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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.

 
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Comments
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!
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