Cotinine testing- can light smokers still pass the tests?

Yes, unless you're lying about 1 ciggie a day. Yes, it could be attributed to second-hand smoke.

Here is a chart of cotidine serum level vs reported cigs/day:

http://www.fbr.org/publications/pamphlets/cotinine...

(NB: FBR is not an independent research foundation; it is an advocate for cotinine testing. FBR makes money administering cotidine tests.)

The width of each horizontal red line is proportional to the number of people with that serum level of cotinine. Look at the data for the pack-a-day smokers. (1 pack = 20 cigarettes, for you nonsmokers.) Most of the datapoints fall between 50 and 280 ng/mL, with outliers as high as 700 ng/mL. Now, I'm inclined to believe that (1) smokers may under-report but will never over-report their cigarette use, so I'm confident that 50 ng/mL represents pack-a-day smokers with fast cotidine metabolism. I also know that (2) when people hedge, there is a limit to how far most of them will stray from a known target number. (psychologists call this "anchoring" for you non-social scientists), so I think that 280 ng/mL may represent two- but probably not three-pack-a-day smokers with fast metabolism, understating their habit by a factor of two but probably not three. In other words, you might claim that your 30 cigarettes/day is a pack-a-day habit, and maybe even your 39 cigarettes/day if you're particularly brazen or deluded, but 50 or 60? Not likely.

Looking at the data this way, there's at least a 2:1 to 3:1 range in cotinine levels for a given frequency of smoking. Let's assume that I've underestimated how deceitful smokers are and use the larger 3:1 range. The range of serum cotinine levels at 20 cigs/day then is 50-150 ng/mL. If the measured level is proportional to exposure, then at 1 cig/day you'd expect to see a range of 2.5-7.5 ng/mL.

According to FBR,

"Cotinine levels <10 ng/mL are considered to be consistent with no active smoking. Values of 10 ng/mL to 100 ng/mL are associated with light smoking or moderate passive exposure, and levels above 300 ng/mL are seen in heavy smokers - more than 20 cigarettes a day." [ibid, "What are the cutoffs that FBR uses?"]

In other words, FBR can't reliably detect a 1 cig/day habit, probably not even 2 cig/day. So, if you've told no lies here and you only smoke 1 cig/day, you probably didn't need to quit at all as long as you didn't light up in the morning before the test.

Cotinine has a reported half-life of between 20 and 24 hours. After 72 hours, on average the serum cotinine level should fall to 1/12 to 1/8 of its average daily level. According to the most conservative estimate, even a 10 cig/day habit would be undetectable after 72 hrs:

(150 ng/mL / 20 cig/day) x (10 cig/day) x (1/8) < 10 ng/mL

If you don't pass, challenge the validity of the result and demand to be retested. FBR has dramatically overstated the precision of this test in identifying smokers. Take a look now at the data for non-smokers (0 cigarettes/day). See the tic mark at the very bottom of the column? That's 10 ng/mL, the dividing line according to FBR between smoker and non-smoker. Either FBR had the bad luck to test almost no non-smokers, or FBR has unethically (and perhaps illegally, if this is being used to price insurance coverage) misrepresented the serum levels of non-smokers, reporting almost everyone, including true non-smokers, as either light smokers or a heavy smokers.

FBR recognizes the fallibility of their test for identifying any but heavy, habitual smokers:

"Can cotinine levels be used reliably in custody cases? FBR discourages the inappropriate dependence on cotinine levels in this type of scenario... Cotinine levels may reflect cigarette exposure, but may not be useful in determining responsibility."

That doesn't prevent an insurer from using an inconclusive test result to deny coverage or add a surcharge, but the insurer probably also recognizes the limits of the test. If the efficacy of the test was successfully challenged in a court of law, the insurer would lose a profitable tool for identifying heavy, habitual smokers. If a "light smoker" challenges the result of the test, a prudent insurer would almost certainly fold, either permitting a retest or disregarding the result altogether. If they don't, you'll have excellent grounds for a civil lawsuit.

The best response if you test positive is simply to challenge the result without giving any reason except that you don't smoke. Whatever the result, it's almost surely lost in the error bounds of the test. If you need an excuse, second-hand smoke would do fine:

"Second hand smoke can be responsible for relatively high cotinine levels; patients should be advised to reduce their exposure to second hand smoke." [ibid, "FBR's cotinine report suggests that my patient may be a light smoker..."]

In fact, because nicotine is metabolized to cotinine much more rapidly than cotinine is metabolized and excreted - this is the basis of the test, after all - one exposure is enough to cause a false positive result. Were you singing republican songs with at an Irish pub the night before, or discussing politics with French friends after dining with them? That could do it, and you couldn't reasonably be retested until the cotinine was excreted, giving you at least another 3 days to detox. Or, convince them that you've been taking large doses of vitamin B3 (nicotinamide) because you're worried about cholesterol. Cotinine is also an intermediate of B3 metabolism, which of course is a weakness of the test at low cotinine concentrations. (Of course, it may not be wise to convince the insurer that you're a hypochondriac.)

If you add your country to your question, I'd be happy to put this in front of the appropriate national authorities and/or WHO.

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Your 'best answer' is totally incorrect. For a very light smoker continine levels start at 1,000ng. For a regular smoker it's 4,000ng. I have failed 2 continine tests for smoking and I am a non smoker. Just being in a room with smokers 2 days before the test was enough to set me over the limit. There is absoutely no way you can smoke 1 cigerette a day and expect to pass any test for at least 5 days. If you are taking the 10ng test then you'll need 7 days away from all smoke if you hope to pass, this includes passive smoking.

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RE :Cotinine testing- can light smokers still pass the tests?

I smoke 1 cigarette every day after work. Now we have to take a cotinine test for insurance (either blood or saliva). If I stop 3 days prior would I pass? And if I didn't-- could this amount be attributed to second-hand smoke?

11 following 9 answers

Not sure, as I'm not a smoker, but I have taken these tests before and one of the rules is not to drink much water beforehand. My experience: I had peed just prior to a random selection for testing, had to come back later in the day for the test when my bladder wasn't dry, and was told not to drink more than a glass of water as that would dilute the results.

Again, I'm no expert, but maybe drinking lots of water before the test you're worried about could help.

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RE :Cotinine testing- can light smokers still pass the tests?

I smoke 1 cigarette every day after work. Now we have to take a cotinine test for insurance (either blood or saliva). If I stop 3 days prior would I pass? And if I didn't-- could this amount be attributed to second-hand smoke?

10 following 12 answers

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Well, given that a person who doesn't even know they are being exposed to second-hand smoke (because there's so little of it) can't pass, the answer is a pretty confident no.

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