Opioid metabolites that might be positive with urine drug testing^[1-5]

Opioid	Metabolites
Codeine	Morphine Hydrocodone*
Morphine	Hydromorphone*
Hydrocodone	Hydromorphone Norhydrocodone Dihydrocodeine
Oxycodone	Oxymorphone Noroxycodone
Oxymorphone	Noroxymorphone
Methadone	2-Ethylidene-1,5-dimethyl-3,3 diphenylpyrrolidine
Tramadol	Nortramadol
Fentanyl	Norfentanyl
Buprenorphine	Norbuprenorphine
Heroin	6-Monoacetyl-morphine Morphine

For further information, refer to UpToDate content on individual opioids.

* Minor metabolite. Only low level of this metabolite appears in urine.

References:

Smith, H. Opioid Metabolism. Mayo Clin Proc. July 200984: 621.
Cone EJ, Caplan YH, Moser F, et al. Evidence that morphine is metabolized to hydromorphone but not to oxymorphone. J Anal Toxicol 2008; 32:319.
Oyler JM, Cone EJ, Joseph RE Jr, Huestis MA. Identification of hydrocodone in human urine following controlled codeine administration. J Anal Toxicol 2000; 24:530.
Hutchinson MR, Menelaou A, Foster DJ, et al. CYP2D6 and CYP3A4 involvement in the primary oxidative metabolism of hydrocodone by human liver microsomes. Br J Clin Pharmacol 2004; 57:287.
Oda Y, Kharasch ED. Metabolism of methadone and levo-alpha-acetylmethadol (LAAM) by human intestinal cytochrome P450 3A4 (CYP3A4): potential contribution of intestinal metabolism to presystemic clearance and bioactivation. J Pharmacol Exp Ther 2001; 298:1021.

Graphic 122869 Version 1.0

Opioid metabolites that might be positive with urine drug testing[1-5]