Naloxone Metabolism Associated With Unexpected Noroxymorphone Detected in Urine During Pregnancy.

Marcela C Smid, Jasmin E Charles, Gwendolyn A McMillin

Abstract readCase Reports

In one paragraph

Article in O&G open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Marcela C SmidDepartment of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, and Department of Pathology, University of Utah Health, Salt Lake City, Utah; and NMS Laboratories, Horsham, Pennsylvania.

Jasmin E CharlesDepartment of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, and Department of Pathology, University of Utah Health, Salt Lake City, Utah; and NMS Laboratories, Horsham, Pennsylvania.

Gwendolyn A McMillinDepartment of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, and Department of Pathology, University of Utah Health, Salt Lake City, Utah; and NMS Laboratories, Horsham, Pennsylvania.

Funding

Project INSPIRE – (Interprofessional Simulation Program for Clinical Resilience and Empathy) for healthcare teams caring for birthing individuals with substance use disorder in UtahU54HD113169 · NICHD · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI Torri D Metz · 2023 to 2026

$10.7M

NICHD NIH HHS U54 HD113169

6 · The paper itself

Abstract

backgroundUrine drug testing (UDT) is commonly used in obstetrics to monitor opioid use disorder treatment, but interpretation can be difficult and may trigger harmful consequences, including child welfare reporting. Noroxymorphone, also referred to as nornaloxone, may arise from metabolism of naloxone, oxycodone, or oxymorphone and may be detected in patients taking buprenorphine/naloxone. CASES: Two pregnant individuals receiving buprenorphine/naloxone had unexpected presumptive positive opiate screens. Confirmatory testing showed isolated low-level noroxymorphone (46 and 79 ng/mL) without detectable parent opioids, consistent with naloxone metabolism rather than opioid use. Both patients experienced significant distress after the initial results.

conclusionClinicians should recognize naloxone-associated noroxymorphone to avoid misclassifying return to use. Confirmatory testing and interpretation are essential to prevent harm and preserve clinician-patient trust.

Identifiers

PMID42798729

DOI10.1097/og9.0000000000000188

PMCPMC13612812

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.