Application of the CEDIA 6-MAM Assay to Routine Drugs-of-Abuse Screening

Abstract

A total of 1010 urine specimens obtained from General Practitioners, drug dependency units, and hospitals throughout the West Midlands were screened using the Microgenics CEDIA 6-monoacetylmorphine (6-MAM) assay as a means of establishing its effectiveness as a screening technique to monitor heroin abuse. A total of 282 specimens screened positive for 6-MAM using the CEDIA 6-MAM assay. However, the presence of 6-MAM could not be confirmed by gas chromatography-mass spectrometry in 21 (7%) of the CEDIA-positive specimens. Morphine was identified in all of these specimens at free concentrations ranging between 410 microg/L to 2010 microg/L. The data presented from this preliminary investigation suggests that either there are substances present within the urine specimens, as yet undetermined, which are interfering with the assay or that there may be a greater degree of cross reactivity to other opiates than previously published. 6-MAM assays may be potentially useful rapid screening techniques for high-throughput drugs-of-abuse screening laboratories performing employment and pre-employment screening. However, all positive results will still need to be confirmed by a more sensitive and specific technique.

Performance of the Emit® II Plus 6-Acetylmorphine Assay on the Viva-E® Analyzer

“…This was attributed to the presence of opiates in these specimens. The presence of 6-AM could not be confirmed by GC/MS in some of the positive specimens screened with the CEDIA 1 assay [11]. With the Emit 1 6-Acetylmorphine Assay cross-reactivity to morphine and metabolites was not observed.…”

Evaluation of an on‐site test device for the heroin metabolite 6‐acetylmorphine in urine

“…Other immunoassays for 6-AM have suffered mainly by crossreactivity towards structurally related compounds, 7,14,15 which resulted in false detection of codeine intake rather than heroin. The observed cross-reactivity to the dominant urinary codeine metabolite codeine-6 glucuronide at 100 μg/mL is at a concentration level that can be achieved after codeine intake, 5 but perhaps not after single dose intake.…”

Forensic Science

“…A review describing alternative strategies for postmortem drug testing has been published (426). Immunoassays have been used for the routine screening of drugs of abuse in biological fluids (427,428). Various extraction procedures for the analysis of drugs in urine and other biological fluids have been described (429)(430)(431)(432)(433)(434).…”