Tincture of opium and codeine

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Tincture of opium and codeine

Post by DrCRZ » Thu Jun 04, 2020 1:59 pm

I have a donor whose urine DS result came back positive for Codeine at 17000 and Morphine >20000 (60,000 per lab). She is using tincture of opium. Could this be a just product impurity at such a high level or can I safely and fairly report this as positive for codeine. She denies using any other codeine product.

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Joined: Mon Apr 27, 2020 4:26 pm

Re: Tincture of opium and codeine

Post by WarmHot » Tue Jun 09, 2020 2:46 pm

Hi, I haven't posted on here before but I'll give it a go. I am the head of toxicology at a private lab spending most of my day reviewing LCMS data for pain management clinics.

I was looking into an answer for you as I too was curious. I am assuming she has a prescription for the opium tincture as it is available via prescription only. The tincture's active ingredient is morphine which does not metabolize into codeine at all. So I looked into the impurity possibility. I did find this from the journal of analytical toxicology: "Because morphine and codeine are naturally occurring compounds, morphine purified from the opium poppy contains a low level of codeine as an impurity. In the USA, the allowable limit of codeine in pharmaceutical formulations of morphine is 0.5% of the morphine dose, and typically, codeine levels of ∼0.05% of the morphine dose are detected"

I would agree with you that there was another source of codeine to cause the concentration to be this high. I am interested to see if anyone else has input.

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