Test Quick Guide

Nicotine or cotinine testing detects evidence of nicotine use and presumed tobacco usage. Testing is often performed on a urine or saliva sample but may also use samples of blood or hair. Nicotine and cotinine testing may be used in a variety of circumstances, including before starting a new insurance policy and to confirm that you have quit using tobacco in a smoking cessation program.

About the Test

Purpose of the test

A nicotine test or cotinine test (cotinine is a metabolite of nicotine) is used to detect evidence of nicotine use and presumed tobacco usage. Testing may be performed in various settings:

  • Smoking cessation programs: Levels of nicotine and/or cotinine may be measured to estimate the amount of nicotine consumed before quitting, as well as to confirm you have quit using tobacco and other nicotine products.
  • Insurance medical exam: While not all insurance companies require a medical exam or nicotine and cotinine testing, some may require that applicants be tested for nicotine exposure as part of a medical exam performed before approving an insurance policy.
  • Employment testing: Many employers restrict tobacco use in the workplace, and nicotine or cotinine tests may be required if you apply for a job prohibiting smoking.
  • Medical testing: Nicotine exposure may be measured before qualifying for surgery or organ transplantation and in cases of suspected nicotine poisoning. Tobacco use increases the risk of poor wound healing and can cause other side effects after an organ transplant. Nicotine poisoning is uncommon, mostly occurring in children who accidentally ingest nicotine patches, gum, or e-cigarette liquid.

What does the test measure?

Nicotine is an addictive chemical naturally found in the leaves of tobacco plants. After fermentation and drying, tobacco leaves may be smoked, chewed, or sniffed. Freebase nicotine or nicotine salts can also be produced synthetically in a laboratory, and nicotine can be used as an ingredient in products like nicotine replacement therapy, e-cigarette liquids, and tobacco-free nicotine products.

Testing for exposure to nicotine detects certain substances in a person’s urine, saliva, blood, or hair sample. Depending on the type of test used, nicotine exposure can be detected by testing levels of nicotine, cotinine, and other substances:

  • Nicotine testing: Although the amount of nicotine in the body may be measured during testing, it is only detectable in the body for a brief time (a few hours) after exposure and may not be a reliable way to detect exposure.
  • Cotinine testing: Exposure to nicotine leads to measurable levels of cotinine in the blood. Cotinine is a metabolite of nicotine produced when nicotine is broken down in the body, primarily by the lungs, liver, and kidneys. It remains in the body longer (up to a few days) than nicotine, so it is a more reliable test to detect and measure nicotine exposure.
  • Other tests: Additional nicotine metabolites that can be measured in the body include trans-3′-hydroxycotinine and nornicotine, although testing for these is less common. Other substances, such as anabasine, may be measured to help distinguish between tobacco use and nicotine replacement therapies.

Nicotine is easily absorbed into the blood following nicotine exposure, leading to increased levels of nicotine and cotinine in the body. There are many ways you may be exposed to nicotine:

  • Tobacco products: Smoked tobacco includes cigarettes, cigars, bidis, kreteks, and loose tobacco used in hookahs or pipes. Chewing tobacco, snuff, dip, and snus are some chewed or sniffed products. Lozenges, strips, or sticks that contain nicotine dissolve in your mouth. Nicotine can also be absorbed through the skin by workers who harvest tobacco and produce its products.
  • Secondhand and thirdhand smoke: Secondhand smoke exposure involves inhaling either smoke from the burning end of a tobacco product or smoke exhaled by a smoker. Thirdhand smoke exposure occurs when inhaling, touching, or ingesting the residue left on surfaces after the smoke clears from the environment.
  • E-cigarettes: Also called vapes, these products heat a liquid and produce an aerosol you inhale. When an e-cigarette liquid contains nicotine, it’s considered an electronic nicotine delivery system (ENDS). These come in various shapes and sizes and may resemble cigarettes, cigars, pipes, pens, or USB sticks.
  • Secondhand and thirdhand aerosols: E-cigarettes and other ENDS emit an aerosol containing nicotine and other chemicals that make up the e-cigarette liquid in the device. Secondhand and thirdhand exposure to these aerosols can occur.
  • Nicotine replacement therapy (NRT): This includes several products that supply you with low doses of nicotine to help reduce withdrawal symptoms during a quit attempt. NRTs include nicotine gum, inhalers, lozenges, nasal spray, and skin patches.
  • Tobacco-free nicotine products: Other synthetic nicotine products include nicotine gels, dissolvables, and tobacco-free nicotine pouches. Nicotine gels allow you to absorb nicotine through your skin. Tobacco-free nicotine pouches are filled with a white powder containing nicotine and are designed to be held between the lip and gums.
  • Certain foods: Some foods, such as cauliflower, eggplant, potatoes, tomatoes, and sweet peppers, contain naturally-occurring nicotine.

Evidence can be detected for a limited time after nicotine exposure, called its detection window — its length varies based on many factors, including the type, amount, and frequency of nicotine exposure. Detection windows can also vary based on the test sample and your race, sex, and genetic makeup.

In general, nicotine can only be detected in the body for a short time, with half eliminated around two hours after your last exposure. Cotinine levels remain elevated for longer, detectable in urine and blood samples for up to seven days. However, you may continue to have low levels of nicotine and cotinine in your body over time due to exposure to secondhand, thirdhand, and environmental nicotine.

When should I get this test?

Nicotine or cotinine testing may be required as part of a smoking cessation program, insurance medical exam, employment testing, or to qualify for a surgery or organ transplant. When used to evaluate you for nicotine poisoning, a doctor may order testing based on the following symptoms:

  • Abdominal cramps
  • Agitation and restlessness
  • Drooling or burning sensation in mouth
  • Tremors or seizures
  • Nausea, vomiting, and diarrhea
  • Changes in breathing and heart rate
  • Headache, dizziness, confusion
  • Weakness or paralysis

Finding a Nicotine and Cotinine Test

How can I get a nicotine and cotinine test?

Nicotine and cotinine testing is often performed in a medical facility or laboratory. Tests can be ordered by a doctor or an administrator of a program that requires nicotine or cotinine testing.

Nicotine tests can also be purchased without a prescription and either conducted at home or prepared at home and mailed to a testing facility.

Can I take the test at home?

At-home drug tests are available to screen for tobacco use and nicotine exposure. While at-home tests that detect nicotine are uncommon, cotinine tests can be conducted on samples of blood, saliva, or urine. At-home testing is not a substitute for laboratory testing performed and overseen by health care professionals.

How much does the test cost?

The cost of nicotine and cotinine testing will vary based on where the test is taken. Your insurance may cover the cost of the test when ordered by a doctor. You can talk to your doctor or an administrator at the program requiring testing for additional information about nicotine and cotinine testing costs.

Taking a Nicotine and Cotinine Test

For laboratory-based testing, samples of urine, saliva, blood, or hair are collected by a health care professional to ensure the test’s accuracy.

Before the test

Before taking a nicotine or cotinine test conducted by a health care professional, it is important to discuss testing procedures with the doctor or staff at the testing location. Procedures for collecting samples may vary based on the reason for testing and the requirements of the test site.

As with other tests, discuss any prescription medicines, over-the-counter medications, or supplements you are taking with your doctor.

For at-home cotinine testing, it’s important to read the instructions provided in the test kit and prepare materials before collecting a sample.

During the test

For urine drug testing performed in a laboratory, you may be instructed to collect a clean catch urine sample. The clean catch method is used to prevent contamination of the sample.

Before a clean catch urine test, wash your hands and clean your genitals with a wipe or cloth provided by the health care provider. Then urinate into the toilet briefly before placing the collection container into the urine stream. After the container is filled to a pre-marked level, it is moved out of the urine stream as you finish urinating into the toilet

Collecting blood for a nicotine or cotinine test involves having a health care professional draw blood from a vein in your arm.

For testing that requires a saliva sample, you may be asked to spit into a collection device, or a pad is placed in the mouth to collect saliva.

In hair follicle drug testing, hair samples are usually collected from the scalp, but hair from another part of the body may be collected if you don’t have sufficient hair on your scalp.

Nicotine and cotinine testing are not painful, although some patients experience temporary discomfort during a blood draw. Samples for testing can often be collected in less than five minutes.

Collecting urine or saliva samples for at-home cotinine testing is similar to the methods used for laboratory-based tests. Once samples are collected, at-home cotinine tests require you to use a test strip or other device to test the sample for cotinine.

Test devices vary, so it’s important to read the instructions provided in the test kit before testing the collected sample.

After the test

After collecting a sample for laboratory-based urine testing, seal the collection container and return it to the health care provider at the testing facility. Once samples of saliva, blood, or hair are collected by a health care provider, no additional actions are required from you.

There are no restrictions on activity after sample collection for nicotine or cotinine testing.

Nicotine and Cotinine Test Results

Receiving test results

The results of nicotine or cotinine testing may be available within a few minutes to a few days, depending on the method and reason for testing. You may learn about your test results through a doctor, other health care provider, or an organization administrator requiring nicotine and cotinine testing. Test results may also be received electronically or in the mail.

Results of at-home cotinine tests are usually available within seven business days of conducting the test. Consult the test instructions for how long to wait before interpreting test results.

Interpreting test results

The nicotine and cotinine results indicate whether or not nicotine or cotinine were found in your sample and may include information about the amount of nicotine or cotinine detected.

When interpreting test results, it’s important to remember that nicotine and cotinine tests are either qualitative or quantitative. The results of qualitative nicotine or cotinine tests are interpreted differently than quantitative tests:

  • Qualitative nicotine and cotinine tests: These show whether nicotine or cotinine was found in the sample but not the amount of these substances. An example is at-home cotinine tests.
  • Quantitative nicotine and cotinine tests: These measure the amount of nicotine and cotinine in the body and are only available in laboratory-based testing conducted by health care professionals.

Positive test results indicate sufficient nicotine or cotinine was detected in the sample to meet the test or laboratory’s cutoff value for a positive result.

A negative test result means insufficient nicotine or cotinine was detected in the sample for a positive result. This result can occur because you haven’t used tobacco or been exposed to nicotine. The exposure was outside the detection window or the level of nicotine detected was too low for a positive result.

The cutoff values for a positive test result (also called the test’s reference range) are not standard between laboratories and vary based on the test’s purpose, the type of test sample, and the individual laboratory or at-home testing kit.

You may find asking questions about nicotine and cotinine test results helpful. Questions for your doctor can include:

  • What substance is being tested?
  • What is my test result?
  • Is my test result able to distinguish between tobacco use and secondhand, thirdhand, and environmental nicotine exposure?
  • Who will have access to my test result or medical record?

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