6-Acetylmorphine (6-MAM), Confirmation

CPT Code(s):
80356

Turnaround Time:
24 - 72 hours

Specimen Requirements

Preferred Specimen:
Urine

Minimum Volume:
5.0 mL

Transport Container:
Yellow Top Tube or Sterile Cup

Transport Temperature:
Room Temperature

Collection Instructions:
Collect urine in plastic container and transfer to plain yellow top tube (without preservative).

Rejection Criteria:
Specimen received outside stability requirements; Excessive blood, particulates, viscosity present. Preservative (speckled top) tube.

Stability Criteria

Room Temperature:
24 hours

Refrigerated:
7 days

Frozen:
30 days

Clinical Significance

The 6-Monoacetylmorphine (6-MAM) test with quantitative results, performed using liquid chromatography-tandem mass spectrometry (LC/MS-MS), has specific clinical significance and diagnostic use in the field of toxicology and addiction medicine.

6-MAM is a metabolite of heroin and is rapidly formed when heroin is metabolized in the body. Unlike other opioid drugs or medications, 6-MAM is specific to heroin use and is not found as a metabolite of other opioids. Therefore, the presence of 6-MAM in a patient's urine or blood sample is a reliable indicator of recent heroin use.

The LC/MS-MS method is a highly sensitive and specific analytical technique used for quantifying substances in biological samples. It combines liquid chromatography, which separates the components of a sample, with tandem mass spectrometry, which identifies and quantifies the separated components based on their molecular characteristics. LC/MS-MS offers excellent sensitivity and specificity, allowing for accurate and precise measurements of 6-MAM levels in biological samples.

The 6-MAM test using LC/MS-MS has several clinical applications and diagnostic uses:

1. Confirmation of Heroin Use: The presence of 6-MAM in a patient's urine or blood sample confirms recent heroin use, providing objective evidence of drug exposure. This information is valuable in assessing a patient's substance use history, evaluating treatment progress, and determining compliance with substance abuse programs.

2. Differentiation of Heroin from Other Opioids: Since 6-MAM is specific to heroin use, the test can differentiate between heroin and other opioids. This differentiation is important when attempting to identify the specific opioid responsible for a patient's drug-related symptoms or overdose.

3. Monitoring Treatment Compliance: For patients undergoing addiction treatment programs, regular monitoring of 6-MAM levels can help assess compliance with medication-assisted treatments (such as methadone or buprenorphine) or abstinence-based programs. A negative 6-MAM test indicates abstinence from heroin, while positive results suggest non-compliance or relapse.

4. Medico-Legal Purposes: The 6-MAM test can be used in medico-legal settings, such as workplace drug testing or legal cases involving drug use. It provides objective evidence of recent heroin use, which can be critical in determining legal or employment outcomes.

In summary, the 6-MAM test with quantitative results using LC/MS-MS is a valuable tool in the field of toxicology and addiction medicine. It confirms recent heroin use, differentiates heroin from other opioids, monitors treatment compliance, and has medico-legal applications. This test, with its high sensitivity and specificity, plays a significant role in assessing substance use, guiding treatment decisions, and providing valuable information to physicians, addiction specialists, and legal professionals.