Cocaine is a Schedule II CNS stimulant with high misuse potential and limited medical use. Testing targets its major metabolite, benzoylecgonine, in urine, and both cocaine and benzoylecgonine in oral fluid. The cocaine immunoassay is notably specific, so a positive screen is almost always a true positive.1
Cocaine is increasingly adulterated with fentanyl or combined with opioids ('speedball'), and stimulant-plus-opioid deaths have risen sharply; a person may be exposed to fentanyl without intending opioid use.2 Detecting benzoylecgonine confirms cocaine exposure but says nothing about co-present opioids, which require their own testing.
Urine testing detects benzoylecgonine, the inactive major metabolite, which has a longer window than the parent drug. Oral fluid detects both cocaine and benzoylecgonine and can be positive when urine is negative, reflecting recent use.3 Sources beyond illicit use are limited but include medical or compounded topical cocaine and coca-leaf tea.1
Confirms cocaine exposure. Benzoylecgonine indicates use within the window of detection; the assay is highly specific.1
Consider fentanyl co-exposure. Cocaine is frequently adulterated with fentanyl, which this test does not detect.
Oral fluid catches recent use. Cocaine and benzoylecgonine in oral fluid can be positive when urine is negative.3
Timing and cutoff. Absence may reflect timing of last use, dose, or levels below the cutoff.
Window differs by matrix. Urine detects benzoylecgonine longer; oral fluid reflects more recent use.
Does not exclude other drugs. A cocaine-negative result says nothing about opioids or other stimulants.
Cocaine analytes measured on definitive testing.
| Metabolite | Clinical Significance |
|---|---|
| Cocaine (parent) | Short half-life (~1.5 h); measured in oral fluid. |
| Benzoylecgonine | Major inactive metabolite; primary urine target, longer window. |