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Interpretation of t...
Interpretation of the presence of 6-monoacetylmorphine in the absence of morphine-3-glucuronide in urine samples : evidence of heroin abuse
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- von Euler, Mia, 1967- (författare)
- Karolinska Institutet
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- Villén, Tomas (författare)
- Division of CLinical Pharmacology, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden
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- Svensson, Jan-Olof (författare)
- Division of CLinical Pharmacology, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden
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- Ståhle, Lars (författare)
- Division of CLinical Pharmacology, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden
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(creator_code:org_t)
- Wolters Kluwer, 2003
- 2003
- Engelska.
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Ingår i: Therapeutic Drug Monitoring. - : Wolters Kluwer. - 0163-4356 .- 1536-3694. ; 25:5, s. 645-648
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- The presence of morphine in a urinary sample may be caused not only by intake of heroin but also by intake of poppy-seed-containing food shortly before urine sampling or intake of drugs containing morphine, ethyl morphine, or codeine. To facilitate the interpretation, the heroin-specific metabolite 6-monoacetylmorphine (6-MAM) can be analyzed along with morphine-3-glucuronide (M3G) in an LC-MS verification analysis. In sporadic samples positive in the immunologic opiate screening test, 6-MAM, but not M3G, was found. To systematically analyze the finding all specimens with positive 6-MAM and/or M3G found during a 1-year period were investigated (n = 1923). Of these, 423 were positive for 6-MAM. In 32 (7.6%) of the samples 6-MAM was detected while the M3G concentrations were below cutoff (300 ng/mL) and in some cases even below the limit of detection (15 ng/mL). The 32 samples with this excretion pattern came from 13 different individuals, all but one with previously known heroin abuse. Eleven urine samples, nine containing M3G and 6-MAM and two with only 6-MAM, were also analyzed for the presence of heroin. In six samples, including the two with only 6-MAM, heroin was detected. There are several plausible explanations for these findings. The intake may have taken place shortly before urine sampling. High concentrations of heroin and 6-MAM may inhibit UGT 2B7, the enzyme responsible for glucuronidation of morphine. The hydrolyzation of 6-MAM to morphine may be disturbed by either internal or external causes. To elucidate this, further studies are required. Nevertheless, our finding demonstrates that routine measurement of 6-MAM when verifying opioid-positive immunologic screening results facilitates interpretation of low concentrations of M3G in urine specimens.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Farmakologi och toxikologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Pharmacology and Toxicology (hsv//eng)
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- ref (ämneskategori)
- art (ämneskategori)
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