The detection of codeine, morphine, 6-monoacetylmorphine, and meconin in human umbilical cord tissue: method validation and evidence of in utero heroin exposure

Published  in Ther Drug Monit. 2014 Jun

Authors: Jones J et al

BACKGROUND:

Heroin abuse is a significant public health issue and is on the rise due to the unintended consequences of strengthening controls for non-medical use of prescription pain killers. Included in this trend is an increase in opiate exposed newborns that are particularly vulnerable to a number of negative health outcomes.

METHODS:

After presenting a fully validated liquid chromatography-tandem mass spectrometric method for codeine, morphine, 6MAM, and meconin, a metabolite of the heroin contaminant noscapine, we compared the outcome of 46 authentic umbilical specimens to results generated using a previous less sensitive method that did not include meconin. Additionally, we provided a summary of opiate finding from a year-long survey of specimens received into a commercial reference laboratory.

RESULTS:

The limits of detection for all four compounds were 0.1 ng/g and the limit of quantitation was 0.2 ng/g and the assay was linear from 0.2 ng/g to 10.0 ng/g. Of the 46 comparative specimens, this method improved the identification of heroin exposure from 2 to 5 and the year-long survey identified 86 heroin exposed newborns with 11 of them identified by the sole identification of meconin.

CONCLUSION:

This study demonstrated that a more sensitive analytical platform and the inclusion of meconin in the opiates assay improved the ability to distinguish between in utero heroin exposure and maternal administration of codeine or morphine.