Cotinine (Nicotine)

1. What is the purpose of this test?

Nicotine is an addictive compound naturally present in tobacco leaves, which can be consumed by smoking, chewing, or sniffing tobacco. It is also produced synthetically and used in various products, including nicotine replacement therapy, e-cigarette liquids, and tobacco-free nicotine products. Testing for nicotine exposure involves detecting specific substances in urine, saliva, blood, or hair samples, including nicotine, cotinine, and other metabolites.

Nicotine testing, while it can measure nicotine levels in the body, is only reliable for a short time after exposure (a few hours). Cotinine testing, on the other hand, detects the presence of cotinine, a nicotine metabolite that remains in the body for several days (up to a few days) after nicotine exposure. This makes cotinine a more dependable indicator of nicotine exposure.

Additional tests may measure nicotine metabolites like trans-3'-hydroxy cotinine and nornicotine, although they are less commonly used. Some tests assess substances like anabasine to distinguish between tobacco use and nicotine replacement therapies.

Nicotine exposure can occur in various ways, including through:

1. Tobacco Products: Smoking (cigarettes, cigars, etc.) and smokeless tobacco products (chewing tobacco, snuff).
2. Secondhand and Thirdhand Smoke: Inhaling or ingesting residual smoke or substances left on surfaces after smoking has occurred.
3. E-cigarettes: Vaping products that may contain nicotine.
4. Secondhand and Thirdhand Aerosols: Exposure to aerosols emitted by e-cigarettes and similar devices.
5. Nicotine Replacement Therapy (NRT): Products like nicotine gum, inhalers, and patches that provide controlled doses of nicotine to help quit smoking.
6. Tobacco-Free Nicotine Products: Synthetic nicotine products, including nicotine gels and tobacco-free nicotine pouches.
7. Certain Foods: Some foods naturally contain nicotine, such as cauliflower, eggplant, potatoes, tomatoes, and sweet peppers.

The duration for which evidence of nicotine exposure can be detected is known as the detection window. This window varies based on multiple factors, including the type, amount, and frequency of nicotine exposure, as well as the sample used for testing and individual characteristics. In general, nicotine can be detected in the body for a short period, with half eliminated within approximately two hours after exposure. Cotinine levels, however, remain detectable in urine and blood samples for up to seven days. Persistent low levels of nicotine and cotinine in the body can result from ongoing exposure to secondhand smoke, thirdhand smoke, and environmental nicotine.

2. How can I do the test?

Nicotine and cotinine testing is typically conducted in a medical facility or laboratory, and these tests can be ordered by a healthcare provider or program administrator that necessitates such testing. Additionally, nicotine tests are available for purchase without a prescription and can be performed at home or self-administered at home and then sent to a testing facility for analysis.

3. What should I do during the test?

For urine drug testing conducted in a laboratory, you will typically receive instructions to perform a clean catch urine sample to prevent contamination. Before the test, clean your hands and genital area with a provided wipe or cloth from the healthcare provider. Begin urinating into the toilet briefly, then position the collection container into the urine stream. Once the container reaches a pre-marked level, remove it from the urine stream and continue urinating in the toilet.

To collect a blood sample for a nicotine or cotinine test, a healthcare professional will draw blood from a vein in your arm.

Saliva samples for testing may require you to either spit into a collection device or place a pad in your mouth to collect saliva.

In hair follicle drug testing, samples are usually taken from the scalp, but if there isn't enough hair on the scalp, hair from another part of the body may be collected.

Nicotine and cotinine testing procedures are not typically painful, although some individuals may experience temporary discomfort during a blood draw. The process for collecting urine or saliva samples for at-home cotinine testing is similar to the methods used in laboratory-based tests. Following sample collection, at-home cotinine tests involve using a test strip or another device to analyze the sample for cotinine.

Since test devices can vary, it is essential to carefully review the instructions provided in the test kit before conducting the test on the collected sample.

4. How can be the result interpreted?

Nicotine and cotinine test results provide information on the presence and potentially the quantity of nicotine or cotinine in your sample.

It's crucial to consider that nicotine and cotinine tests fall into two categories: qualitative and quantitative, and they are interpreted differently:

1. Qualitative nicotine and cotinine tests: These tests determine whether nicotine or cotinine is present in the sample but do not provide information on the specific amount of these substances. At-home cotinine tests are an example of qualitative tests.
2. Quantitative nicotine and cotinine tests: These tests measure the precise amount of nicotine and cotinine in the body. Quantitative tests are typically conducted in a laboratory by healthcare professionals.

A positive test result indicates that a sufficient amount of nicotine or cotinine has been detected in the sample, meeting the test or laboratory's predefined cutoff value for a positive result.

Conversely, a negative test result suggests that an insufficient level of nicotine or cotinine was found in the sample, making it insufficient for a positive result. This outcome may occur because you have not used tobacco or been exposed to nicotine, the exposure was outside the detection window, or the detected nicotine level was too low to yield a positive result.

The cutoff values for positive test results, also known as the test's reference range, are not standardized and may vary between laboratories. These values are influenced by factors such as the test's intended purpose, the type of test sample, and the specific laboratory or at-home testing kit used.