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HelpTest Code 6MAMM 6-Monoacetylmorphine (6-MAM), Confirmation, Meconium
Reporting Name
6-MAM Confirmation, MUseful For
Detection of in utero heroin exposure up to 5 months before birth
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
MeconiumOrdering Guidance
For chain-of-custody testing, order MAMMX / 6-Monoacetylmorphine (6-MAM) Confirmation, Chain of Custody, Meconium.
Specimen Required
Supplies: Stool container, Small (Random), 4 oz (T288)
Container/Tube: Stool container
Specimen Volume: 1 g (approximately 1 teaspoon)
Collection Instructions:
1. Collect entire random meconium (newborn's first bowel movements) specimen.
2. Send specimen frozen.
Additional Information: When refrigerated, a significant percentage of 6-monoacetylmorphine (MAM) will convert to morphine in less than 24 hours.
Specimen Minimum Volume
0.3 g (approximately 1/4 teaspoon)
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Meconium | Frozen | 14 days |
Reference Values
Negative
Positive results are reported with a quantitative liquid chromatography tandem mass spectrometry result.
Cutoff concentration: 5 ng/g
Day(s) Performed
Monday through Sunday
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
G0480
80356 (if appropriate for select payers)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| 6MAMM | 6-MAM Confirmation, M | 29345-6 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 31874 | 6-Monoacetylmorphine | 29345-6 |
| 31875 | Interpretation | 69050-3 |
Interpretation
The presence of 6-monoacetylmorphine (6-MAM) in meconium is definitive for heroin use by the mother. However, the absence of 6-MAM does not rule-out heroin use because of its short half-life and stability.
Clinical Reference
1. Giovannelli M, Bedforth N, Aitkenhead A. Survey of intrathecal opioid usage in the UK. Eur J Anaesthesiol. 2008;25:118-122
2. Levine B, ed. Principles of Forensic Toxicology. 4th ed. AACC Press; 2013
3. Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 13th ed. McGraw-Hill; 2018
4. Szeto HH. Kinetics of drug transfer to the fetus. Clin Obstet Gynecol. 1993;36:246-254
5. Kwong TC, Ryan RM. Detection of intrauterine illicit drug exposure by newborn drug testing. Clin Chem. 1997;43(1):235-242
6. Ostrea EM Jr, Brady MJ, Parks PM, et al. Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr. 1989;115(3):474-477
7. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero mechanisms, consequences, and management. Obstet Gynecol Surv. 2005;60(1):45-56; quiz 73-74
8. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
9. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020
Report Available
2 daysMethod Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.