title: A practical approach to determine cutoff concentrations for opiate testing with simultaneous detection of codeine, morphine, and 6-acetylmorphine in urine.
abstract: BACKGROUND
  Both the Department of Defense (DoD) and the Department of Health and Human Services (DHHS) currently require two confirmation tests to verify use of heroin, one test for total morphine and a separate test for 6-acetylmorphine (6-AM). Our aim was to determine appropriate free-codeine, free-morphine, and 6-AM cutoff concentrations that could be substituted for total-morphine, total-codeine, and 6-AM cutoff concentrations and to develop a less labor-intensive method for measuring codeine, morphine, and 6-AM.
  
  
  METHODS
  Urine samples containing opiates were extracted, derivatized, and analyzed using gas chromatography-mass spectrometry with selective ion monitoring.
  
  
  RESULTS
  The limits of detection for codeine, morphine, and 6-AM were 6, 5, and 0.5 microg/L, respectively. Recoveries were >90%. Quantification was linear over the concentration range of 6-1000 microg/L for codeine, 5-5000 microg/L for morphine, and 0.5-800 microg/L for 6-AM. Cutoff concentrations for confirmation of opiates were 100, 100, and 10 microg/L for free codeine, free morphine, and 6-AM.
  
  
  CONCLUSIONS
  The proposed cutoff concentrations for free morphine and 6-AM provide better detection windows for morphine and heroin use than the cutoff concentrations for total morphine and 6-AM used at present. Detection of free codeine, instead of total codeine, simplifies interpretation of codeine use. The single-extraction method enables simultaneous, less labor-intensive analysis of morphine, codeine, and 6-AM.
authors: Address correspondence to this author at: Forensic Toxicology, AFIP Annex, 1413 Research Blvd., Rockville, MD 20850, USA. paul@afip.osd.mil.
authors: B D
authors: BD
authors: Paul
authors: E T
authors: ET
authors: Shimomura
authors: M L
authors: ML
authors: Smith
mesh_terms: D003061:Codeine / Q000652:urine*; D008401:Gas Chromatography-Mass Spectrometry; D006556:Heroin Dependence / Q000652:urine; D006801:Humans; D009020:Morphine / Q000652:urine*; D009022:Morphine Derivatives / Q000652:urine*; D011863:Radioimmunoassay; D012016:Reference Values; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000379:methods*
chemical_list: D009022:Morphine Derivatives; D009020:Morphine; C026979:6-O-monoacetylmorphine; D003061:Codeine