Urine thebaine determination by liquid chromatography tandem mass spectrometry after poppy seed consumption.

Laboratories are challenged to distinguish whether a positive urine morphine result is due to heroin use or possible poppy seed consumption. Thebaine is an opium alkaloid that has been shown to be present in the urine of individuals who have consumed poppy seeds, as well as those who have used opium. It is not present in heroin. We present a sensitive, specific liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for thebaine. We show that thebaine is detectable after consumption of two different poppy seed-containing products for up to 72 h in urine. We discuss limitations of the assay and suggest how the test might best be used.

Carfentanil Use in a Patient Undergoing Treatment for Substance Use Disorder.

Carfentanil is a synthetic opioid approximately 10,000 times as powerful as morphine. It is not approved for human use. However, cases of death associated with carfentanil have become more frequent in recent years. In this report, the case of a patient with a positive urine test for norcarfentanil (a metabolite of carfentanil) is described. The analytical method leading to the detection is summarized. This is a rarely reported case of survival of carfentanil use. It is unique in the published literature of an account of a norcarfentanil-positive patient concurrently enrolled in a substance use disorder treatment program. To the authors' knowledge, this is the first documented case of a carfentanil exposure in the state of New York.