{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:14:26Z","timestamp":1786947266030,"version":"build-2736575974"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","funder":[{"DOI":"10.13039\/100005269","name":"Center for Substance Abuse Prevention","doi-asserted-by":"publisher","award":["75S20122C00002 HHSS277201800001C"],"award-info":[{"award-number":["75S20122C00002 HHSS277201800001C"]}],"id":[{"id":"10.13039\/100005269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005269","name":"Center for Substance Abuse Prevention","doi-asserted-by":"publisher","award":["75S20122C00002 HHSS277201800001C"],"award-info":[{"award-number":["75S20122C00002 HHSS277201800001C"]}],"id":[{"id":"10.13039\/100005269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Total morphine is an important urinary marker of heroin use but can also be present from prescriptions or poppy seed ingestion. In specimens with morphine concentrations consistent with poppy seed ingestion (&amp;lt;4,000\u2009ng\/mL), 6-acetylmorphine has served as an important marker of illicit drug use. However, as illicit fentanyl has become increasingly prevalent as a contaminant in the drug supply, fentanyl might be an alternative marker of illicit opioid use instead of or in combination with 6-acetylmorphine. The aim of this study was to quantify opiates, 6-acetylmorphine, fentanyl and fentanyl analogs in 504 morphine-positive (immunoassay 2,000\u2009ng\/mL cutoff) urine specimens from workplace drug testing. Almost half (43%) of morphine-positive specimens had morphine concentrations below 4,000\u2009ng\/mL, illustrating the need for markers to differentiate illicit drug use. In these specimens, fentanyl (22% co-positivity) was more prevalent than 6-acetylmorphine (12%). Co-positivity of 6-acetylmorphine and semi-synthetic opioids increased with morphine concentration, while fentanyl prevalence did not. In 110 fentanyl-positive specimens, the median norfentanyl concentration (1,520\u2009ng\/mL) was 9.6\u00d7 higher than the median fentanyl concentration (159\u2009ng\/mL), illustrating the possibility of using norfentanyl as a urinary marker of fentanyl use. The only fentanyl analog identified was para-fluorofentanyl (n\u2009=\u200950), with results from most specimens consistent with para-fluorofentanyl contamination in illicit fentanyl. The results confirm the use of fentanyl by employees subject to workplace drug testing and highlight the potential of fentanyl and\/or norfentanyl as important markers of illicit drug use.<\/jats:p>","DOI":"10.1093\/jat\/bkae003","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T16:09:35Z","timestamp":1706803775000},"page":"185-190","source":"Crossref","is-referenced-by-count":6,"title":["Fentanyl as a marker of illicit drug use in morphine-positive urine specimens from workplace drug testing"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5977-3049","authenticated-orcid":false,"given":"Svante","family":"Vikingsson","sequence":"first","affiliation":[{"name":"Center for Forensic Science Advancement and Application, RTI International , 3040 East Cornwallis Rd., Research Triangle Park, NC 27709, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth E","family":"Winecker","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Advancement and Application, RTI International , 3040 East Cornwallis Rd., Research Triangle Park, NC 27709, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Kuntz","sequence":"additional","affiliation":[{"name":"Clinical Reference Laboratory , 8433 Quivira Rd, Lenexa, KS 66214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Clark","sequence":"additional","affiliation":[{"name":"Clinical Reference Laboratory , 8433 Quivira Rd, Lenexa, KS 66214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Jacques","sequence":"additional","affiliation":[{"name":"Clinical Reference Laboratory , 8433 Quivira Rd, Lenexa, KS 66214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Dale","family":"Hart","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Advancement and Application, RTI International , 3040 East Cornwallis Rd., Research Triangle Park, NC 27709, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene D","family":"Hayes","sequence":"additional","affiliation":[{"name":"Division of Workplace Programs, Substance Abuse and Mental Health Services Administration , 5600 Fishers Lane, Rockville, MD 20857, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald R","family":"Flegel","sequence":"additional","affiliation":[{"name":"Division of Workplace Programs, Substance Abuse and Mental Health Services Administration , 5600 Fishers Lane, Rockville, MD 20857, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa S","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Workplace Programs, Substance Abuse and Mental Health Services Administration , 5600 Fishers Lane, Rockville, MD 20857, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,2,1]]},"reference":[{"key":"2024032816484869100_R1","volume-title":"Disposition of Toxic Drugs and Chemicals in Man","author":"Baselt","year":"2014","edition":"10th"},{"key":"2024032816484869100_R2","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1520\/JFS11948J","article-title":"Gas chromatographic\/mass spectrometric analysis of morphine and codeine in human urine of poppy seed eaters","volume":"33","author":"elSohly","year":"1988","journal-title":"Journal of Forensic Sciences"},{"key":"2024032816484869100_R3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.forsciint.2019.06.023","article-title":"Profiling of morphine and codeine in urine after the ingestion of curry containing poppy seed as an evidence for opiates defence in Malaysia","volume":"302","author":"Gan","year":"2019","journal-title":"Forensic Science International"},{"key":"2024032816484869100_R4","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1002\/dta.2058","article-title":"Urinary excretion study following consumption of various poppy seed products and investigation of the new potential street heroin marker ATM4G","volume":"9","author":"Maas","year":"2017","journal-title":"Drug Testing and Analysis"},{"key":"2024032816484869100_R5","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.forsciint.2018.11.026","article-title":"Morphine concentrations in human urine following poppy seed paste consumption","volume":"295","author":"Ozbunar","year":"2019","journal-title":"Forensic Science International"},{"key":"2024032816484869100_R6","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.forsciint.2014.04.042","article-title":"Morphine and codeine concentrations in human urine following controlled poppy seeds administration of known opiate content","volume":"241","author":"Smith","year":"2014","journal-title":"Forensic Science International"},{"key":"2024032816484869100_R7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/jat\/bkv081","article-title":"Concentrations of morphine and codeine in paired oral fluid and urine specimens following ingestion of a poppy seed roll and raw poppy seeds","volume":"39","author":"Samano","year":"2015","journal-title":"Journal of Analytical Toxicology"},{"key":"2024032816484869100_R8","article-title":"2020 National Drug Threat Assessment","author":"Drug Enforcement Administration","year":"2021"},{"key":"2024032816484869100_R9","article-title":"NFLIS-Drug 2022 Annual Report","author":"Drug Enforcement Administration","year":"2023"},{"key":"2024032816484869100_R10","article-title":"The importance of fentanyl testing in forensic toxicology","author":"White","year":"2022"},{"key":"2024032816484869100_R11","article-title":"Quest Diagnostics Drug Testing Index - Full year 2022 tables","author":"Quest Diagnostics","year":"2023"},{"key":"2024032816484869100_R12","article-title":"NFLIS-Drug 2018 Annual Report","author":"Drug Enforcement Administration","year":"2019"},{"key":"2024032816484869100_R13","article-title":"National vital statistics system","volume-title":"Provisional Drug Overdose Death Counts","author":"Centers for Disease Control and Prevention"},{"key":"2024032816484869100_R14","article-title":"DRI Opiate Assay","volume-title":"Product insert 0140-13-EN","author":"Thermo Scientific","year":"2017"},{"key":"2024032816484869100_R15","article-title":"CEDIA Heroin Metabolite (6-AM) Assay","volume-title":"Product insert 10006723-10-EN","author":"Thermo Scientific","year":"2017"},{"key":"2024032816484869100_R16","article-title":"ARK Fentanyl II Assay","volume-title":"Product insert 1600-1032-00 Rev 04","author":"ARK Diagnostics","year":"2021"},{"key":"2024032816484869100_R17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/jat\/30.1.1","article-title":"Evidence of morphine metabolism to hydromorphone in pain patients chronically treated with morphine","volume":"30","author":"Cone","year":"2006","journal-title":"Journal of Analytical Toxicology"},{"key":"2024032816484869100_R18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0959-289X(97)80051-9","article-title":"Perioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination","volume":"6","author":"Sibilla","year":"1997","journal-title":"International Journal of Obstetric Anesthesia"},{"key":"2024032816484869100_R19","first-page":"1447","article-title":"Pain patch","volume":"53","author":"Seccareccia","year":"2007","journal-title":"Canadian Family Physician"},{"key":"2024032816484869100_R20","article-title":"P182 anomalous results of morphine and 6-acetylmorphine in urine samples","author":"Stout","year":"2011"},{"key":"2024032816484869100_R21","first-page":"713","article-title":"Metabolism of cocaine and heroin is catalyzed by the same human liver carboxylesterases","volume":"279","author":"Kamendulis","year":"1996","journal-title":"Journal of Pharmacology & Experimental Therapeutics"},{"key":"2024032816484869100_R22","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/jat\/26.8.561","article-title":"Acetylcodeine as a urinary marker to differentiate the use of street heroin and pharmaceutical heroin","volume":"26","author":"Brenneisen","year":"2002","journal-title":"Journal of Analytical Toxicology"},{"key":"2024032816484869100_R23","article-title":"NPS Opioids in the United States Q4 2022","author":"The Center for Forensic Science Research & Education","year":"2023"},{"key":"2024032816484869100_R24","article-title":"Fentanyl Profiling Program Report - First Half CY 2021","author":"Drug Enforcement Administration","year":"2021"},{"key":"2024032816484869100_R25","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.15585\/mmwr.mm7139a3","article-title":"Notes from the field: overdose deaths involving para-fluorofentanyl - United States, July 2020-June 2021","volume":"71","author":"Bitting","year":"2022","journal-title":"MMWR Morbidity and Mortality Weekly Report"}],"container-title":["Journal of Analytical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jat\/advance-article-pdf\/doi\/10.1093\/jat\/bkae003\/56749499\/bkae003.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/48\/3\/185\/57109021\/bkae003.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/48\/3\/185\/57109021\/bkae003.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T17:50:46Z","timestamp":1711648246000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jat\/article\/48\/3\/185\/7595876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,1]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2,1]]},"published-print":{"date-parts":[[2024,3,28]]}},"URL":"https:\/\/doi.org\/10.1093\/jat\/bkae003","relation":{},"ISSN":["0146-4760","1945-2403"],"issn-type":[{"value":"0146-4760","type":"print"},{"value":"1945-2403","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4,1]]},"published":{"date-parts":[[2024,2,1]]}}}