Workers who smoke cigarettes are more expensive to employ. Why? Because smoking negatively affects the health of smokers which increases the cost of health care insurance—to the tune of $193 billion between 2000 and 2014. Consider that lost productivity accounted for $97 billion and health care expenditures accounted for $96 billion. Wow! No wonder employers are interested in hiring workers who do not smoke and the Affordable Care Act, commonly known as Obamacare, actually paves the way for employers to screen applicants and employees for Cotinine, a metabolite of Nicotine that proves that a person has been smoking.
Whether you are considering cotinine testing for employment or as part of a corporate wellness program, to screen job applicants or deter smoking as part of a cessation program you need to consider testing for cotinine.
Tobacco use is the single most preventable cause of disease, disability, and
death in the United States with an estimated 443,000 premature deaths each year
– another 8.6 million people live with serious illness caused by smoking.1
In 1984, Surgeon General C. Everett Koop presented the first of a series of reports revealing the health consequences of tobacco use including involuntary exposure. While the United States has not overcome the challenges of the the “smoke-free” society that Koop hoped for by the year 2000, industries across the country now recognize the importance of testing.
For over 20 years, OraSure Technologies has offered a wide range of tobacco (cotinine) testing products for multiple specimen types and 20 years, OraSure Technologies has offered a wide range of tobacco (cotinine) testing products for multiple specimen types and thus is well qualified to meet today’s challenges.
OraSure Lab-based Saliva Cotinine Test will give you an exact measurement of cotinine which you can access on an Internet system 24/7.
shelf life of 15-18 months
1. Why test for cotinine and not nicotine?
Cotinine is the first-stage metabolite of nicotine.
Because the window of detection for nicotine is
relatively short (approximately 2 hours), cotinine
extends the window of detection for several days and
is the preferred method of screening for tobacco use.3
2. Which sample types can be tested for cotinine?
OraSure manufactures laboratory-based cotinine tests
for urine, serum and oral fluid samples. Concentrations
will vary depending on sample type but each provide
comparable positive rates. For oral fluid testing, oral
fluid is collected with the OraSure® Oral Specimen
Collection Device and screened by the laboratory with
our corresponding test.
3. Will a second-hand smoke exposure produce
a positive result?
No. In numerous studies, cotinine detection levels
have been examined across specimen types and
exposure rates for passive exposure. Cotinine tests
have been clinically designed to accomodate for the
minute traces commonly found from second-hand
exposure when compared to levels found in smokers.
The cutoff value of these tests are set by OraSure to
properly distinguish passive exposure from true
smokers. Below are some common examples of
testing outcomes:4-6
As you’ll note, the lower concentration of second-hand smoke is well below the test cutoff, and therefore would not be reported as a positive. In addition, urine tests are typically much higher than serum or oral fluid as a result of the higher concentrations of cotinine found in urine. However, the positive rates across sample types remains relatively similar.7
4. Can the cotinine level be used to determine
the type and volume of tobacco used?
No. While it’s true that the more a person smokes,
the higher the cotinine level is likely to be, a number
of contributing factors influence testing outcomes
such as:
• Size of the individual
• Percentage of body fat present
• Rate of metabolism
• Hydration state of the individual
• Type of cigarette/cigar/pipe smoked
or tobacco chewed
• Smoking style
• Elapsed time from smoking to testing
• The pH of the urine (if urine testing is conducted)
5. What practices or other substances may be
used that could generate a positive cotinine
test result?
Certain cultures found in India or Asia are known to
chew and ingest betelnuts. The preparation of this
product is commonly mixed with tobacco producing a
positive cotinine test result.8 Additionally, certain
vegetables contain small concentrations of nicotine
like eggplant or tomatoes. Only copious amounts
consumed could trigger a cotinine positive test result.3
Finally, cotinine may also be found amongst tobacco
workers who strip the tobacco leaves from their stalks.
Absorption through the skin can produce a positive
result even if the worker does not in fact smoke. There
are a few other examples where a positive result may
occur from a non-smoker but theses circumstances are
very rare. Investigation of the individual’s lifestyle or
occupation typically uncovers these anomalies.
6. Which testing method is
the most accurate?
The different cutoffs in the three
test types generate similar
sensitivity and specificity for the cotinine tests with similar
windows of detection. The better
question to ask is which method
best suits my testing purposes.
If a flexible, non-invasive format is
what you need for your testing
program, then the OraSure® Oral
Fluid Specimen Collection
Device offers the same
performance as our urine and
serum tests while providing
optimal versatility in the cotinine
testing industries.
7. How is the sample
collected?
The donor controls his or her
own sample under direct visual supervision. The
“collector” really is an observer and not in the “chain-of-
custody” – the process most often legally
challenged. If the donor wants to challenge the
collection, the only person to challenge is the donor.
The entire process can be completed anytime –
anywhere and takes just minutes to administer.
8. What is the stability of the sample and how is
it shipped?
Specimens stored in the Oral Fluid Specimen Vial may
be kept at 39ºF to 98ºF for up to 21 days (including the
time for shipping and testing). Shipping of the
specimen is generally done via overnight courier as
part of your arrangement with the laboratory.
9. How is the sample analyzed?
Oral fluid samples are screened in a certified laboratory
using the OraSure® MICRO-PLATE tests which use
enzyme immunoassay technology (EIA), proven
reliable for routine cotinine testing. Studies have
shown that there is good agreement between test
results and confirmation testing by gas
chromatography/mass spectrometry
(GC/MS or GC/MS/MS). Your laboratory
can help you set up confirmation
strategies in accordance with your
testing policy.
10. What is the detection window
for oral fluid?
Just like traditional urine drug testing,
the window in oral fluid testing is
similar for cotinine. What we have
found is that oral fluid screening
identifies recent usage that can be
missed by urine testing. Oral fluid
samples provide a close match to drug
levels in blood, identifying donors that
are under the influence at the time the
sample is collected. Since the
OraSure® testing system detects the nicotine
metabolite, the window of detection in oral fluid starts
almost immediately after tobacco use and can last up
to about three days.
11. Can oral fluid be adulterated?
OraSure Technologies has studied a wide range of
compounds and techniques available today, and has
not identified any that can alter the results of the test.
Furthermore, the risk of the donor introducing any
compound into the vial is highly unlikely since every
collection is directly and easily observed. These facts
will cut all costs associated with adulterant and
dilution testing common with urine testing.
12. What are the economic advantages of using
oral fluid?
Oral fluid drug testing, with its “anywhere / anytime”
collection process, results in significantly lower costs
associated with collections, scheduling fees, and lost
time on the job. Oral fluid collections reduce the labor
costs for gender-specific collectors and shy-bladder
syndrome (can’t go), and eliminate
dilution testing – all of which
contribute to the higher costs of
urine testing.
13. How soon can you expect
your results?
The lab receives samples via
overnight courier. Testing is
performed the day samples arrive
and positive or negative results are
reported within 24 hours. Should
confirmation testing be required,
an additional 24 to 48 hours should
be expected.
14. Is oral fluid a biohazard?
No. OSHA does not consider oral fluid
collection hazardous. In addition, oral fluid specimens
are not subject to the same handling and disposal
procedures that are issues with other bodily fluids.
15. Who uses OraSure?
Millions of OraSure® Collection Devices have been
utilized nationally and internationally by large and
small organizations over the past 20 years. These
include insurance companies for insurance risk
assessment, hospitals and businesses for health and
wellness programs, as well as companies conducting
research or clinical trial applicant evaluations.
16. How is training done?
Test administrators can be trained and certified in
about an hour by our OraSure sales and technical staff.
This can be done by phone, in person, or with a webbased
training class.
17. Who is OraSure Technologies?
OraSure has a 20-year legacy of offering accurate and
precise enzyme immunoassay (EIA) products for
laboratory testing. We have a long history of meeting
the needs of the substance abuse testing industry. Our
team of scientists pioneered oral fluid testing and has
led the industry with innovative and cost-effective
solutions. OraSure manufactures and sells products for
testing drugs, alcohol, Flu, HIV, and HCV.
References: 1) CDC. Tobacco Use–Targeting the Nation’s Leading Killer, 2011. 2) National Library of Medicine. The C. Everett Koop Papers. Tobacco, Second-Hand Smoke, and the Campaign for a Smoke-Free America, http://profiles.nlm.gov/ps/retrieve/narrative/QQ/p-nid/85, accessed 9/21/11. 3) Benowitz, N. Cotinine as a Biomarker of Environmental Tobacco Smoke Exposure. Epidemilogic Reviews, 1996; 18(2):188-204. 4) Zuccaro, P. et al. Serum Cotinine as a Marker of Environmental Tobacco Smoke Exposure in Epidemiological Studies: The Experience of the MATISS Project. European Journal of Epidemiology, 2003; 18(6):487-92. 5) Jenkins, R. et al. Personal Exposure to Environmental Tobacco Smoke: Salivary Cotinine, Airborne Nicotine, and Nonsmoker Misclassification. Journal of Exposure Analysis and Environmental Epidemiology, 1999; 9(4):352-63. 6) Haufroid, V. et al. Urinary Cotinine as a Tobacco-Smoke Exposure Index: A Minireview. International Archives of Occupational Environmental Health, 1998; 71:162-68. 7) OraSure Technologies, Inc., Auto-Lyte® Cotinine EIA Serum, Auto-Lyte® Cotinine EIA Urine, Cotinine Urine Micro-Plate EIA, Cotinine Serum Micro-Plate EIA, OraSure® Oral Fluid Cotinine Micro-Plate EIA Package Inserts. On file at OraSure. 8) Hu, Chiung-Wen, et al. High-Throughput Siultaneous Analysis of Five Urinary Metabolites of Areca Nut and Tobacco Alkaloids by Isotope-Dilution Liquid Chromatography-Tandem Mass Spectrometry with On-Line Solid-Phase Extraction. Cancer Epidemiology, Biomarkers & Prevention, 2010; 19(10):2570-2581.