This report studies the importance of passive exposure of medical personnel to cocaine hydrochloride and its impact on urine screening testing. Eleven medical staff members were exposed to cocaine hydrochloride by means of aerosol and cutaneous application, similar to that which may occur in medical practice. Urine drug screening tests were negative for everyone tested. This finding is supported by known drug kinetics. It is unlikely that a single passive exposure of medical staff to cocaine hydrochloride will produce a positive urine screening test. In all cases of positive urine tests, contaminants should be tested for which may indicate a source of the drug. The routine use of gloves and masks—which is recommended to prevent HIV infection—should further decrease medical personnel's passive exposure to cocaine hydrochloride.
Get full access to this article
View all access options for this article.
References
1.
KozelNJCriderRAAdamsEH. National surveillance of cocaine use and related health consequences. MMWR1982;31:265–73.
2.
O'MalleyPMBachmanJGJohnstonLD. Period, age, and cohort effects on substance use among American youth 1976–82. Am J Public Health1984;74:682–8.
3.
Van TuinenMGrahamD. The prevalence of alcohol, tobacco, and other drugs among Missouri 12th graders. Mo Med1991;88:353–60.
4.
GillogleyKMEvansATHansenRLSamuelsSJBatraKK. The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening. Am J Obstet Gynecol1990;163:1535–42.
5.
WellsVEHalperinWThunM. The estimated predictive value of screening for illicit drugs in the workplace. Am J Public Health1988;78:817–9.
6.
CohenS. Drugs in the workplace. J Clin Psychiatry1984;45:4–8.
7.
Survey of employer anti-drug programs. Washington, DC: Bureau of Labor Statistics, 1989. U. S. Dept. of Labor report 760.
8.
ZwerlingCRyanJOravE. The efficacy of pre-employment drug screening for marijuana and cocaine in predicting employment outcome. JAMA1990;264:2639–43.
9.
SchwartzRH. Urine testing in the detection of drugs of abuse. Arch Intern Med1988;148:2407–12.
10.
SchwartzRHAltieriMBogemaS. Topical anesthesia using TAC (tetracaine, adrenalin, and cocaine) produces “dirty urine”. A word of caution (Letter). OTOLARYNGOL HEAD NECK SURG1990; 102: 200–1.
SheenJH. Topical nasal anesthesia with cocaine. JAMA1978;239:235–6.
13.
Cocaine. In: EllenhomMJBarcelouxDG, eds. Medical toxicology: diagnosis and treatment of human poisoning. New York: Elsevier, 1988: 645–61.
14.
BralliarBBSkarfBOwensJB. Ophthalmic use of cocaine and the urine test for benzoylecgonine (Letter). N Engl J Med1989;320:1757.
15.
ElSohlyMAStanfordDFElSohlyHN. Cocoa tea and urinalysis for cocaine metabolites (Letter). J Anal Toxicol1986;10:256.
16.
HeidemannSMGoettingMG. Passive inhalation of cocaine by infants. Henry Ford Hosp Med J1990;38:252–4.
17.
ElSohlyMA. Urinalysis and casual handling of marijuana and cocaine (Letter). J Anal Toxicol1991;15:46.
18.
Guidelines for a drug-free workplace. Federal Register, April 11, 1988.
19.
AmbreJFischmanMRuoT. Urinary excretion of ecgonine methyl ester, a major metabolite of cocaine in humans. J Anal Toxicol1984;8:23–5.
20.
ResnickRBKestenbaumRSSchwartzLK. Acute systemic effects of cocaine in man: A controlled study by intranasal and intravenous routes. Science1977;195:696–8.
21.
Van DykeCJatlowPUngererJ, et al. Oral cocaine: Plasma concentrations and central effects. Science1978;200:211–3.
22.
AmbreJ. The urinary excretion of cocaine and metabolites in humans: A kinetic analysis of published data. J Anal Toxicol1985;9:241–5.
23.
WilkinsonPVan DykeCJatlowP, et al. Intranasal and oral cocaine kinetics. Clin Pharmacol Ther1980;27:386–94.
24.
JavaidJIFischmanMWSchusterCRDekirmenjianHDavisJM. Cocaine plasma concentrations: Relation to physiological and subjective effects in humans. Science1978;202:227–8.
25.
HamiltonHEWallaceJEShimekELJrLandP, et al. Cocaine and benzoylecgonine excretion in humans. J Forensic Sci1977;22:697–707.
26.
BuddRDMathisDFYangFC. TLC analysis of urine for benzoylecgonine and norpropozyphene. Clin Toxicol1980; 16: 1–5.
27.
WallaceJEHamiltonHEKingDEBasonDJSchwertnerHAHarrisSC. Gas-liquid chromatographic determination of cocaine and benzoylecgonine in urine. Anal Chem1976;48:34–8.
28.
KoganMJVerebeyKGDePaceACResnickRBMuleSJ. Quantitative determination of benzoylecgonine and cocaine in human biofluids by gas-liquid chromatography. Anal Chem1977;49:1965–9.
29.
JacobPBakerBA EliasJonesRTBenowitzNL. Determination of cocaine in plasma by automated gas chromatography. J Chromatogr1984;306:173–81.
30.
AppelTAWadeNA. Screening of blood and urine for drugs of abuse utilizing diagnostic products corporation's Coat-a-Count Radioimmunoassay kits. J Anal Toxicol1989;13:274–6.
