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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 32, Number 4, May,
pp.319-323
SHORT COMMUNICATION:
Evidence that Morphine is Metabolized to Hydromorphone But Not
to Oxymorphone
Edward J. Cone1, Yale H. Caplan2, Frank Moser3, Tim Robert3
and David Black3
1Johns Hopkins School of Medicine, Department of Psychiatry and
Behavioral Sciences, Baltimore, Maryland 21224;
2National Scientific
Services, 3411 Phillips Drive, Baltimore, Maryland 21208; and
3Aegis
Sciences Corporation, 515 Great Circle Road, Nashville, Tennessee
37228
A minor pathway for the biotransformation of morphine
to hydromorphone has been identified in humans. Recently, an
unsubstantiated claim that morphine is metabolized to hydromorphone
and then to oxymorphone was published. The goal of this study
was to determine if credible evidence that oxymorphone is a metabolite
of either morphine or hydromorphone exists. Urine specimens from
pain patients who were treated exclusively with high daily doses
of morphine (N = 34) or hydromorphone (N = 26) were analyzed
by liquid chromatography–tandem mass spectrometry for oxymorphone,
hydromorphone, and morphine (LOD = 25 ng/mL). Specimens were
also tested for a variety of other medications. Criteria for
inclusion of patients’ specimens were as follows: 1. patients
were undergoing exclusive dosing with either morphine or hydromorphone;
2. non-prescribed medications were not detected; and 3. urine
concentrations of morphine were > 100,000 ng/mL for the high-dose
morphine group and > 1000 ng/mL of hydromorphone for the high-dose
hydromorphone group. Consistent with earlier reports, hydromorphone
was detected in patients treated with high-dose morphine. The
ratio of hydromorphone to morphine ranged from 0.2 to 2.2%. Oxymorphone
was not detected in any specimen from high-dose morphine or high-dose
hydromorphone patients. The authors conclude, based on these
data, that oxymorphone is not a metabolite of morphine or hydromorphone.
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