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Test Code COKEM Cocaine and Metabolites Confirmation, Meconium

Reporting Name

Cocaine and Metabolites, Confirm, M

Useful For

Detecting in utero drug exposure up to 5 months before birth

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Meconium


Ordering Guidance


For chain-of-custody testing, order COKMX / Cocaine and Metabolite Confirmation, Chain of Custody, Meconium.



Specimen Required


Supplies: Stool container, Small (Random), 4 oz (T288)

Container/Tube: Stool container

Specimen Volume: 1 g (approximately 1 teaspoon)

Collection Instructions: Collect entire random meconium specimen.


Specimen Minimum Volume

0.3 g (approximately 1/4 teaspoon)

Specimen Stability Information

Specimen Type Temperature Time
Meconium Frozen (preferred) 21 days
  Refrigerated  21 days
  Ambient  72 hours

Reference Values

Negative

 

Positive results are reported with a quantitative liquid chromatography tandem mass spectrometry (LC-MS/MS) result.

 

Cutoff concentrations for LC-MS/MS testing:

Cocaine: 20 ng/g

Benzoylecgonine: 20 ng/g

Cocaethylene: 20 ng/g

m-Hydroxybenzoylecgonine: 20 ng/g

Day(s) Performed

Monday through Sunday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

G0480

80353 (if appropriate for select payers)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
COKEM Cocaine and Metabolites, Confirm, M 69008-1

 

Result ID Test Result Name Result LOINC Value
31859 Cocaine 69009-9
31860 Benzoylecgonine 69010-7
31861 Cocaethylene 69011-5
31862 m-Hydroxybenzoylecgonine 69012-3
31864 Interpretation 69050-3
31865 Chain of Custody 77202-0

Interpretation

The presence of any of the following: cocaine, benzoylecgonine, cocaethylene, or m-hydroxybenzoylecgonine, at 20 ng/g or more, is indicative of in utero drug exposure up to 5 months before birth.

Clinical Reference

1. Isenschmid DS. Cocaine. In: Levine B, ed. Principles of Forensic Toxicology. 2nd ed. AACC Press; 2003:207-228

2. US Drug Enforcement Administration: Cocaine. DEA; 2020. Accessed June 2, 2025. Available at https://www.dea.gov/factsheets/cocaine

3. National Institute on Drug Abuse: Cocaine DrugFacts. NIDA; 2021. Accessed June 2, 2025. Available at www.drugabuse.gov/publications/drugfacts/cocaine

4. Isenschmid DS. Cocaine-effects on human performance and behavior. Forensic Sci Rev. 2002;14(1-2):61-100

5. Kolbrich EA, Barnes AJ, Gorelick DA, Boyd SJ, Cone EJ, Huestis MA. Major and minor metabolites of cocaine in human plasma following controlled subcutaneous cocaine administration. J Anal Toxicol. 2006;30(8):501-510

6. Kwong TC, Ryan RM. Detection of intrauterine illicit drug exposure by newborn drug testing. National Academy of Clinical Biochemistry. Clin Chem. 1997;43(1):235-242

7. Ostrea EM Jr, Brady MJ, Parks PM, Asensio DC, Naluz A. Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr. 1989;115(3):474-477

8. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv. 2005;60(1):45-74

9. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020.

10. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. St Louis, MO: Elsevier; 2023:chap 43

Report Available

2 to 3 days

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

Forms

If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.