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HelpTest ID: 6MAMU 6-Monoacetylmorphine Confirmation, Random, Urine
Reporting Name
6-MAM Confirmation, UUseful For
Determinating heroin use
Specimen Type
UrineOrdering Guidance
1. For situations where chain of custody is required, a Chain-of-Custody Kit (T282) is available. For chain-of-custody testing, order 6MAMX / 6-Monoacetylmorphine, Chain of Custody, Random, Urine.
2. If urine creatinine is required or adulteration of the sample is suspected, order ADULT / Adulterants Survey, Random, Urine.
3. Additional drug panels and specific requests are available. Call 800-533-1710 or 507-266-5700.
Specimen Required
Supplies: Urine Tubes, 10 mL (T068)
Container Tube: Plastic, 10-mL urine tube
Specimen Volume: 10 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
Additional Information:
1. No specimen substitutions.
2. STAT requests are not accepted for this test.
Specimen Minimum Volume
2.1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 14 days | ||
| Ambient | 72 hours |
Reference Values
Negative
6-MAM cutoff concentration: <5 ng/mL
Day(s) Performed
Tuesday, Wednesday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80356
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| 6MAMU | 6-MAM Confirmation, U | 19593-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 30983 | 6-Monoacetylmorphine by GC/MS | 19593-3 |
| 29898 | 6-MAM Interpretation | 69050-3 |
| 29899 | Chain of Custody | 77202-0 |
Clinical Information
Heroin (diacetylmorphine) is a semisynthetic opiate that is closely related to morphine. It is no longer used clinically in the United States, though elsewhere it is used for rapid relief of pain.(1) Like morphine and other opiates, its relaxing and euphoric qualities make heroin a popular drug of abuse. Heroin is commonly injected intravenously, although it can be administered by other means, such as snorting, smoking, or inhaling vapors.
Heroin shares the core structure of morphine, with the addition of 2 acetyl groups, which are thought to enhance its permeation into the central nervous system.(2,3) Heroin is metabolized by sequential removal of these acetyl groups; loss of first acetyl group converts heroin into 6-monoacetylmorphine (6-MAM) and loss of the second acetyl group converts 6-MAM to morphine, the dominant metabolite of heroin.(2,3) Heroin is rarely found intact in urine since only 0.1% of a dose is excreted unchanged. 6-MAM is a unique metabolite of heroin, and its presence is a definitive indication of recent heroin use. Like heroin, 6-MAM has a very short half-life and detection window.
Interpretation
The presence of 6-monoacetylmorphine (6-MAM) in urine is definitive for recent heroin use. However, the absence of 6-MAM does not rule-out heroin use because of its short half-life. 6-MAM is typically only detectable within 24 hours of heroin use. 6-MAM is further metabolized into morphine, which may be detected 1 to 2 days after 6-MAM is no longer measurable. Morphine will typically be found in a specimen containing 6-MAM.(2,3)
Clinical Reference
1. Giovannelli M, Bedforth N, Aitkenhead A. Survey of intrathecal opioid usage in the UK. Eur J Anaesthesiol. 2008;25(2):118-1122
2. Principles of Forensic Toxicology. 2nd ed. AACC Press; 2003:187-205
3. Hardman JG, Limbird LE, Gilman AG. Goodman and Gilman's. The Pharmacological Basis of Therapeutics. 10th ed. McGraw-Hill Book Company; 2001:590-592
4. Principles of Forensic Toxicology. 4th ed. AACC Press; 2013
5. Langman LJ, Bechtel LK, Meier BM, Holstege C. Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:872
Report Available
3 to 7 daysMethod Name
Gas Chromatography Mass Spectrometry (GC-MS)
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
mml-heroin, mml-substancemonitoring, mml-opioids