL

Oxymorphone by LC-MS/MS: 25 ng/mL

Noroxymorphone-by LC-MS/MS: 25 ng/mL

Naloxone-by LC-MS/MS: 25 ng/mL

Morphine by LC-MS/MS: 25 ng/mL


This procedure reports the total urine concentration; this is the sum of the unconjugated and conjugated forms of the parent drug.


This test detects drugs structurally similar to morphine. Other drugs in the opioid class, such as fentanyl, meperidine, and methadone are not detected.

Method Description

Opiates exist in patient urine as both free and either sulfate or glucuronide conjugates. Specimens are initially screened by immunoassay followed by enzyme hydrolysis is used to liberate the conjugated drug. Specimens are then centrifuged, diluted, and the analytes are separated by liquid chromatography-tandem mass spectroscopy and analyzed by multiple reaction monitoring.(Unpublished Mayo method)

Day(s) and Time(s) Performed

Monday through Friday

Analytic Time

2 days

Specimen Retention Time

14 days

Performing Laboratory

Mayo Medical Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information



G0480 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
OPATX Opiate Confirmation, CoC, U In Process


Result ID Test Result Name Result LOINC Value
6541 Opiates Immunoassay Screen 19295-5
36213 Codeine-by LC-MS/MS 16250-3
42005 Dihydrocodeine-by LC-MS/MS 19448-0
36214 Hydrocodone-by LC-MS/MS 16252-9
42006 Norhydrocodone-by LC-MS/MS 78868-7
36215 Hydromorphone-by LC-MS/MS 16998-7
36216 Oxycodone-by LC-MS/MS 16249-5
42007 Noroxycodone-by LC-MS/MS 77779-7
36212 Oxymorphone-by LC-MS/MS 17395-5
42008 Noroxymorphone-by LC-MS/MS No LOINC Needed
42009 Naloxone-by LC-MS/MS 77207-9
36217 Morphine-by LC-MS/MS 16251-1
36218 Opiates Interpretation 69050-3
36219 Chain of Custody No LOINC Needed

Method Name

Immunoassay Followed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Confirmation with Quantitation