title: Analysis of the cocaine metabolite in the urine of patients and physicians during clinical use.
abstract: Cocaine is considered a superb anesthetic for many otolaryngologic procedures and has been shown to be positive in the urine of patients for up to 72 hours after surgery with a standard radioimmunoassay test. The standard cutoff for drug screening of benzoylecgonine, the main urine metabolite of cocaine, has been 300 ng/ml. However, the new threshold value in many laboratories is now 150 ng/ml. In review of the literature, no study has been performed that quantitates the actual level of the urine cocaine metabolite after a routine otolaryngologic procedure in both physicians and their patients with the gold standard for urine testing, gas chromatography. This study documents the quantitative level of the urine cocaine metabolite in patients and reveals that there are metabolite levels present in physicians during a single exposure, although they are below the current cutoff level that will be picked up on current screening assays. Evidence has also been presented demonstrating a cumulative effect on the benzoylecgonine levels in physicians who clinically use cocaine anesthesia more frequently; these levels can be above the cutoff level on current screening assays.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000.
authors.forename: A D
authors.initials: AD
authors.lastname: Bruns
authors.forename: L A
authors.initials: LA
authors.lastname: Zieske
authors.forename: A J
authors.initials: AJ
authors.lastname: Jacobs
mesh_terms: D000281:Administration, Intranasal; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000378:metabolism / Q000652:urine*; D002849:Chromatography, Gas; D003042:Cocaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000378:metabolism / Q000652:urine*; D008401:Gas Chromatography-Mass Spectrometry; D005932:Gloves, Surgical; D006801:Humans; D008397:Masks; D008403:Mass Screening; D009294:Narcotics / Q000652:urine*; D016273:Occupational Exposure; D010038:Otorhinolaryngologic Diseases / Q000601:surgery; D010361:Patients; D010820:Physicians; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000652:urine; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D009294:Narcotics; C005618:benzoylecgonine; D003042:Cocaine