Volume 87 Issue 47 | p. 4 | Letters
Issue Date: November 23, 2009

Drug Testing And 'Caine' Drugs

Department: Letters

The "What's That Stuff?" article on dental anesthetics may unfortunately lead some to the erroneous conclusion that cocaine and the so-called caine anesthetics are closely related (C&EN, June 29, page 33). The article claims that with names like benzocaine, some may think that these anesthetics must be derivatives of cocaine.

In turn, the misapprehension is created that commonly used dental anesthetics such as benzocaine may yield false positives in urine drug testing, indicating illicit use of cocaine. A cursory review of the structures for lidocaine, procaine, and articaine shows they lack the ecgonine nucleus. Furthermore, the common dental analgesics are not related to cocaine nor to its metabolites synthetically. In addition, cocaine and its derivatives are Federal Schedule II drugs, whereas procaine, lidocaine, and the other "caine" drugs are unscheduled.

During 16 years as the director of a Florida-licensed and federally certified employment-related drug-testing laboratory that also performed "driving under the influence of alcohol" and "driving under the influence of drugs" work for Florida's 20th judicial circuit, I (Robert White) had ample opportunity to refute many false reasons for a defendant or claimant to explain a confirmed positive "cocaine" urine drug test.

One of the most popular explanations was, "I went to my dentist and he gave me lidocaine. It must be the lidocaine that caused my positive for cocaine." This claim is predicated on the assumption that lidocaine mimics cocaine because both end in caine. It was proven in my lab and others' labs that ingestion of the caine drugs will not precipitate an immunoassay presumptive positive ("screening" result) for the major cocaine metabolite, benzoylecgonine (BE), the primary substance actually targeted by most cocaine immunoassays. In addition, gas chromatography/mass spectrometry (GC/MS) selected-ion monitoring for urine BE does not show any detectable peak for derivatized BE postingestion of drugs such as lidocaine. Similarly, analysis of the same urine for ecgonine methyl ester and parent cocaine by full-spectrum GC/MS reveals no peak for either substance postingestion. Thus, neither parent cocaine nor its metabolites are related to the caine drugs metabolically or immunologically.

In summary, the caine drugs such as lidocaine and procaine have their own structures separate from the ecgonine nucleus of cocaine and its derivatives and their own pharmacodynamic effects. The caine drugs are different both pharmacodynamically and pharmacokinetically, as well as legally, from cocaine. Thus, cocaine and the caine drugs should not be grouped together or confused with one another as that may lead to erroneous medicolegal conclusions that may be inferred from the cited article.

Robert M. White
Peter F. Eisenhart
Naples, Fla.

Chemical & Engineering News
ISSN 0009-2347
Copyright © American Chemical Society
EM  (August 9, 2015 9:51 AM)
I greatly respect and appreciate your knowledge and research Mr. White however, there has to be some connection between lidocaine & cocaine because there are several people that this is happening to. I am not a drug user and rarely even drink alcohol but tested positive for cocaine in a hair drug test from my employer. So, to prove them wrong, I went to a different lab and paid for a hair drug test myself and it came up positive again. 3 months prior to the drug test I had been injected with Lidocaine several times for a biopsy. I had also had a tooth pulled and developed 'dry socket' and they gave me petroleum based Xylocaine to keep putting in the dry socket until it began to heal. However, I was told by 3 different doctors that Lidocaine will not show up as cocaine because they are not related in any way. Too many [none drug user's] are losing jobs and reputations because of this. [Something] is obviously being missed. Thank you.
J Gibson  (August 11, 2015 9:22 PM)
Trace amounts of cocaine have been detected in everyday items we use from money to cigarettes. Such small amounts won't affect you but could show up in drug screens.
Randy Brasfield  (August 13, 2015 11:47 AM)
I also lost my job after testing positive for cocaine on a random hair drug test. I had been to the dentist and was given several shots of lidocaine, I haven't done any cocaine so I naturally assumed it to be from the lidocaine. I have paid for drug testing and they keep telling me that its cocaine and I can't get any lab to test for lidocaine and the cocaine to see if it's more than a coincidence. I'd like to clear my name!
Ray Anderson  (September 4, 2015 1:49 AM)
I had some major dental work done the past 3 months. Had about eight cavities filled and a couple of teeth needed to be permanently removed. All 5 times the dentist injected me with a couple of shots I supposed n I novaCaine or lidocaine.wasn't sure because I was in a lot pain and I told her I wouldnt be able to tolerate anymore. I was also prescribed lidocaine to use orally to relive pain in my gums and teeth..plus u had a really hard time chewing and still bothers me now due to three teeth I had to permanently removed. I went for a pretty employment drug screening...the results took over a week to come back and the doctor had told me I tested positive for cocaine. I never used cocaine in my life !! There must be some kind of mistake and now I'm without a job.
Daniel  (October 28, 2015 6:34 PM)
I believe that in other countries, cocaine is still used for eye and/or dental surgery. So if you took a trip south of the border or some other place for cheaper medical services, you may have been given actual cocaine.
Karry Kaduk  (November 2, 2015 9:07 PM)
I had a work related injury on a table saw cutting two finger tips off. After going to two emergency rooms on IV at both with cefazolin sodium, sodium chloride, hydromorphine hci and tetanus/diphtheria toxiods in the first emergency room. And at the second hospital I received enoxaparin sodium, morphine sulfate and ondansectron then at 8:50 pm a urine test sample was taken and sent to workman’s comp. Now all benefits have been denied. So I am livid and very disappointed and then today unemployment denied me benefits also.I can not understand why I am testing positive for cocaine now workmans comp. and unemployment denied and terminated from my job. Hired an atty. but that will take time and financially out of time. can all of these given meds. intraveniously cause this test positive for cocaine
Rene D  (November 13, 2015 10:27 PM)
I have never used cocaine but today after having test done in emergeny room was informed that I tested positive for cocaine. I couldn't believe this and upon discharge this Dr. Placed in my records that reason I was there for heart issues and chronic drug abuse. I have used lidocaine topical for arthritis. I have to believe that this is what caused me to test positive for cocaine. Im very upset about this and intend on getting this removed from my records.
Kat  (January 13, 2016 12:38 AM)
I was called back to a previous employer and had to take a hair test. The test came back positive for cocaine. Never ever have I touched the stuff in my life. I too had recently had extensive dental work done where on each visit I was given more than one caine drug at one time. I believe the FDA knows that there are trace amounts of cocaine in some of these medications but feel like it's not enough that it has to be reported. I don't know but something is definitely not right. I didn't go looking for this job. I didn't lose a job. The only thing different in my life after this test is them telling me that I use drugs when I know that I never have and that s**t is very frustrating.
Rebecca Jackson  (February 15, 2016 2:38 PM)
I also tested positive for cocaineto which I know is false I've use lidocaine patches and some ambesol for my tooth that is it they have made an error in there reading
ricko19627@gmail.com  (March 13, 2016 4:24 PM)
I believe that I need a knee operation and I am making anew appointment with my doctor soon to set up with a specialist. My wife has procaine pads from a previous injury and I have been using a few to relieve my knee pain. Will this show up as an illegal drugs on a drug test?
fionasmith  (March 17, 2016 1:43 PM)
I have had several dental appointments and a lot of teeth removed and replaced I have had several injections over a period of a few months, I have recently had a hair strand test to prove I am clean of heroin which came back as expected Negative but I have had positive for cocaine- I don't and wouldn't use cocaine I DON'T UNDERSTAND HOW??/ I AM FIGHTING to get my baby girl 👶 home and this is unbelievable I don't know wat to do am in court tomorrow and am now going to look so bad, please does anyone Know what's going on???????? PLEASE HELP ME!!!!!!!!!! XXX
Betty Penta  (May 15, 2016 10:40 AM)
Imy grandson tested positive for hair test and had recently had lidocain at dentist and lidocain patch for back pain How long does it stay in system if they want it repeated wouldn't it be the same
This could cause loosing a job that was a life time dream
Allexsis C.  (May 20, 2016 8:27 AM)
So glad I have found this website because I to recently lost my job due to my hair follicle drugtest coming back positive for cocaine and the metabolite present was something called benzolecgonine.I have never done drugs in my life and plus I am also pregnant so I was really in disbelief and didn't know what to do.When I went to the dentist I was given local anesthesia and about 5-6 shots of lidocaine because I was still feeling pain while he was trying to pull the tooth. Now about a week or two after I had my tooth pulled I took the drugtest and about a week later that's when I got a call from my employer saying that they have to let me go because of my positive result for cocaine! I was so hurt and immediately thought that it had to be a mistake because I don't use drugs, after multiple calls of trying to tell them that it had to be some sort of mistake,I was finally called back to do a re-test and it still came back positive for cocaine!I tried to think of everything that could cause something like this to happen and found a few things on the internet also stating that there were some sort of connection with dental work and positive results for cocaine. Really don't know what to do at this point but now I see that it has also happened to you guys as well so I know that it has to be due to the dental work. Something really has to be done about this.! I lost a really good job due to this bs. Smh
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