title: Hydrophilic interaction LC-MS/MS analysis of opioids in urine: significance of glucuronide metabolites.
abstract: BACKGROUND
  In clinical laboratories, a large proportion of the toxicology workload is drug confirmations. Our GC-MS method for opioid confirmation detects total codeine, morphine, hydrocodone, hydromorphone, oxycodone and oxymorphone. The objective of this study was to develop a LC-MS/MS assay measuring the above drugs and glucuronide metabolites. In addition, to determine if measuring free drug only would lead to false negative results.
  
  
  RESULTS
  In 85 patient urines, 43% were positive for morphine glucuronide, but not morphine, 48% were positive for hydromorphone glucuronide, but not hydromorphone, 33% were positive for codeine glucuronide, but not codeine, and 44% were positive for oxymorphone glucuronide, but not oxymorphone.
  
  
  CONCLUSIONS
  We developed an LC-MS/MS assay capable of detecting codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone and glucuronide metabolites. Detection of free drug only led to false negative confirmations.
authors.affiliation: Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94107, USA. deborah.french@ucsf.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: French
authors.forename: Alan
authors.initials: A
authors.lastname: Wu
authors.forename: Kara
authors.initials: K
authors.lastname: Lynch
mesh_terms: D000701:Analgesics, Opioid / Q000652:urine*; D002853:Chromatography, Liquid / Q000379:methods; D003061:Codeine / Q000652:urine; D008401:Gas Chromatography-Mass Spectrometry; D020719:Glucuronides / Q000652:urine*; D006801:Humans; D006853:Hydrocodone / Q000652:urine; D004091:Hydromorphone / Q000652:urine; D057927:Hydrophobic and Hydrophilic Interactions / Q000187:drug effects*; D010098:Oxycodone / Q000652:urine; D010111:Oxymorphone / Q000652:urine; D015203:Reproducibility of Results; D053719:Tandem Mass Spectrometry / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D020719:Glucuronides; D006853:Hydrocodone; D010111:Oxymorphone; D010098:Oxycodone; D004091:Hydromorphone; D003061:Codeine