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Test Code ADMPU Addiction Medicine Profile with Reflex, 22 Drug Classes, High Resolution Mass Spectrometry and Immunoassay Screen, Random, Urine


Ordering Guidance


This test does not screen for drug classes other than those listed above.



Specimen Required


Supplies: Urine Container, 60 mL (T313)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 60-mL urine container

Specimen Volume: 30 mL

Collection Instructions:

1. Collect a random urine specimen.

2. Submit 30 mL in 1 plastic bottle.

3. No preservative.

Additional Information:

1. No specimen substitutions.

2. Submitting less than 30 mL may compromise the ability to perform all necessary testing.

3. STATS are not accepted for this procedure.


Secondary ID

615908

Useful For

Detecting drug use involving stimulants, barbiturate, benzodiazepines, cocaine, opioids, tetrahydrocannabinol, alcohol, and nicotine

 

This test is not intended for use in employment-related testing.

Profile Information

Test ID Reporting Name Available Separately Always Performed
LPCM List Patient's Current Medications No Yes
ADULT Adulterants Survey, U Yes Yes
PNRCH Drug Immunoassay Panel, U No Yes
TOPSU Targeted Opioid Screen, U Yes, TOSU Yes
TABSU Targeted Benzodiazepine Screen, U Yes, TBSU Yes
TSTIM Targeted Stimulant Screen, U Yes, TSPU Yes
ETGSR Ethyl Glucuronide Scrn w/Reflex, U No Yes
NICOU Nicotine and Metabolites, U Yes Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
COKEU Cocaine and metabolite Conf, U Yes No
BARBU Barbiturates Confirmation, U Yes No
THCU Carboxy-THC Confirmation, U Yes No
ETGC Ethyl Glucuronide Confirmation, U Yes No

Testing Algorithm

Testing begins with an adulterant survey. If the sample is found to be adulterated, testing will end, and the remaining tests will be canceled.

 

If the specimen is normal or only diluted, remaining testing will continue.

 

If immunoassay screen is positive, confirmation testing can be ordered separately. Confirmation with quantification of positives for barbiturates, cocaine and metabolites, tetrahydrocannabinol metabolite, and ethyl glucuronide/ethyl sulfate will be performed at an additional charge.

Method Name

ADULT: Spectrophotometry (SP)

PNRCH: Screened by Immunoassay/Confirmed by Gas Chromatography-Mass Spectrometry (GC-MS)

TOPSU, TABSU, TSTIM: Liquid Chromatography-Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)

ETGSR: Screened by Immunoassay/Confirmed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

NICOU: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Reporting Name

Addiction Med Profile,22,HRMS/IA, U

Specimen Type

Urine

Specimen Minimum Volume

20 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 14 days
  Frozen  14 days

Reject Due To

  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Clinical Information

This test uses screening techniques that involves immunologic testing and high-resolution accurate mass spectrometry screening for drugs by class. All positive immunoassay screening results are confirmed by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS), and quantitated, before a positive result is reported.

 

The following drugs/drug classes are tested by immunoassay and confirmed by GC-MS:

-Barbiturates

-Cocaine

-Tetrahydrocannabinol

 

Ethyl glucuronide is also screened using an immunoassay and confirmation of ethyl glucuronide/ethyl sulfate is performed using LC-MS/MS.

 

The targeted opioid, benzodiazepine, and stimulant screen portions are performed using liquid chromatography-tandem mass spectrometry, high-resolution accurate mass  and are completed for all opioids, benzodiazepines, and stimulants. Opioids are a large class of medications commonly used to relieve acute and chronic pain or help manage opioid abuse and dependence. Medications that fall into this class include: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol, and others. Opioids work by binding to the opioid receptors that are found in the brain, spinal cord, gastrointestinal tract, and other organs. Common side effects include drowsiness, confusion, nausea, constipation, and, in severe cases, respiratory depression depending on the dose. These medications can also produce physical and psychological dependence and have a high risk for abuse and diversion, which is one of the main reasons many professional practice guidelines recommend compliance testing in patients prescribed these medications.

 

Opioids are readily absorbed from the gastrointestinal tract, nasal mucosa, lungs, and after subcutaneous or intermuscular injection. Opioids are primarily excreted from the kidney in both free and conjugated forms. This assay doesn't hydrolyze the urine sample and looks for both parent drugs and metabolites (including glucuronide forms). The detection window for most opioids in urine is approximately 1 to 3 days with longer detection times for some compounds (ie, methadone).

 

Benzodiazepines represent a large family of medications used to treat a wide range of disorders from anxiety to seizures and are also used in pain management. With a high risk for abuse and diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. However, traditional benzodiazepine immunoassays suffer from a lack of cross-reactivity with all the benzodiazepines, so many compliant patients taking clonazepam (Klonopin) or lorazepam (Ativan) may screen negative by immunoassay but are positive when confirmatory testing is done. The new targeted benzodiazepine screening test provides a more sensitive and specific test to check for compliance to all the commonly prescribed benzodiazepines and looks for both parent and metabolites in the urine.

 

Stimulants are sympathomimetic amines that stimulate the central nervous system activity and, in part, suppress the appetite. Amphetamine and methamphetamine are also prescription drugs used in the treatment of narcolepsy and attention-deficit disorder/attention-deficit hyperactivity disorder (ADHD). Methylphenidate is another stimulant used to treat ADHD. Phentermine is indicated for the management of obesity. All of the other amphetamines (eg, methylenedioxymethamphetamine: MDMA) are Drug Enforcement Administration (DEA) scheduled Class I compounds. Due to their stimulant effects, the drugs are commonly sold illicitly and abused. Physiological symptoms associated with very high amounts of ingested amphetamine or methamphetamine include elevated blood pressure, dilated pupils, hyperthermia, convulsions, and acute amphetamine psychosis.

 

Ethyl glucuronide is a direct metabolite of ethanol that is formed by enzymatic conjugation of ethanol with glucuronic acid. Alcohol in urine is normally detected for only a few hours, whereas ethyl glucuronide can be detected in the urine for 1 to 3 days. This procedure uses immunoassay reagents that are designed to produce a negative result when no drugs are present in a natural (eg, unadulterated) specimen of urine; the assay is designed to have a high true-negative rate. Like all immunoassays, it can have a false-positive rate due to cross-reactivity with natural chemicals and drugs other than those they were designed to detect. The immunoassay also has a false-negative rate to the antibody's ability to cross-react with different drugs in the class being screened for.

 

NICOU:

Tobacco use is the leading cause of death in the United States. Nicotine, coadministered in tobacco products such as cigarettes, pipe, cigar, or chew, is an addicting substance that causes individuals to continue use of tobacco despite concerted efforts to quit. Nicotine stimulates dopamine release and increases dopamine concentration in the nucleus accumbens, a mechanism that is thought to be the basis for addiction for drugs of abuse.

Nicotine is rapidly metabolized in the liver to cotinine, exhibiting an elimination half-life of 2 hours. Cotinine exhibits an apparent elimination half-life of 15 hours. Patients using tobacco products excrete nicotine in urine in the concentration range of 1000 to 5000 ng/mL. Cotinine accumulates in urine in proportion to dose and hepatic metabolism (which is genetically determined); most tobacco users excrete cotinine in the range of 1000 to 8000 ng/mL. Urine concentrations of nicotine and metabolites in these ranges indicate the subject is using tobacco or is receiving high-dose nicotine patch therapy.

In addition to nicotine and metabolites, tobacco products also contain other alkaloids that can serve as unique markers of tobacco use. Two such markers are anabasine and nornicotine. Anabasine is present in tobacco products, but not nicotine replacement therapies. Nornicotine is present as an alkaloid in tobacco products and as a metabolite of nicotine. The presence of anabasine greater than 10 ng/mL or nornicotine greater than 30 ng/mL in urine indicates current tobacco use, irrespective of whether the subject is on nicotine replacement therapy. The presence of nornicotine without anabasine is consistent with use of nicotine replacement products. Heavy tobacco users who abstain from tobacco for 2 weeks exhibit urine nicotine values below 30 ng/mL, cotinine values below 50 ng/mL, anabasine levels below 2 ng/mL, and nornicotine levels below 2 ng/mL.

Passive exposure to tobacco smoke can cause accumulation of nicotine metabolites in nontobacco users. Urine cotinine has been observed to accumulate up to 20 ng/mL from passive exposure. Neither anabasine nor nornicotine accumulates from passive exposure.

Tobacco users engaged in programs to abstain from tobacco require support in the form of counseling, pharmacotherapy, and continuous encouragement. Occasionally, counselors may elect to monitor abstinence by biochemical measurement of nicotine and metabolites in a random urine specimen to verify abstinence. If results of biologic testing indicate the patient is actively using a tobacco product during therapy, additional counseling or intervention may be appropriate.

Quantification of urine nicotine and metabolites while a patient is actively using a tobacco product is useful to define the concentrations that a patient achieves through self-administration of tobacco. Nicotine replacement dose can then be tailored to achieve the same concentrations early in treatment to assure adequate nicotine replacement so the patient may avoid the strong craving they may experience early in the withdrawal phase. This can be confirmed by measurement of urine nicotine and metabolite concentrations at steady-state (2-3 days after replacement therapy is started). Once the patient is stabilized on the dose necessary to achieve complete replacement and responding well to therapy, the replacement dose can be slowly tapered to achieve complete withdrawal.

 

This test is intended to be used in a setting where the test results can be used to make a definitive diagnosis.

Reference Values

ADULTERANT SURVEY:

Cutoff concentrations

Oxidants: 200 mg/L

Nitrites: 500 mg/L

 

DRUG IMMUNOASSAY PANEL:

Negative

Screening cutoff concentrations:

Barbiturates: 200 ng/mL

Cocaine (benzoylecgonine-cocaine metabolite): 150 ng/mL

Tetrahydrocannabinol carboxylic acid: 50 ng/mL

This report is intended for use in clinical monitoring or management of patients. It is not intended for use in employment-related testing.

 

TARGETED OPIOID SCREEN:

Not Detected

 

Cutoff concentrations:

Codeine: 25 ng/mL

Codeine-6-beta-glucuronide: 100 ng/mL

Morphine: 25 ng/mL

Morphine-6-beta-glucuronide: 100 ng/mL

6-monoacetylmorphine: 25 ng/mL

Hydrocodone: 25 ng/mL

Norhydrocodone: 25 ng/mL

Dihydrocodeine: 25 ng/mL

Hydromorphone: 25 ng/mL

Hydromorphone-3-beta-glucuronide: 100 ng/mL

Oxycodone: 25 ng/mL

Noroxycodone: 25 ng/mL

Oxymorphone: 25 ng/mL

Oxymorphone-3-beta-glucuronide: 100 ng/mL

Noroxymorphone: 25 ng/mL

Fentanyl: 2 ng/mL

Norfentanyl: 2 ng/mL

Meperidine: 25 ng/mL

Normeperidine: 25 ng/mL

Naloxone: 25 ng/mL

Naloxone-3-beta-glucuronide: 100 ng/mL

Methadone: 25 ng/mL

EDDP: 25 ng/mL

Propoxyphene: 25 ng/mL

Norpropoxyphene: 25 ng/mL

Tramadol: 25 ng/mL

O-desmethyltramadol: 25 ng/mL

Tapentadol: 25 ng/mL

N-desmethyltapentadol: 50 ng/mL

Tapentadol-beta-glucuronide: 100 ng/mL

Buprenorphine: 5 ng/mL

Norbuprenorphine: 5 ng/mL

Norbuprenorphine glucuronide: 20 ng/mL

 

TARGETED BENZODIAZEPINE SCREEN:

Not Detected

 

Cutoff concentrations:

Alprazolam: 10 ng/mL

Alpha-Hydroxyalprazolam: 10 ng/mL

Alpha-Hydroxyalprazolam Glucuronide: 50 ng/mL

Chlordiazepoxide: 10 ng/mL

Clobazam: 10 ng/mL

N-Desmethylclobazam: 200 ng/mL

Clonazepam: 10 ng/mL

7-aminoclonazepam: 10 ng/mL

Diazepam: 10 ng/mL

Nordiazepam: 10 ng/mL

Flunitrazepam: 10 ng/mL

7-aminoflunitrazepam: 10 ng/mL

Flurazepam: 10 ng/mL

2-Hydroxy Ethyl Flurazepam: 10 ng/mL

Lorazepam: 10 ng/mL

Lorazepam Glucuronide: 50 ng/mL

Midazolam: 10 ng/mL

Alpha-Hydroxy Midazolam: 10 ng/mL

Oxazepam: 10 ng/mL

Oxazepam Glucuronide: 50 ng/mL

Prazepam: 10 ng/mL

Temazepam: 10 ng/mL

Temazepam Glucuronide: 50 ng/mL

Triazolam: 10 ng/mL

Alpha-Hydroxy Triazolam: 10 ng/mL

Zolpidem: 10 ng/mL

Zolpidem Phenyl-4-Carboxylic acid: 10 ng/mL

 

TARGETED STIMULANT SCREEN:

Not Detected

 

Cutoff concentrations:

Methamphetamine: 100 ng/mL

Amphetamine: 100 ng/mL

3,4-methylenedioxymethamphetamine (MDMA): 100 ng/mL

3,4-methylenedioxy-N-ethylamphetamine (MDEA): 100 ng/mL

3,4-methylenedioxyamphetamine (MDA): 100 ng/mL

Ephedrine: 100 ng/mL

Pseudoephedrine: 100 ng/mL

Phentermine: 100 ng/mL

Phencyclidine (PCP): 20 ng/mL

Methylphenidate: 20 ng/mL

Ritalinic acid: 100 ng/mL

 

ETHYL GLUCURONIDE SCREEN:

Negative

 

Screening cutoff concentrations:

Ethyl Glucuronide: 500 ng/mL

 

NICOTINE AND METABOLITES:

Non-tobacco user with no passive exposure:

Nicotine: <5.0 ng/mL

Cotinine: <5.0 ng/mL

Anabasine: <2.0 ng/mL

Nornicotine: <2.0 ng/mL

Interpretation

A positive result derived by this testing indicates that the patient has used one of the drugs detected by these techniques in the recent past. See individual tests (eg, COKEU / Cocaine and Metabolite Confirmation, Random, Urine) for more information.

 

For information about drug testing, including estimated detection times, see Specific Drug Groups at https://www.mayocliniclabs.com/test-info/drug-book/index.html

Cautions

ETGSR: Care should be taken when interpreting results since there are many factors (eg, fluid intake and other biologic factors) that may influence a urine test result. It is possible that substances other than those investigated in the specificity study may interfere with the test and cause false-positive or negative results.

 

NICOU: Knowledge of time elapsed between last dose and specimen collection is important for interpretation of test results.

Clinical Reference

1. Physicians' Desk Reference; 60th ed. Medical Economics Company, 2006

2. Bruntman LL, ed. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Book Company; 2006

3. Langman LJ, Bechtel L, Meier BM, Holstege CP: Clinical toxicology In: Rifai N, Horwath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887

4. Gutstein HB, Akil H: Opioid analgesics. In: Brunton LL, Lazo JS, Parker KL, eds: Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Companies; 2006

5. Chronic Pain in America: Roadblocks to Relief, survey conducted for the American Pain Society, The American Academy of the Pain Medicine and Janssen Pharmaceutical, 1999

6. Magnani B, Kwong T: Urine drug testing for pain management. Clin Lab Med. 2012 Sep;32(32):379-390

7. Jannetto PJ, Bratanow NC, Clark WA, et al: Executive summary: 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 Jan;2(4):489-526

8. McMillin GA, Marin SJ, Johnson-Davis KL, Lawlor BG, Strathmann FG: A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays. Am J Clin Pathol. 2015 Feb;143(2):234-240

9. Cone EJ, Caplan YH, Black DL, Robert T, Moser F: Urine drug testing of chronic pain patients: licit and illicit drug patterns. J Anal Toxicol. 2008 Oct;32(8):530-543

Method Description

Adulterant:

All results are measured using spectrophotometry at wavelengths specified by the reagent manufacturer. The use of a refractometer may also be used in the specific gravity measurement.(Package insert: Creatinine plus ver 2, Specimen Validity Test Nitrite, Specimen Validity Test Oxidant, Specimen Validity Test pH, Specimen Validity Test Specific Gravity, Roche Diagnostics;12/2016)

 

Drug Panel:

The barbiturate, cocaine metabolite, and tetrahydrocannabinol metabolite assays are based on the kinetic interaction of microparticles in a solution as measured by changes in light transmission. In the absence of sample drug, soluble drug conjugates bind to antibody-bound microparticles, causing the formation of particle aggregates. As the aggregation reaction proceeds in the absence of sample drug, the absorbance increases. When a urine sample contains the drug in question, this drug competes with the drug derivative conjugate for microparticle-bound antibody. Antibody bound to sample drug is no longer available to promote particle aggregation, and subsequent particle lattice formation is inhibited. The presence of sample drug diminishes the increasing absorbance in proportion to the concentration of drug in the sample. Sample drug content is determined relative to the value obtained for a known cutoff concentration of drug.(Package inserts: Barbiturates. Roche Diagnostics; 11/2017, Cannabinoids. Roche Diagnostics; 11/2017, Cocaine. Roche Diagnostics; 11/2017)

 

Targeted Screening Panels for opioids, benzodiazepines, and stimulants:

The urine sample is diluted with internal standard and clinical laboratory reagent water and then analyzed by liquid chromatography- tandem mass spectrometry using a high resolution-accurate mass orbitrap detector.(Unpublished Mayo method)

 

Ethyl Glucuronide Screen:

This assay is a homogeneous, semiquantitative enzyme immunoassay. The assay is based on competition between free drug in the urine sample and a drug labeled with the enzyme glucose-6-phosphate dehydrogenase for a fixed amount of specific antibody binding sites. Active enzyme converts nicotinamide adenine dinucleotide (NAD[+]) to NADH, which results in an absorbance change that can be measured spectrophotometrically at 340 nm.(Package insert: DRI Ethyl Glucuronide Assay. Microgenics Corporation; 09/2015)

 

Nicotine and Metabolites:

Nicotine and metabolites are extracted from urine by solid-phase extraction techniques. The extract eluate is quantified by high-performance liquid chromatography-tandem mass spectrometry.(Moyer TP, Charlson JR, Enger RJ, et al: Simultaneous analysis of nicotine, nicotine metabolites, and tobacco alkaloids in serum or urine by tandem mass spectrometry, with clinically relevant metabolic profiles. Clin Chem. 2002 Sep;48:1460-1471; Oh J, Park MS, Chun MR, et al: A simple and high-throughput LC-MS/MS method for simultaneous measurement of nicotine, cotinine, 3-OH cotinine, nornicotine, and anabasine in urine and its application in the general Korean population. J Anal Toxicol. 2020 Nov 24:bkaa177. doi: 10.1093/jat/bkaa177. Epub ahead of print)

Day(s) Performed

ADULT, PNRCH: Monday through Saturday

TOPSU, TABSU, TSTIM: Monday through Friday

ETGSR: Monday through Sunday

NICOU: Monday through Sunday

Profile tests: Monday through Sunday; Reflex tests: Varies

Report Available

2 to 5 days

Specimen Retention Time

2 weeks

Performing 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. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

80307

80347

80364

80326

80323

G0482 (if appropriate)

G0483 (if appropriate)

LOINC Code Information

Result ID Test Result Name Result LOINC Value
LPCM List Patient's Current Medications 66423-5
610273 Methamphetamine 19554-5
20606 Creatinine, U 2161-8
82510 Nicotine 3854-7
604871 Alprazolam 94116-1
42323 Codeine 19411-8
2574 Barbiturates 70155-7
616033 Ethyl Glucuronide Screen, U 58375-7
21652 Cocaine 19359-9
42324 Codeine-6-beta-glucuronide 89310-7
604867 Alpha-Hydroxyalprazolam 19325-0
21321 Cotinine 10366-3
22312 Specific Gravity 5810-7
610274 Amphetamine 19343-3
610275 3,4-methylenedioxymethamphetamine (MDMA) 19568-5
23509 pH 2756-5
21324 Nornicotine 33917-6
604891 Alpha-Hydroxyalprazolam Glucuronide 94115-3
42325 Morphine 19597-4
2664 Tetrahydrocannabinol 19415-9
42326 Morphine-6-beta-glucuronide 89308-1
604872 Chlordiazepoxide 19385-4
21323 Anabasine 33915-0
23511 Oxidants 58714-7
610276 3,4-methylenedioxy-N-ethylamphetamine (MDEA) 59844-1
610277 3,4-methylenedioxyamphetamine (MDA) 19565-1
23510 Nitrites 32710-6
604889 Clobazam 94114-6
42327 6-monoacetylmorphine 19321-9
42328 Hydrocodone 19482-9
604890 N-Desmethylclobazam 94113-8
30914 Comment 48767-8
610278 Ephedrine 99108-3
610279 Pseudoephedrine 99109-1
604873 Clonazepam 19399-5
42329 Norhydrocodone 89304-0
42330 Dihydrocodeine 19446-4
604267 7-aminoclonazepam 94112-0
610280 Phentermine 19674-1
610281 Phencyclidine (PCP) 19659-2
604874 Diazepam 19443-1
42331 Hydromorphone 19486-0
42332 Hydromorphone-3-beta-glucuronide 89309-9
604880 Nordiazepam 19624-6
610282 Methylphenidate 19577-6
610283 Ritalinic acid 99110-9
604875 Flunitrazepam 19466-2
42333 Oxycodone 19642-8
42334 Noroxycodone 89303-2
604866 7-aminoflunitrazepam 94111-2
610284 Stimulant Interpretation 54247-2
604876 Flurazepam 19474-6
42335 Oxymorphone 19646-9
42336 Oxymorphone-3-beta-glucuronide 89301-6
604868 2-Hydroxy Ethyl Flurazepam 94110-4
604877 Lorazepam 19520-6
42337 Noroxymorphone 89302-4
42338 Fentanyl 59673-4
604878 Lorazepam Glucuronide 94109-6
604879 Midazolam 19585-9
42339 Norfentanyl 43199-9
42340 Meperidine 19532-1
604869 Alpha-Hydroxy Midazolam 94108-8
604881 Oxazepam 19638-6
42341 Normeperidine 27920-8
42342 Naloxone 42618-9
604882 Oxazepam Glucuronide 94107-0
604883 Prazepam 19678-2
42343 Naloxone-3-beta-glucuronide 89307-3
42344 Methadone 19550-3
604884 Temazepam 19698-0
604885 Temazepam Glucuronide 94106-2
42345 EDDP 93495-0
42346 Propoxyphene 19429-0
604886 Triazolam 19714-5
604870 Alpha-Hydroxy Triazolam 94105-4
42347 Norpropoxyphene 19632-9
42348 Tramadol 19710-3
604887 Zolpidem 94104-7
604888 Zolpidem Phenyl-4-Carboxylic acid 94103-9
42349 O-desmethyltramadol 86453-8
42350 Tapentadol 72485-6
604949 Benzodiazepine Interpretation 69050-3
42351 N-desmethyltapentadol 89306-5
42352 Tapentadol-beta-glucuronide 89300-8
42353 Buprenorphine 93494-3
42354 Norbuprenorphine 82371-6
42355 Norbuprenorphine glucuronide 89305-7
65059 Opioid Interpretation 69050-3