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HelpTest Code MTDNU Methadone Confirmation, Random, Urine
Reporting Name
Methadone Confirmation, UUseful For
Monitoring for compliance of methadone treatment for analgesia or drug rehabilitation
Assessing compliance with rehabilitation programs by urine measurement of 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine
Performing Laboratory
Mayo Clinic Laboratories in Rochester
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 MTDNX / Methadone Confirmation, Chain of Custody, Random, Urine.
2. Additional drug panels and specific requests are available. Call 800-533-1710 or 507-266-5700.
3. If urine creatinine is required or adulteration of the sample is suspected, order ADULT / Adulterants Survey, Random, Urine.
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.
Specimen Minimum Volume
2.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 14 days |
Reference Values
Negative
Cutoff concentrations:
METHADONE BY GC-MS
<100 ng/mL
2-ETHYLIDENE-1,5-DIMETHYL-3,3-DIPHENYLPYRROLIDINE GC-MS
<100 ng/mL
Day(s) Performed
Tuesday, Thursday
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
80358
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MTDNU | Methadone Confirmation, U | 104626-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 56028 | EDDP-by GC-MS | 104627-5 |
| 83129 | Methadone-by GC-MS | 104628-3 |
| 21107 | Methadone Interpretation | 69050-3 |
| 21110 | Chain of Custody | 77202-0 |
Interpretation
The absolute concentration of methadone and its metabolites found in patient urine specimens can be highly variable and does not correlate with dose. However, the medical literature and our experience show that patients who are known to be compliant with their methadone therapy have ratios of 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP):methadone of greater than 0.60.(7)
An EDDP:methadone ratio less than 0.090 strongly suggests manipulation of the urine specimen by direct addition of methadone to the specimen.(6)
Clinical Reference
1. Gutstein HB, Akil H. Opioid analgesics. In: Hardman JG, Limbird LE, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 10th ed. McGraw-Hill; 2001:569-619
2. Eap CB, Buclin T, Baumann P. Interindividual variability of the clinical pharmacokinetics of methadone: implications for the treatment of opioid dependence. Clin Pharmacokinet. 2002;41(14):1153-1193
3. Ferrari A, Coccia CP, Bertolini A, Sternieri E. Methadone-metabolism, pharmacokinetics and interactions. Pharmacol Res. 2004;50(6):551-559
4. Baselt RC. Disposition of Toxic Drugs and Chemicals in Man. 10th ed. Biomedical Publications; 2014
5. Levine B. Principles of Forensic Toxicology. 2nd ed. AACC Press; 2003:385
6. Galloway FR, Bellet NF. Methadone conversion to EDDP during GC-MS analysis of urine samples. J Anal Toxicol. 1999;23(7):615-619
7. George S, Braithwaite RA. A pilot study to determine the usefulness of the urinary excretion of methadone and its primary metabolite (EDDP) as potential markers of compliance in methadone detoxification programs. J Anal Toxicol. 1999;23(2):81-85
8. Langman LJ, Bechtel LK, Meier BM, Holstege C. Clinical toxicology. In: Rifai N, Horwath AR, Wittwer CT. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018
Report Available
3 to 7 daysMethod Name
Gas Chromatography Mass Spectrometry (GC-MS) Confirmation with Quantitation
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.