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Blood Test Tracker

Urine Cocaine Metabolite (Benzoylecgonine) Screen

A urine screen for benzoylecgonine, the main breakdown product of cocaine. It shows recent exposure, usually over the past few days.

AI-drafted. Awaiting verificationAlso called COC, BZELOINC 14314-9

What it is

Your body breaks cocaine down quickly into benzoylecgonine, which leaves in urine. This test looks for that breakdown product. It is usually an immunoassay screen that reports only negative or positive against a set cutoff, such as 150 or 300 ng/mL. It does not show how much was taken or exactly when.

Why it matters

A clinician may order it as part of a drug screen for a medical evaluation, treatment or monitoring, and an employer or program may require it. It is a snapshot of recent exposure and not a diagnosis of any condition. Because screening tests can occasionally be wrong, a positive result is usually followed by a second, more specific test. If a result is unexpected, talk with the clinician or review officer who ordered it.

If it’s high

A positive result means the lab found benzoylecgonine at or above its cutoff. This most often reflects cocaine use in the last few days. Tea made from coca leaves can also cause it. A screen result on its own is preliminary, and a confirmation test is the step that settles it.

Common causes

  • Cocaine use in the past few days
  • Tea made from coca leaves
  • A false-positive screen result, which a confirmation test can rule out

What can help

  • Ask whether the result was only a screen and whether it was confirmed with a second test
  • If this was a workplace or program test, ask how to speak with the medical review officer
  • If you use substances and want support, ask your clinician about confidential help

What can affect your result

  • Time since last use: the test reflects recent use, usually the past few days
  • How dilute the urine is
  • The lab's cutoff (150 or 300 ng/mL are common)
  • Coca-leaf tea
  • Whether the result is a screen or a confirmed result
  • Very dilute urine, from drinking a lot of fluid or taking water pills, can bring a low level below the test's cutoff and give a negative result.
  • Tea made from coca leaves (sometimes sold as 'Inca' or 'coca' tea) can cause a positive result.
  • Immunoassays for this metabolite rarely react with other substances, but first-step urine screens in general can give false positives, so a positive screen is usually confirmed with a second test.
  • Labs use different cutoffs for the screen, commonly 150 or 300 ng/mL. A lower cutoff can detect use for longer.

Any time of day. Reflects recent use only, usually the past few days. Heavier or repeated use and a lower cutoff can make it show up for longer.

When to talk to a clinician

A urine screen cannot tell how much was used or whether someone is in danger. If you or someone else has chest pain, trouble breathing, a racing or irregular heartbeat, confusion, seizures or fainting after using any substance, call 911 or your local emergency number.

Questions you could ask

  • How long after use can this test detect cocaine?
  • Was my sample reported as dilute, and does that matter for how the result is read?
  • Was this a screening result, and was it confirmed with a second test?
  • Is there anything I eat, drink or take that could explain it?

Questions people ask

How long does cocaine show up in urine?

Usually for a few days after use. How long depends on how much and how often someone used it and on the lab's cutoff, and a lower cutoff, like the federal 150 ng/mL screen, can detect use for longer.

Can something else cause a positive cocaine screen?

These tests are fairly specific for the cocaine breakdown product, so other drugs rarely cause a false positive, although it can happen. Tea made from coca leaves can also cause a positive result. Because screening tests can be wrong, a positive result is usually checked with a second test.

What does 'negative, dilute' mean?

The lab found no cocaine metabolite above its cutoff, but the urine was more watery than usual. Very dilute urine can hide a low level, so some programs ask for a new sample.

Show the science and sources

For clinicians and researchers

Initial tests are usually urine immunoassays directed at benzoylecgonine (BZE), the major cocaine metabolite, reported qualitatively against a cutoff. Cocaine is metabolized rapidly, so the detection window is short, generally a few days after use, and it lengthens with heavier or repeated use and with a lower cutoff; published windows vary by source. The HHS Mandatory Guidelines for urine (88 FR 70768, 2023) set the federal initial test cutoff for cocaine metabolite at 150 ng/mL and the confirmatory cutoff for benzoylecgonine at 100 ng/mL. Mayo Clinic Laboratories' monitoring profiles screen at 150 ng/mL by immunoassay with GC-MS as needed, and state that they are for clinical monitoring, not employment testing. LOINC has cutoff-specific screen codes for 150 and 300 ng/mL, so both cutoffs are in use. Benzoylecgonine immunoassays are fairly specific, but false-positive screens have been reported, which is why a positive screen is confirmed by a second, more specific method. Specimen validity: under the federal criteria a primary specimen is reported dilute when creatinine is at least 2 and below 20 mg/dL with specific gravity above 1.0010 and below 1.0030. Dilution lowers analyte concentrations, so a negative result on a dilute specimen is less conclusive than a negative on a normal specimen.

LOINC 14314-9 (primary), 19359-9, 3393-6, 43984-4, 43985-1, 42241-0, 14315-6. Specimen: urine.

Sources

  1. Mandatory Guidelines for Federal Workplace Drug Testing Programs (urine), 88 FR 70768, U.S. Department of Health and Human Services (Federal Register) (2023)
  2. CSMPU: Controlled Substance Monitoring Profile, Random, Urine (Mayo Clinic Laboratories catalog, mirrored at testcatalog.org), Mayo Clinic Laboratories
  3. Drug Testing, MedlinePlus (U.S. National Library of Medicine)
  4. Accidental Detection of Cocaine in Urine in Pediatric Patients: Case Series and Literature Review, Children (Basel) (2024)
  5. Residents' Knowledge regarding Recreational Drug Screening Immunoassays at a Swiss Hospital Group, International Journal of Analytical Chemistry (2024)
  6. LOINC codes verified with the NLM Clinical Tables LOINC search, U.S. National Library of Medicine

AI-drafted. Awaiting verification. Last reviewed 2026-10-03. How we build and check these pages.

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