What Can Cause A False Positive For Cocaine?

In our latest question and answer, the pharmacist discusses what other medications can cause a false positive for cocaine.

Question

Can amoxicillin or hydroxyzine give my son a false positive for cocaine?

Asked by KMP On Jun 09, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Jun 09, 2022
Last updated Apr 20, 2024

Key points

  • Urine drug screens for cocaine most commonly look for its main metabolite, benzoylecgonine.
  • False-positive urine drug screening results for cocaine are extremely rare.

A variety of medications can cause a false positive result on a drug screen, but the occurrence of a false-positive result for cocaine is very rare. False positives are far more common for other medications such as amphetamines and opioids.

Cocaine False Positives

Most urine drug screens utilized to test for cocaine ingestion look for cocaine's main metabolite, benzoylecgonine.

One of the most utilized references regarding drug screenings, Urine Drug Screening: Practical Guide for Clinicians, reports that false-positives for cocaine are exceedingly uncommon. Per the guide:

"Cross-reactivity between this screen [urine] and substances other than cocaine are nearly nonexistent. Urine screens for cocaine are very accurate in detecting recent cocaine ingestion"

Nevertheless, there are a few reported substances that can cause false positives for cocaine. These include:

  • Consumption of natural products containing coca plant leaves
  • Topical cocaine for anesthesia

If you have received an unexpected positive result, it is recommended to perform a confirmatory test to make sure there was no handling or sample error.

We wrote extensively about "false-positives" in another article, which can be found here: What Cause False Positives On Drug Tests?

Below, we discuss various drug screening procedures..

Urine Drug Analysis For Cocaine

Urine drug analysis is commonly used as the standard for employment screenings as it is quick and painless. This procedure requires individuals to urinate into a medical cup. The test requires at least 30 mL of urine and will test for recent or new drug use.

To be considered a positive result for cocaine, the concentration of cocaine levels must be 300ng/ml or higher.

Though it is commonly thought that amoxicillin could cause a false positive result, one study found that the opposite is true. It concluded that amoxicillin is unlikely to produce a false positive urine screen for cocaine.

As of the writing of this article, there is no sufficient evidence showing that any prescription drug will consistently cause a false-positive for cocaine.

References

  • Failure of amoxicillin to produce false-positive urine screens for cocaine metabolite, PubMed
  • Urine Drug Screening: Practical Guide for Clinicians, Mayo Clinic Proceedings

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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