B-323 Urinary Thebaine Improves Opioid Interpretation in Pain Management

Abstract

Abstract Background Poppy seed from Papaver somniferum plant is used in bakery results in positive urine test for Morphine and Codeine up to 48 h. This leads to prescription compliance failure in the setting of clinical pain management. To mitigate misinterpretation, Thebaine testing was introduced to confirmatory opioid panel. Thebaine is naturally found in poppy seeds but not in prescription opiate formularies. A positive Thebaine result helps identify poppy seed consumption rather than from opioid prescription abuse. Method Each of the seven healthy adult volunteers (age 20–50) consumed one poppy seed filled kolache. Urine samples were then collected from each person at pre and post-consumed time points at 2, 4, and 24 h. All samples were screened on Abbott Architect c16000 immunoassay (Abbott Park, IL) for opioids at 300 ng/mL cutoff. The samples were quantitated using ThermoFisher Vanquish Quantis LC-MS/MS (Waltham, MA) for Codeine, Morphine, and Thebaine at AMR 10–500 ng/mL, 10–500 ng/mL, and 5–250 ng/mL, respectively. Data acquisition/analyses were performed on TraceFinder software. The deuterated internal standards were purchased from Cerilliant Corporation (Round Rock, TX). All samples met calibrators and quality controls quality criteria. Results All post-consumption immunoassay results were positive for opioid. All LC-MS/MS positive results showed various levels of Codeine, Morphine, and Thebaine at 230–4300 ng/mL, 9–290 ng/mL, and 5–210 ng/mL, respectively (Fig. 1).Fig. 1. Conclusion Poppy seed consumption results in positive opioid class by immunoassay and positives Codeine, Morphine by LC-MS/MS. Detection of Thebaine in these samples would enable accurate clinical interpretation for poppy seed dieters and abusers of Codeine and Morphine prescription.