Cotinine Test Levels: What Your Number Means by Sample
Cotinine Test Levels: What Your Number Means by Sample
A cotinine test measures cotinine, the primary breakdown product of nicotine, in blood, saliva, or urine. There is no single cutoff. Research uses roughly 3 ng/mL in blood, 12 in saliva, and 30 in urine. An employer blood test through Quest Diagnostics flags positive at 16 ng/mL. Cheap urine strips use a 200 ng/mL threshold. Daily nicotine pouch users produce cotinine concentrations comparable to cigarette smokers in national survey data.
Cotinine Cutoffs by Test and Sample
| Test or source | Sample | Cutoff or range (ng/mL) | What it is used for |
|---|---|---|---|
| SRNT 2019 update, NHANES-based | Serum or plasma | 3 (race-specific values 1 to 6) | Research: separating any nicotine/tobacco user from non-user |
| SRNT 2019 update, UK study | Saliva | 12 | Research cutpoint |
| SRNT 2019 update | Urine (free cotinine) | About 30 (range 30 to 50) | Research cutpoint |
| SRNT 2019 update, pregnancy | Serum or saliva; urine | 5 to 10; 25 to 50 | Suggested cutoffs for pregnant smokers |
| Quest Diagnostics employer test | Blood | Positive at 16 or more | Employer wellness and tobacco-surcharge programs |
| Single-band urine test strips | Urine | Nominal 200 | Quick yes/no screen; roughly $1 to $3 per strip |
| Cedars-Sinai health library | Urine | Non-smoker under 10; light smoker or secondhand smoke 11 to 30; heavy smoker may exceed 500 | Clinical reference ranges (labs vary) |
Source: SRNT 2019 update (Benowitz et al. 2020, PMID 31570931), Quest Diagnostics, Cedars-Sinai. Units: ng/mL. Cutoffs are not interchangeable across specimens.
How this table was built
Every value above comes from the named laboratory, hospital, or the SRNT expert report on biochemical verification of tobacco use. No numbers were estimated or averaged across sources. This page does not interpret any individual's result; the ordering lab or clinician determines which cutoff applies. Roon makes a nicotine-free caffeine pouch and this article links to it. Every number here comes from publicly available primary sources so you can verify it yourself.
What Is Cotinine?
Cotinine is the main metabolite your body produces after nicotine enters the bloodstream. Labs measure cotinine instead of nicotine because nicotine clears within hours, while cotinine persists long enough to detect. Its half-life averages about 16 hours but ranges from 8 to more than 30 hours from person to person (Benowitz et al. 2020). Quest Diagnostics states a 24-hour half-life in its employer materials, which falls within that range. For full detection windows by test type, see How Long Does Nicotine Stay in Your System?.
Why Can One Test Say Positive and Another Say Negative?
Because the cutoffs differ by specimen and by purpose, from 3 ng/mL in research serum to 200 ng/mL on a urine strip. A light or occasional nicotine user, or someone regularly exposed to secondhand smoke, can register above the 3 ng/mL serum research cutpoint while sitting comfortably below a 200 ng/mL urine strip. The SRNT report notes that single-band urine strips are semiquantitative and "not suitable for measuring low cotinine concentrations" from secondhand or thirdhand smoke (Benowitz et al. 2020).
The specimen matters too. Each sample type has its own cutpoint, so a saliva number cannot be read against a blood or urine cutoff. Quest offers confirmatory testing when immunoassay results are repeatedly disputed and recommends that employers have an appeals process for people quitting with patches or gum.
How Fast Does Cotinine Fall?
At the average 16-hour half-life, cotinine drops by half every 16 hours:
- 48 hours (3 half-lives): about 12.5% of the starting level remains
- 96 hours (6 half-lives): about 1.6% remains
The SRNT report estimates roughly 80 to 100 hours to fall below the research cutpoint, and suggests allowing 6 to 7 days when verifying that someone has stopped smoking. Cedars-Sinai states that cotinine levels begin returning to normal after 7 to 10 days without nicotine exposure.
Heavy users start from a higher level, so they take longer to drop below any given cutoff. None of the sources here supports a way to flush cotinine out faster.
Do Nicotine Pouches Show Up on a Cotinine Test?
Yes. Nicotine pouches deliver nicotine, and the body converts it to cotinine the same way it converts nicotine from cigarettes or patches. In the PATH Study Wave 7 (2022 to 2023, n = 4,527 adults), exclusive pouch users had a geometric mean urinary cotinine of 2,137.2 ng/mg creatinine compared with 0.2 for non-tobacco users, and their nicotine metabolite levels were not statistically different from exclusive cigarette smokers (Dai and Young 2026, PMID 40923918). For details on which employers and insurers test, see Do Nicotine Pouches Show Up on a Drug Test?.
Can a Test Tell Tobacco from Other Nicotine Sources?
When a cotinine test comes back positive and the person claims to be using nicotine replacement therapy (NRT) rather than tobacco, labs can run a follow-up for anabasine and anatabine. These minor tobacco alkaloids appear in negligible amounts in pharmaceutical-grade nicotine, so elevated levels suggest tobacco use specifically (Benowitz et al. 2020).
The SRNT report sets a urine cutpoint of 2 ng/mL for both. A 2023 Belgian lab study (163 subjects) proposed much lower thresholds, greater than 0.097 ng/mL for anatabine and greater than 0.236 ng/mL for anabasine, because the 2 ng/mL reference missed many smokers (sensitivity dropped to 75% and 47%, respectively) (Colsoul et al. 2023, PMID 37146788).
In the PATH data, exclusive pouch users showed far lower anabasine (0.6 vs. 9.3 ng/mg creatinine) and anatabine (0.4 vs. 14.7) than exclusive smokers on average. Individual results vary, and some e-liquids contain measurable tobacco alkaloids, so the test is not reliable for every vaper.
What Should You Do Before Acting on a Cotinine Result?
This page is a reference, not a reading of your individual result. Ask the ordering lab or clinician which cutoff and specimen they used before drawing conclusions.
- Pregnancy: cutoffs differ (5 to 10 ng/mL serum or saliva, 25 to 50 urine per the SRNT). Your prenatal provider should interpret the result.
- Nicotine replacement therapy: NRT such as patches or gum produces cotinine, so a cotinine test will not accurately reflect tobacco use in someone on NRT. The anabasine follow-up helps in that case.
- Trying to quit: free, confidential coaching is available at 1-800-QUIT-NOW (1-800-784-8669). More on the quitline.
Related from Roon
- Do Nicotine Pouches Show Up on a Drug Test?
- How Long Does Nicotine Stay in Your System?
- Nicotine Withdrawal Timeline
Frequently Asked Questions
What cotinine level means you are a smoker?
It depends on the test. In research using the SRNT framework, a serum cotinine above 3 ng/mL classifies someone as a nicotine or tobacco user, though race-specific thresholds range from 1 to 6 ng/mL. Quest Diagnostics flags blood cotinine at 16 ng/mL or above for employer wellness programs. Urine strips require roughly 200 ng/mL. A heavy daily smoker usually lands above all of these, but a light or occasional user may clear some thresholds and not others.
Does secondhand smoke show up on a cotinine test?
It can. Cedars-Sinai lists 11 to 30 ng/mL as the urine range for light smokers or people exposed to secondhand smoke. That level sits above the 3 ng/mL research cutpoint and below the 200 ng/mL urine strip threshold, which the SRNT describes as unsuitable for detecting low concentrations from secondhand exposure.
Is a cotinine test the same as a nicotine test?
In practice, yes. Most tests marketed as "nicotine tests" actually measure cotinine, because cotinine stays detectable in the body for days while nicotine clears within hours. The exception is a panel that also checks for anabasine or anatabine to distinguish tobacco from NRT.
Do caffeine pouches or nicotine-free pouches produce cotinine?
No. Cotinine is a metabolite of nicotine. A pouch that contains caffeine and no nicotine introduces no nicotine into the body, so there is nothing for the liver to convert into cotinine. No study has tested Roon specifically, but the chemistry is straightforward: zero nicotine in means zero cotinine out.
A Pouch That Gives a Cotinine Test Nothing to Find
A cotinine test responds to one thing: nicotine. Roon contains none. Each pouch holds 80 mg caffeine with 60 mg L-theanine, 25 mg methylliberine (Dynamine) and 5 mg theacrine (TeaCrine), and nothing in it turns into cotinine.
If you're ready to quit nicotine pouches without losing the habit that works for you, try Roon. It adds no nicotine of its own, though it cannot clear nicotine you are still taking from other products. The methylliberine in the formula slows how the body clears caffeine: in a randomized, double-blind crossover PK study (n=12), co-administration extended caffeine's half-life from 7.2 to 15 hours with no increase in peak concentration (study). That study used 100 mg methylliberine with 150 mg caffeine, roughly 4x the methylliberine and 1.9x the caffeine in one Roon pouch, so the direction of the effect applies, not the exact magnitude. In practice one pouch carries you through roughly 6 to 8 hours, well short of that 15-hour half-life, so plan your last pouch at least 8 hours before you want to sleep.
Prices run from $9.16 per tin on the 12-tin subscription, as little as $0.61 per pouch. Try Roon.
Sources
- Benowitz NL et al. "Biochemical Verification of Tobacco Use and Abstinence: 2019 Update." Nicotine Tob Res 2020;22(7):1086-97. PMC7882145. (Benowitz has consulted for Pfizer and Achieve Life Sciences and has served as an expert witness against tobacco companies.)
- Quest Diagnostics. Employer tobacco cessation (cotinine) testing page. questdiagnostics.com.
- Cedars-Sinai. "Nicotine Cotinine (Urine)." cedars-sinai.org.
- Dai HD, Young B. "Biomarkers of Exposure to Tobacco-Related Toxicants among Adult Nicotine Pouch Users." Nicotine Tob Res 2026;28(2):260-7. PMID 40923918.
- Colsoul ML et al. "Novel Proposed Cutoff Values for Anatabine and Anabasine in Differentiating Smokers from Non-smokers." Clin Biochem 2023;116:128-31. PMID 37146788.
- CDC Quitline. 1-800-QUIT-NOW. cdc.gov.
Written by Roon Team
