Otolaryngologists have long recognized the value of cocaine as a topical anesthetic and vasoconstricting agent. It is used in nasal surgery and as a vasoconstrictor before examination. As drug abuse has increased, screening for drugs of abuse has become common. This study was designed to determine how medicinal cocaine affects the urine test for the metabolite benzoylecgonine, the most common screening test for cocaine. Group I consisted of 12 patients scheduled for elective nasal surgery. Cocaine was given in our usual preoperative manner as 4 ml of 4% solution on cottonoids. Group II consisted of 30 volunteers in whom approximately 1 ml of 4% solution was sprayed intranasally. In both groups, a urine sample was collected before dosing and at regular intervals afterwards. All samples were negative before application of cocaine and all were positive 24 hours later. The duration of the positive result had some variability, but all were negative by 72 hours. The results show that medicinally used cocaine does make a drug screen positive. Patients should be informed that cocaine is being used and could cause a positive test for several days.
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