title: Detection of codeine, morphine, 6-monoacetylmorphine, and meconin in human umbilical cord tissue: method validation and evidence of in utero heroin exposure.
abstract: BACKGROUND
  Heroin abuse is a significant public health issue and is on the rise because of the unintended consequences of strengthening controls for nonmedical use of prescription pain killers. Included in this trend is an increase in opiate exposed newborns that are particularly vulnerable to a number of negative health outcomes.
  
  
  METHODS
  After presenting a fully validated liquid chromatography-tandem mass spectrometric method for codeine, morphine, 6-monoacetylmorphine, and meconin, a metabolite of the heroin contaminant noscapine, we compared the outcome of 46 authentic umbilical specimens with the results generated using a previous less sensitive method that did not include meconin. Additionally, we provided a summary of opiate finding from a year-long survey of specimens received into a commercial reference laboratory.
  
  
  RESULTS
  The limits of detection for all 4 compounds were 0.1 ng/g, the limit of quantitation was 0.2 ng/g, and the assay was linear from 0.2 to 10.0 ng/g. Of the 46 comparative specimens, this method improved the identification of heroin exposure from 2 to 5, and the year-long survey identified 86 heroin-exposed newborns with 11 of them identified by the sole identification of meconin.
  
  
  CONCLUSIONS
  This study demonstrated that a more sensitive analytical platform and the inclusion of meconin in the opiates assay improved the ability to distinguish between in utero heroin exposure and maternal administration of codeine or morphine.
authors.affiliation: United States Drug Testing Laboratories, Inc, Des Plaines, IL.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Jones
authors.forename: Mary
authors.initials: M
authors.lastname: Jones
authors.forename: Brian
authors.initials: B
authors.lastname: Jones
authors.forename: Kristin
authors.initials: K
authors.lastname: Sulaiman
authors.forename: Charles
authors.initials: C
authors.lastname: Plate
authors.forename: Douglas
authors.initials: D
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000032:analysis*; D002138:Calibration; D002851:Chromatography, High Pressure Liquid; D003061:Codeine / Q000032:analysis*; D005260:Female; D003932:Heroin / Q000032:analysis*; D006556:Heroin Dependence / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D009020:Morphine / Q000032:analysis*; D009022:Morphine Derivatives / Q000032:analysis*; D009665:Noscapine / Q000031:analogs & derivatives* / Q000032:analysis; D011247:Pregnancy; D011786:Quality Control; D012015:Reference Standards; D015203:Reproducibility of Results; D052616:Solid Phase Extraction; D015813:Substance Abuse Detection; D053719:Tandem Mass Spectrometry; D014470:Umbilical Cord / Q000737:chemistry*
chemical_list: D000701:Analgesics, Opioid; D009022:Morphine Derivatives; D003932:Heroin; D009020:Morphine; D009665:Noscapine; C026979:6-O-monoacetylmorphine; C520721:meconin; D003061:Codeine