Minor Metabolites of Opiates

It is important to understand the metabolism of the opiates for proper interpretation, particularly of the minor metabolites: morphine is a minor metabolite of codeine; hydro-morphone and dihydrocodeine are minor metabolites of hydrocodone; oxymorphone is a metabolite of oxycodone; and hydrocodone and hydromorphone are minor metabolites found in the presence of very high codeine and morphine concentrations, respectively (36,37). Detection of one of these minor metabolites is an analytical true positive result. These metabolites are themselves opiates that are also drugs of abuse. Therefore, without the full understanding of opiates metabolism, the presence of a minor metabolite (e.g., hydromorphone) in addition to the prescribed medication (morphine) will be perceived as an unexpected finding. The positive result may be mistakenly interpreted as evidence of illicit use of hydromorphone (Dilaudid®), a clinical false positive.

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