Metabolites of Opioids

OPIATEMETABOLITESCOMMENT
BuprenorphineNorbuprenorphine
Norbuprenorphine-3-glucuronide
Buprenorphine-3-glucuronide
ButorphanolHydroxybutorphanol
Norbutorphanol
CodeineHydrocodone (minor)
Norcodeine
Morphine
If codeine to hydrocodone ratio < 10, codeine is not the sole
source.
If codeine to morphine ratio < 6, codeine is likely not the sole
source.
Level generally lower than its hydrocodone source and below
detection if only codeine was ingested.
FentanylNorfentanyl
HeroinMorphine
Codeine (contaminant)
6-Monoacetylmorphine
HydrocodoneHydromorphone
Dihydrocodeine
Normorphine
Norhydrocodone
Hydrocodol
Hydromorphol
If codeine to hydrocodone ratio < 10, codeine is not the sole
source.
Level generally lower than its hydrocodone source and below
detection if only codeine was ingested.
HydromorphoneDihydromorphine
Hydromorphone-3-glucuronide
Level generally lower than its hydrocodone source and below
detection if only codeine was ingested
Methadone2-Ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine
2-Ethyl-5-methyl-3, 3-diphenylpyrrolidine
MorphineHydromorphone (minor)
Morphine-3-glucuronide
Morphine-6-glucuronide
Normorphine
If codeine to morphine ratio < 6, codeine is likely not the sole
source.
Level generally lower than its hydrocodone source and below
detection if only codeine was ingested.
OxycodoneOxymorphone
Noroxycodone
Oxycodols and their respective oxide
OxymorphoneOxymorphone-3-gluucornide
Oxymorphol
TramadolO-desmethyl-tramadol
Nortramadol

Modified from: Manchikanti L. et al. Monitoring opioid adherence in chronic pain patients: Tools, techniques and utility. Pain Physician 2008; 11:S155-S180 (22); Oyler JM et al. Identification of hydrocodone in human urine following codeine administration. J Analytical Toxicology 2000; 24:530-535 (32); and Cone EJ, Caplan YH. Urine toxicology testing in chronic pain management Postgrad Med 2009; 121:91-l02 (23).