Opiate concentrations following the ingestion of poppy seed products - evidence for 'the poppy seed defence'

The Substance Abuse and Mental Health Services Administration1 stipulated 300 ng/ml cut-off limit for opiate assays has been called into question due to positive results being obtained following the ingestion of poppy seed containing food products.

To establish the plausibility of "the poppy seed defence" the concentrations of codeine, norcodeine, morphine, normorphine and thebaine (a potential marker for seed ingestion) in several varieties of seeds were quantified by GC-MS. The maximum morphine and codeine concentrations were found to be 33.2 and 13.7 m g/g seed respectively. The country of origin of the seed specimen and the preparation of the seeds before their use was found to influence the alkaloid concentration determined.

All urine specimens analysed following the consumption of bread rolls (mean 0.76 g seed per roll) by four subjects produced negative results in the EMIT opiate assay with the exception of one subject (body weight 63.0 kg) who consumed two poppy seed rolls. In this subject opiate positive screening results (Behring EMIT II opiate assay) were obtained for up to 4 - 6 h post ingestion with maximum urinary morphine and codeine concentrations of 832.0 ng/ml (@ 2 - 4 h post ingestion) and 47.9 ng/ml (@ 0 - 2 h post ingestion) respectively being achieved.

Following the ingestion of poppy seed cake (mean 4.69 g seed per slice) by four individuals opiate positive screening results were obtained for up to 12 - 24 h. In one subject (dose equivalent to 0.07 g poppy seed/kg body weight) maximum urinary morphine and codeine concentrations of 302.1 ng/ml (@ 0 - 2 h) and 83.8 ng/ml (@ 2 - 4 h) respectively were recorded.

These findings demonstrate the plausibility of the poppy seed defence. Great care should therefore be taken when interpreting the data produced from drugs of abuse screening for opiates.

• tell your doctor and pharmacist if you are allergic to methadone or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); antihistamines; buprenorphine (Subutex); butorphanol (Stadol NS); calcium channel blocking agents such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop), nisoldipine (Sular), and verapamil (Calan, Covera, Isoptin, Verelan); diuretics ('water pills'); erythromycin (E.E.S., E-Mycin, Erythrocin); laxatives; medications for anxiety, mental illness, nausea, or pain; medications for HIV including abacavir (Ziagen), amprenavir (Agenerase), didanosine (Videx), efavirenz (Sustiva), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), stavudine (Zerit), and zidovudine (Retrovir);certain medications for irregular heartbeat such as disopyramide (Norpace), flecainide (Tambocor), mexiletine (Mexitil), moricizine (Ethmozine), procainamide (Procanbid, Pronestyl), propafenone (Rythmol), propranolol (Inderal), quinidine (Quinidex), and tocainide (Tonocard); certain medications for seizures such as carbamazepine (Carbatrol, Epitol, Tegretol),phenytoin (Dilantin, Phenytek); phenobarbital nalbuphine (Nubain); naloxone (Narcan);naltrexone (ReVia, Depade); pentazocine (Talwin); rifampin (Rifadin, Rimactane, in Rifamate); risperidone (Risperdal); sedatives; certain selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine (Luvox) and sertraline (Zoloft); sleeping pills; certain steroids such as cortisone, fludricortisone (Flurinef), and hydrocortisone (Cortef); and tranquilizers. Also tell your doctor or pharmacist if you are taking the following medications or have stopped taking them in the past 14 days: monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelpar), and tranylcypromine (Parnate). Many other medications may also interact with methadone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John's wort.
• tell your doctor if you have or have ever had asthma or other breathing problems or a blockage in your intestine. Your doctor may tell you that you should not take methadone.
• tell your doctor if you have or have ever had a head injury, a brain tumor, a stroke, or any other condition that caused high pressure inside your skull; irregular heartbeat; urethral stricture (narrowing of the tube that carries urine out of the body), enlarged prostate (a male reproductive gland), or any other condition that causes difficulty urinating; Addison's disease (a condition in which the body does not make enough of certain natural substances); mental illness; chronic obstructive pulmonary disease (COPD; a group of lung diseases); kyphoscoliosis (condition in which the spine curves abnormally); sleep apnea (condition in which breathing stops for short periods during sleep); low levels of potassium or magnesium in your blood; or thyroid , heart, liver, or kidney disease. Also tell your doctor if you drink or have ever drunk large amounts of alcohol or if you use or have ever used street drugs or have overused prescription medications.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking methadone, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methadone.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• remember that alcohol can add to the drowsiness caused by this medication.
• tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
• you should know that methadone may cause dizziness when you get up too quickly from a lying position. This is more common when you first start taking methadone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

Methadone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• drowsiness
• weakness
• headache
• nausea
• vomiting
• constipation
• loss of appetite
• weight gain
• stomach pain
• dry mouth
• sweating
• flushing
• difficulty urinating
• swelling of the hands, arms, feet, and legs
• mood changes
• vision problems
• difficulty falling asleep or staying asleep
• decreased sexual desire or ability
• missed menstrual periods

Some side effects can be serious. If you experience any of the following symptoms or those mentioned in the IMPORTANT WARNING section, call your doctor immediately:

• seizures
• itching
• hives
• rash

Methadone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.