Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites.

This study of 20,089 urine specimens from chronic pain patients provided a unique opportunity to evaluate the prevalence of prescription opiates and metabolites, assess the usefulness of inclusion of normetabolites in the test panel, and compare opiate and oxycodone screening results to liquid chromatography with tandem mass spectrometry (LC-MS-MS) results. All specimens were screened by an opiate [enzyme-linked immunosorbent assay (ELISA), 100 ng/mL] and oxycodone assay [ELISA, 100 ng/mL or enzyme immunoassay (EIA), 50 ng/mL] and simultaneously tested by LC-MS-MS [limit of quantitation (LOQ) = 50 ng/mL] for 10 opiate analytes (codeine, norcodeine, morphine, hydrocodone, dihydrocodeine, norhydrocodone, hydromorphone, oxycodone, noroxycodone, and oxymorphone). Approximately two-thirds of the specimens were positive for one or more opiate analytes.

Urine drug testing of chronic pain patients. III. Normetabolites as biomarkers of synthetic opioid use.

Opioids are important therapeutic agents available to patients with moderate to severe pain. The synthetic opioids, buprenorphine, fentanyl, meperidine, methadone, and propoxyphene have been utilized for decades as analgesics. One of the major biotransformation pathways of these drugs occurs through N-demethylation leading to the formation and excretion of normetabolites.

Urine testing for norcodeine, norhydrocodone, and noroxycodone facilitates interpretation and reduces false negatives.

Urine drug testing of pain patients provides objective information to health specialists regarding patient compliance, diversion, and concurrent illicit drug use. Interpretation of urine test results for semi-synthetic opiates can be difficult because of complex biotransformations of parent drug to metabolites that are also available commercially and may be abused. Normetabolites such as norcodeine, norhydrocodone and noroxycodone are unique metabolites that are not available commercially.

Multiple drug ingestion by ecstasy abusers in the United States.

The abuse of ecstasy-type drugs such as 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-methylenedioxyamphetamine (MDA) is generally associated with young adults attending "Rave" parties. Little toxicological information has been reported regarding ecstasy usage by individuals undergoing monitoring in other settings in the United States. The goal of this study was to determine the prevalence and patterns of licit and illicit drugs in urine specimens of ecstasy users.