Because cocaine is weakly basic and oral fluid is generally more acidic than plasma, the concentration of ionized cocaine in oral fluid is generally higher than plasma and is detectable for longer time periods as compared to plasma. When cocaine is consumed by smoking or through intranasal routes, oral fluid/plasma ratio is higher for several hours. There are a number of reports on excretion of cocaine and its metabolites in oral fluid. Cocaine and its metabolites (anhydroecgonine, benzoylecgonine and ecgonine methyl ester) appear in oral fluid after intravenous injection, inhalation and intranasal administration of the drug. At higher concentrations, cocaine concentrations exceed benzoylecgonine and ecgonine methyl ester concentrations. However, at a level less than 100ng/mL, the concentrations of cocaine, benzoylecgonine and ecgonine methyl ester in oral fluid are comparable. SAMHSA-proposed cutoffs are 20 ng/mL for screening (cocaine metabolites) and 8 ng/mL for confirmation (cocaine or benzoylecgonine). The methods of analyses of cocaine and its metabolites include immunoassays (68), GC-MS (69-71) and LC-MS (72).

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