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HelpTest Code OPATS Opiate Panel, Free (Unconjugated), Serum
Ordering Guidance
This test should only be ordered by healthcare professionals to monitor patients who have been prescribed any of the following opiates/opiates antagonists: codeine, oxycodone, noroxycodone, oxymorphone, hydrocodone, norhydrocodone, dihydrocodeine, morphine, 6-monoacetylmorphine, hydromorphone, and noroxymorphone.
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Red top (Serum gel/SST are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL serum
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Secondary ID
623435Useful For
Monitoring therapeutic efficacy, compliance, misuse and/or abuse in serum specimens of patients who have been prescribed any of the following: codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and dihydrocodeine,
Detection and quantification of codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, noroxycodone, noroxymorphone, norhydrocodone, dihydrocodeine, and 6-monoacetylmorphine
Special Instructions
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Opiate Panel, Free (Unconjugated),SSpecimen Type
Serum RedSpecimen Minimum Volume
Serum: 0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days |
| Frozen | 28 days | |
| Ambient | 24 hours |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Clinical Information
Opiates are the natural or synthetic drugs that have a morphine-like pharmacological action. They are used primarily for relief of pain and often produce physical and psychological dependence. This test is for use by healthcare professionals to determine if patients prescribed any of the following opiates/opioids are receiving the right dose for therapeutic efficacy and/or are compliant: codeine, oxycodone, noroxycodone, oxymorphone, hydrocodone, norhydrocodone, dihydrocodeine, morphine, 6-monoacetylmorphine, hydromorphone, and noroxymorphone.
Reference Values
Therapeutic range/Metabolite information (as applicable):
6-monoacetylmorphine: Metabolite of heroin
Codeine: 10-100 ng/mL
Morphine: 10-80 ng/mL when used as sole therapy; Minor metabolite of codeine
Hydromorphone: 1.0-30 ng/mL when used as sole therapy; Metabolite of hydrocodone and minor metabolite of morphine
Hydrocodone: 10-100 ng/mL
Dihydrocodeine: 72-150 ng/mL when used as sole therapy; Minor metabolite of hydrocodone
Norhydrocodone: Metabolite of hydrocodone
Oxycodone: 10-100 ng/mL
Noroxycodone: Metabolite of oxycodone
Oxymorphone: 1.0-8.0 ng/mL when used as sole therapy; Metabolite of oxycodone
Noroxymorphone: Metabolite of oxymorphone
Cutoff concentrations:
6-Monoacetylmorphine: 1.0 ng/mL
Codeine: 1.0 ng/mL
Morphine: 1.0 ng/mL
Hydromorphone: 1.0 ng/mL
Hydrocodone: 1.0 ng/mL
Dihydrocodeine: 1.0 ng/mL
Norhydrocodone: 1.0 ng/mL
Oxycodone: 1.0 ng/mL
Noroxycodone: 1.0 ng/mL
Oxymorphone: 1.0 ng/mL
Noroxymorphone: 1.0 ng/mL
Interpretation
Clinically, the presence of oxycodone, noroxycodone, oxymorphone, noroxymorphone, morphine, hydrocodone, norhydrocodone, hydromorphone, dihydrocodeine, codeine, and/or 6-monoacetylmorphine in serum can be
used to verify adherence or compliance to prescribed opioids, and discourage drug misuse, abuse, and diversion.
The following adult therapeutic ranges are suggested by literature but must be interpreted alongside other clinical features/test results, symptoms, collection time since last dosage was taken, and signs of abuse/misuse.
6-monoacetylmorphine: Not established, it is a metabolite of heroin
Codeine: 10-100 ng/mL
Morphine: 10-80 ng/mL when used as sole therapy; it is also a minor metabolite of codeine
Hydromorphone: 1.0-30 ng/mL when used as sole therapy; it is also a metabolite of hydrocodone and minor metabolite of morphine.
Hydrocodone: 10-100 ng/mL
Dihydrocodeine: 72-150 ng/mL when used as sole therapy; it is also a minor metabolite of hydrocodone.
Norhydrocodone: Not established; it is a metabolite of hydrocodone.
Oxycodone: 10-100 ng/mL
Noroxycodone: Not established; it is a metabolite of oxycodone.
Oxymorphone: 1.0-8.0 ng/mL when used as sole therapy; it is a metabolite of oxycodone.
Noroxymorphone: Not established; it is a metabolite of oxymorphone.
Cautions
Any aberrant result should be discussed with the patient and could be confirmed by re-testing or using an alternative matrix (eg, urine).
Clinical Reference
1. Jannetto PJ, Bratanow NC, Clark WA, et al. American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526. doi:10.1373/jalm.2017.023341
2. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
Method Description
The opiates are extracted from serum using a solvent to precipitate proteins. The supernatant is removed and analyzed by liquid chromatography tandem mass spectrometry.(Unpublished Mayo method)
Day(s) Performed
Wednesday
Report Available
2 to 9 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
G0480
80361 (if appropriate for select payers)
80365 (if appropriate for select payers)
80356 (if appropriate for select payers)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| OPATS | Opiate Panel, Free (Unconjugated),S | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 623436 | 6-monoacetylmorphine - Free | 49749-5 |
| 623437 | Codeine - Free | 12784-5 |
| 623438 | Morphine - Free | 11244-1 |
| 623439 | Hydromorphone - Free | 12787-8 |
| 623440 | Hydrocodone - Free | 12786-0 |
| 623441 | Dihydrocodeine - Free | 12785-2 |
| 623442 | Norhydrocodone - Free | In Process |
| 623443 | Oxycodone - Free | 12789-4 |
| 623444 | Noroxycodone - Free | In Process |
| 623445 | Oxymorphone - Free | 46974-2 |
| 623446 | Noroxymorphone - Free | In Process |