A preliminary study of hydrocodone and hydromorphone to oxycodone ratios for distinguishing impurities from independent opioid use.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Elsevier Science Country of Publication: United States NLM ID: 0133660 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2933 (Electronic) Linking ISSN: 00099120 NLM ISO Abbreviation: Clin Biochem Subsets: MEDLINE
    • Publication Information:
      Publication: Tarrytown, NY : Elsevier Science
      Original Publication: [Toronto] Canadian Society of Clinical Chemists.
    • Subject Terms:
      Hydrocodone*/analysis ; Opioid-Related Disorders*; Humans ; Hydromorphone/analysis ; Oxycodone ; Analgesics, Opioid ; Chromatography, Liquid/methods ; Oxymorphone ; Tandem Mass Spectrometry/methods
    • Abstract:
      Background: Urine drug testing (UDT) monitors prescription compliance and/or drug abuse. However, interpretation of UDT results obtained by liquid chromatography-tandem mass spectrometry (LC-MS-MS) can be complicated by the presence of drug impurities that are detected by highly sensitive methods. Hydrocodone is a drug impurity that can be found as high as 1% in oxycodone pills.
      Objectives: We evaluated the frequency and concentration of hydrocodone and its metabolite, hydromorphone, in patients taking oxycodone to check if the ratio of hydrocodone or hydromorphone to oxycodone could distinguish between oxycodone only use from those consuming additional opiates.
      Design & Methods: We correlated LC-MS/MS results with medication records of 319 patients with positive oxycodone results over 7 months (4/2021-11/2021).
      Results: Fifteen of 319 patients with positive oxycodone results were taking oxycodone only. For these 15 patients, the mean ratio of hydrocodone to oxycodone was 0.57% (range 0.05%-3.35%), and the mean ratio of hydromorphone to oxycodone was 0.81% (range 0.18-3.51%).
      Conclusions: Hydrocodone and/or hydromorphone are detectable in patients taking only oxycodone and can likely be identified as an impurity if their calculated ratio to oxycodone is <1 %. Further validation of the ratios in a larger sample size is recommended.
      Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
      (Copyright © 2022 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Hydrocodone; Hydromorphone; Impurities; Oxycodone; Oxymorphone; Urine drug testing
    • Accession Number:
      6YKS4Y3WQ7 (Hydrocodone)
      Q812464R06 (Hydromorphone)
      CD35PMG570 (Oxycodone)
      0 (Analgesics, Opioid)
      9VXA968E0C (Oxymorphone)
    • Publication Date:
      Date Created: 20221219 Date Completed: 20230124 Latest Revision: 20230202
    • Publication Date:
      20250114
    • Accession Number:
      10.1016/j.clinbiochem.2022.12.009
    • Accession Number:
      36535386