title: Prevalence of heroin markers in urine for pain management patients.
abstract: Surveys of current trends indicate heroin abuse is associated with nonmedical use of pain relievers. Consequently, there is an interest in evaluating the presence of heroin-specific markers in chronic pain patients who are prescribed controlled substances. A total of 926,084 urine specimens from chronic pain patients were tested for heroin/diacetylmorphine (DAM), 6-acetylmorphine (6AM), 6-acetylcodeine (6AC), codeine (COD), and morphine (MOR). Heroin and markers were analyzed using liquid chromatography tandem mass spectrometry (LC-MS-MS). Opiates were analyzed following hydrolysis using LC-MS-MS. The prevalence of heroin use was 0.31%, as 2871 were positive for one or more heroin-specific markers including DAM, 6AM, or 6AC (a known contaminant of illicit heroin). Of these, 1884 were additionally tested for the following markers of illicit drug use: 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine (MAMP), 11-nor-9-carboxy-Δ(9)-tetracannabinol (THCCOOH), and benzoylecgonine (BZE); 654 (34.7%) had positive findings for one or more of these analytes. The overall prevalence of heroin markers were as follows: DAM 1203 (41.9%), 6AM 2570 (89.5%), 6AC 1082 (37.7%). MOR was present in 2194 (76.4%) and absent (<LOQ) in 677 (23.6%) of the heroin-positive specimens. COD was present in 1218 (42.4%) specimens. Prevalence of combinations for specimens containing MOR were as follows: DAM only 13 (0.59%), 6AM only 1140 (52.0%), 6AC only 24 (1.1%), DAM/6AM/6AC 710 (32.4%), 6AM/6AC 188 (8.6%), DAM/6AM 113 (5.2%), DAM/6AC 6 (0.27%). Importantly, the prevalence of combinations for specimens without MOR were as follows: DAM only 161 (23.8%), 6AM only 217 (32.1%), 6AC only 92 (13.6%), DAM/6AM/6AC 50 (7.4%), 6AM/6AC 7 (1.0%), DAM/6AM 145 (21.4%), DAM/6AC 5 (0.74%). Unexpected patterns of excretion were observed, such as the presence of DAM and 6AC in the absence of 6AM and MOR; therefore, multiple heroin markers may be useful to assess for heroin use.
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Knight
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA.
authors.forename: Brandi L
authors.initials: BL
authors.lastname: Puet
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA. Electronic address: anne.depriest@aegislabs.com.
authors.forename: Anne
authors.initials: A
authors.lastname: DePriest
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Heltsley
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hild
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA; Vanderbilt University, Department of Pathology, Immunology and Microbiology, Nashville, TN 37232, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Black
authors.affiliation: Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Robert
authors.affiliation: University of Maryland, School of Pharmacy, 20 North Pine St., Baltimore, MD 21201, USA.
authors.forename: Yale H
authors.initials: YH
authors.lastname: Caplan
authors.affiliation: Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Cone
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D002047:Buprenorphine / Q000627:therapeutic use; D002853:Chromatography, Liquid; D059350:Chronic Pain / Q000188:drug therapy*; D003061:Codeine / Q000031:analogs & derivatives* / Q000652:urine; D003932:Heroin / Q000652:urine*; D006556:Heroin Dependence / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D013287:Illicit Drugs / Q000652:urine; D008691:Methadone / Q000627:therapeutic use; D009022:Morphine Derivatives / Q000652:urine*; D018710:Pain Clinics; D053719:Tandem Mass Spectrometry
chemical_list: D000701:Analgesics, Opioid; D015415:Biomarkers; D013287:Illicit Drugs; D009022:Morphine Derivatives; D002047:Buprenorphine; C053740:acetylcodeine; D003932:Heroin; C026979:6-O-monoacetylmorphine; D008691:Methadone; D003061:Codeine
keywords: 6AM; Compliance monitoring; Heroin; Pain management; Urine drug testing