Document Detail

Anomalous observations of codeine in patients on morphine.
MedLine Citation:
PMID:  19935365     Owner:  NLM     Status:  In-Process    
Urine drug monitoring is used by physicians treating chronic pain patients with opioid therapy. Patients are tested in part to insure that they are not taking other drugs. Therefore, the finding of codeine in a patient who is only prescribed morphine has clinical implications. Morphine preparations are known to have small amounts of codeine as an impurity estimated to be about 0.04%. In a population of 535 pain patients prescribed morphine, Kadian, MS Contin, and/or Avinza, the investigators observed 24 samples that contained codeine >20 ng/mL. Fifteen of the 24 contained codeine >20 and <50 ng/mL. Of the 9 samples that were >50 ng/mL, 7 had high levels of codeine (indicating codeine use), 1 was from a patient who had a prescription for codeine, and 1 was also positive for 6-acetylmorphine, indicating heroin use. A control group of 680 patients taking oxycodone was negative for codeine. The finding of codeine was ascribed to the manufacturing process of the morphine medications. Clinicians and laboratories testing urine for drugs should be aware of this possibility.
Robert West; Bridgit Crews; Charles Mikel; Perla Almazan; Sergey Latyshev; Amadeo Pesce; Cameron West
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Therapeutic drug monitoring     Volume:  31     ISSN:  1536-3694     ISO Abbreviation:  Ther Drug Monit     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7909660     Medline TA:  Ther Drug Monit     Country:  United States    
Other Details:
Languages:  eng     Pagination:  776-8     Citation Subset:  IM    
Millennium Laboratories Research Institute, San Diego, CA 92127, USA.
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