title: Anomalous observations of codeine in patients on morphine.
abstract: Urine drug monitoring is used by physicians treating chronic pain patients with opioid therapy. Patients are tested in part to insure that they are not taking other drugs. Therefore, the finding of codeine in a patient who is only prescribed morphine has clinical implications. Morphine preparations are known to have small amounts of codeine as an impurity estimated to be about 0.04%. In a population of 535 pain patients prescribed morphine, Kadian, MS Contin, and/or Avinza, the investigators observed 24 samples that contained codeine >20 ng/mL. Fifteen of the 24 contained codeine >20 and <50 ng/mL. Of the 9 samples that were >50 ng/mL, 7 had high levels of codeine (indicating codeine use), 1 was from a patient who had a prescription for codeine, and 1 was also positive for 6-acetylmorphine, indicating heroin use. A control group of 680 patients taking oxycodone was negative for codeine. The finding of codeine was ascribed to the manufacturing process of the morphine medications. Clinicians and laboratories testing urine for drugs should be aware of this possibility.
authors.affiliation: Millennium Laboratories Research Institute, San Diego, CA 92127, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.forename: Bridgit
authors.initials: B
authors.lastname: Crews
authors.forename: Charles
authors.initials: C
authors.lastname: Mikel
authors.forename: Perla
authors.initials: P
authors.lastname: Almazan
authors.forename: Sergey
authors.initials: S
authors.lastname: Latyshev
authors.forename: Amadeo
authors.initials: A
authors.lastname: Pesce
authors.forename: Cameron
authors.initials: C
authors.lastname: West
mesh_terms: D002626:Chemistry, Pharmaceutical; D002851:Chromatography, High Pressure Liquid; D002908:Chronic Disease; D003061:Codeine / Q000652:urine*; D004340:Drug Contamination; D006801:Humans; D057230:Limit of Detection; D009020:Morphine / Q000627:therapeutic use* / Q000652:urine; D010146:Pain / Q000188:drug therapy* / Q000652:urine; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D053719:Tandem Mass Spectrometry
chemical_list: D009020:Morphine; D003061:Codeine