Department of Defense Changes Codeine Cutoff Rate

By Chester Curtis, Directorate of Prevention, Resilience and ReadinessJune 26, 2024

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On March 4, the Defense Department’s Military Personnel Drug Abuse Testing Program raised the codeine cutoff rate from 2,000 ng/mL of codeine to 4,000 ng/mL to mitigate false positive results for military service members.

Drug test cutoff levels are set measurement thresholds that determine if a test specimen is positive or negative for a specific controlled substance. For oral fluid or urine drug tests, cutoff levels are expressed using nanograms (ng) per milliliter (mL).

According to a study in the Journal of Analytical Toxicology, poppy seeds used in food products are derived from the opium-producing poppy. Consumption of food products containing poppy seeds—such as poppy seed cakes, cookies, muffins and flatbreads—can result in opiate-positive urine drug test results and may pose challenges in distinguishing poppy seed consumption from opiate use.

The seeds themselves do not contain opiates, but the latex of the poppy seed contains numerous alkaloids, including morphine and codeine, and the seeds may be contaminated with them via the poppy latex during the harvesting process.

Codeine is a pain reliever that is related to morphine, is addictive and has the potential to be misused.

The Military Personnel Drug Abuse Testing Program suspended codeine reporting on Jan. 20, 2023, following concerns that a substantially lower amount of poppy seed consumption could result in a positive codeine urinalysis.

A listing of cutoff concentrations from the program includes the addition of a reflex screening test for thebaine, an opioid produced by the poppy plant that can be used as a urinary marker of poppy seed ingestion. Specimens containing 4,000 ng/mL to 10,000 ng/mL of codeine will be reported as negative if thebaine is also present at a concentration of 5 ng/mL or greater. Since Jan. 20, 2023, all pending codeine-positive results are reported based on the new codeine cutoff and thebaine reflex screen.

“These changes will significantly reduce the risk of a codeine-positive result from normal consumption of food products containing poppy seeds,” says Carolyn Massiah, substance misuse specialist with the Directorate of Prevention, Resilience and Readiness.

While the military drug testing program has implemented measures to distinguish poppy seed ingestion from codeine misuse, including raising the drug cutoff rate for codeine, avoiding foods containing poppy seeds remains the best policy.