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HelpTest Code COKMX Cocaine and Metabolite Confirmation, Chain of Custody, Meconium
Useful For
Detecting in utero drug exposure up to 5 months before birth
Chain of custody is required whenever the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was under the control of personnel involved with testing the specimen at all times; this control implies that the opportunity for specimen tampering would be limited. Since the evidence of illicit drug use during pregnancy can be cause for separating the baby from the mother, a complete chain of custody ensures that the test results are appropriate for legal proceedings.
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COCH | Chain of Custody Processing | No | Yes |
Reporting Name
Cocaine and metabolite Conf, CoC, MSpecimen Type
MeconiumSpecimen Required
Supplies: Chain of Custody Meconium Kit (T653) includes the specimen containers, seals, and documentation required.
Specimen Volume: 1 g (approximately 1 teaspoon)
Collection Instructions: Collect entire random meconium specimen.
Additional Information:
1. Specimen that arrives with a broken seal does not meet the chain of custody requirements.
2. The laboratory recommends sending chain-of-custody specimens by overnight shipment.
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Meconium | Frozen (preferred) | 21 days | |
| Refrigerated | 21 days | ||
| Ambient | 72 hours |
Reject Due To
| Other | Grossly bloody reject, Pink OK |
Clinical Information
Cocaine is an alkaloid found in Erythroxylon coca, which grows principally in the northern South American Andes and, to a lesser extent, in India, Africa, and Java.(1) Cocaine is a powerfully addictive stimulant drug. Cocaine abuse has a long history, is rooted in the drug culture in the United States,(2) and is one of the most common illicit drugs of abuse.(3,4) Cocaine is rapidly metabolized primarily to benzoylecgonine, which is further metabolized to m-hydroxybenzoylecgonine (m-HOBE).(1,5) Cocaine is frequently used with other drugs, most commonly alcohol, and the simultaneous use of both can be determined by the presence of the unique metabolite cocaethylene.(4)
Intrauterine drug exposure to cocaine has been associated with placental abruption, premature labor, small for gestational age status, microcephaly, and congenital anomalies (eg, cardiac and genitourinary abnormalities, necrotizing enterocolitis, and central nervous system stroke or hemorrhage).(6)
The disposition of drug in meconium, the first fecal material passed by the neonate, is not well understood. The proposed mechanism is that the fetus excretes drug into bile and amniotic fluid. Drug accumulates in meconium either by direct deposition from bile or through swallowing of amniotic fluid.(7) The first evidence of meconium in the fetal intestine appears at approximately the 10th to 12th week of gestation, and slowly moves into the colon by the 16th week of gestation.(8) Therefore, the presence of drugs in meconium has been proposed to be indicative of in utero drug exposure during the final 4 to 5 months of pregnancy, a longer historical measure than is possible by urinalysis.(7)
Chain of custody is a record of the disposition of a specimen to document each individual who collected, handled, and performed the analysis. When a specimen is submitted in this manner, analysis will be performed in such a way that it will withstand regular court scrutiny.
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.
Cautions
No significant cautionary statements
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 February 7, 2023. Available at www.dea.gov/sites/default/files/2020-06/Cocaine-2020.pdf
3. National Institute on Drug Abuse: Cocaine DrugFacts. NIDA; 2021 Accessed February 8, 2023. Available at www.drugabuse.gov/publications/drugfacts/cocaine
4. Isenschmid DS: Cocaine-effects on human performance and behavior. Forensic Sci Rev. 2002 Feb;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 Oct;30:501-510
6. Kwong TC, Ryan RM: Detection of intrauterine illicit drug exposure by newborn drug testing. National Academy of Clinical Biochemistry. Clin Chem. 1997 Jan;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 Sep;115(3):474-477
8. Ahanya SN, Lakshmanan J, Morgan BLG, Ross MG: Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv. 2005 Jan;60(1):45-56
Method Description
Meconium is mixed with internal standard and extracted with methanol. The methanolic extract is further processed by solid-phase extraction. The extract is analyzed by liquid chromatography tandem mass spectroscopy.(Unpublished Mayo method)
Day(s) Performed
Monday through Sunday
Report Available
2 daysSpecimen Retention Time
2 weeksPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
80353
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| COKMX | Cocaine and metabolite Conf, CoC, M | 69008-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 36166 | Cocaine | 69009-9 |
| 36167 | Benzoylecgonine | 69010-7 |
| 36168 | Cocaethylene | 69011-5 |
| 36169 | m-Hydroxybenzoylecgonine | 69012-3 |
| 36170 | Interpretation | 69050-3 |
| 36171 | Chain of Custody | 77202-0 |
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Specimen Minimum Volume
0.3 g (approximately 1/4 teaspoon)
Reference Values
Negative
Positives are reported with a quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS) result.
Cutoff concentrations for LC-MS/MS testing:
Cocaine: 20ng/g
Benzoylecgonine: 20 ng/g
Cocaethylene: 20 ng/g
m-Hydroxybenzoylecgonine: 20ng/g
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.Forms
1. Chain of Custody Request is included in the Chain-of-Custody Meconium Kit (T653).
2. If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.