Opioids are a group of drugs that include prescription medications and illicit substances. Opioids are also commonly misused and can lead to addiction. Understanding opioid elimination and detection times can be important when utilizing opioid use disorder treatments, understanding withdrawal symptoms, and for professional decision-making.
- Opioids are prescribed to treat medical conditions and are sometimes obtained and used illicitly.
- Opioids can be detected in the body with the use of blood, saliva, urine, and hair tests, and they have varying detection windows.
- Understanding how opioids are metabolized and eliminated by the body can be useful for professionals and individuals in substance use treatment.
Understanding opioid metabolism
Opioids include a range of medical and illicit substances, such as oxycodone, codeine, morphine, heroin, and fentanyl. The body metabolizes and eliminates these substances in the same way, primarily in the liver, although they have varying effect durations and detection windows. [1]
Some opioids take effect quickly and are short-acting, while others take longer to have an effect but last longer. Extended- or controlled-release opioids are designed to release the medication into the body slowly, having longer-lasting effects. For example, the effects of immediate-release tramadol last up to 6 hours, whereas the effects of extended-release tramadol can last 24 hours. [2]
Because extended-release formulations take longer to release the medication into the body, their elimination time is longer, which means that they can be detected in the body for longer.
The half-life of a drug refers to its duration in the body. After one half-life, 50% of the drug is eliminated from the blood, and it typically takes around 5 half-lives for complete elimination. The same is true of opioids, and this allows us to measure and establish detection windows for this class of substances. [3]
Detection times by opioid and test type
The following table shows the detection times of opioids depending on the type of test. [2][4][5][6]
| Urine | Blood | Saliva | Hair | |
|---|---|---|---|---|
| Heroin | Up to 48 hours | 6 hours | Up to 36 hours | ~90 days |
| Morphine | 1-3 days | 24 hours | Up to 36 hours | ~90 days |
| Codeine | Up to 48 hours | Up to 24 hours | Up to 36 hours | ~90 days |
| Oxycodone | 2-4 days | Up to 24 hours | Up to 48 hours | ~90 days |
| Hydrocodone | 2 days | Up to 48 hours | Up to 36 hours | ~90 days |
| Hydromorphone | Up to 3 days | Up to 4 hours | Up to 48 hours | ~90 days |
| Methadone | 3-11 days | Up to 36 hours | Up to 48 hours | ~90 days |
| Fentanyl | 1-2 days | Up to 48 hours | N/A | ~90 days |
| Tramadol | Up to 4 days | Up to 24 hours | Up to 48 hours | ~90 days |
Extended-release formulations of the above opioids are often metabolized and eliminated more slowly, meaning that their detection windows in urine and blood may be longer.
Factors influencing how long opioids stay in your system
Various factors can influence how long a substance remains in the body and the detection window, including: [1][2][7]
- Body weight, age, and metabolism.
- Duration and frequency of use. More chronic and regular use will result in longer elimination times.
- Dosage. Higher doses can take longer to be eliminated.
- Route of administration. Oral ingestion of opioids can result in longer metabolism times than injected opioids.
- Hydration and urine pH (in urine testing).
- Other substance use. Substances can impact how opioids are metabolized and increase elimination times.
- Liver and kidney functioning. Impaired functioning can slow metabolism and elimination.
- Physical health issues. Other health conditions can affect how drugs are metabolized.
Implications for drug testing
Drug tests that check for opioid use can sometimes give false-positive results, meaning that they incorrectly indicate that an opioid has been used. [7] Sometimes, a different medication that has been used can result in a false-positive opioid drug test, such as: [8]
- Quinolone antibiotics such as levofloxacin
- Rifampin
- Quetiapine
- Diphenhydramine (Benadryl)
- Doxylamine
- Verapamil
Additionally, the consumption of poppy seeds can result in a positive opioid test, although this tends to occur only in tests with higher thresholds. [8] Another complication when interpreting opioid test results relates to the metabolism of codeine and heroin. Both metabolize into morphine, meaning that someone taking codeine could be incorrectly identified as positive for morphine. [5][8]
Steps to take if concerned about test outcomes
Where false-positives occur, it may be necessary to conduct further tests to confirm or clarify results. Someone who receives incorrect test results can request additional testing in most circumstances. However, it may be necessary to seek legal advice and representation in some cases. [7][8]
Seeking help and support
People who are misusing opioids, struggling with dependence and addiction issues, or require support in reducing and stopping opioid use can seek professional help. Various treatments are available, provided through inpatient and outpatient treatment programs, that can help with opioid use issues.
More information on treatment options can be found on the Recovered website, including the types of medications used to help with opioid withdrawal and recovery maintenance, the different therapies that can be used to support abstinence and recovery, and support groups that can be utilized during recovery.
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