Pastry precautions: Poppy seed-containing products cause significant positive results in urine drug tests

To the Editor, Chronic pain management programs typically utilize urine drug testing to ensure patient compliance and to detect diversion or misuse, which can result in treatment discontinuation. The interpretation of urine drug test results can be challenging, particularly with respect to potential interferences or exposure to opioid-containing foods, like poppy seed-containing products (1). Current guidelines suggest that urinary codeine concentrations exceeding 300 ng/mL, along with a morphine-to-codeine ratio <2, are most consistent with codeine use, ruling out poppy seed ingestion (2). However, recent studies have challenged these guidelines by demonstrating high codeine concentrations and low morphine-to-codeine ratios in various food products (3). Furthermore, our toxicology laboratory has recently received many samples with high concentrations of codeine and its glucuronide metabolite from patients who deny codeine use and attribute their results to poppy seed-containing foods. As a result, we aimed to provide additional information on the effects of the consumption of poppy seed-containing foods on screening and confirmatory urine opioid test results.