FOCUS ON ALCOHOL TESTING BY DAVID KUNTZ, PHD, CLINICAL REFERENCE LABORATORY
Testing for Alcohol Abuse in the Non- Regulated Workplace—Old and New Tests
T
here are approximately 15.9 mil- lion alcohol-abusing individuals in the United States. Excessive
alcohol consumption is the fourth lead- ing preventable cause of death in the United States. It is annually responsible for 88,000 deaths and 2.5 million years of potential life lost with estimated costs to society at $223.5 million in 20061
correlated to alcohol use patterns for the last thirty days and far more specific to indicate alcohol abuse.
. Te
2011 National Survey on Drug Use and Health (NSDUH) reported that 51.8 percent of Americans are current drinkers of alcohol, with 22.6 percent participating in binge drinking (five or more drinks on the same occasion on at least 1 day in the past 30 days) with 6.2 percent being heavy drinkers (five or more drinks each on five or more days in the past 30 days). Ap- proximately 75 percent of these binge and heavy alcohol users were employed. To assess impairment, the standard
technology is breath alcohol detection using procedures under DOT Rule 49 CFR Part 40. Tis rule also established the criteria for training and reporting of alcohol positives. But for most nonregulated pre-employment and random tests, only urine is collected and the determination of alcohol use is far more difficult to assess for job impairment when alcohol consumption is prohibited.
Laboratory-Based Alcohol Biomarkers To detect alcohol abuse, a series of lab- oratory-based alcohol biomarkers have been developed to provide physiological indicators of alcohol ingestion. Biomark- ers can indicate drinking on the job and problematic drinking with associated liver damage. They can also be used to monitor and evaluate patients in alcohol- ism treatment and prevention programs. Some of the newer biomarkers can be
44 datia focus
Urine Alcohol Detection Measuring urine alcohol is commonly performed by gas chromatography-flame ionization detection (GC-FID). Howev- er, when using this method it is difficult to interpret the potential state of intoxi- cation of the donor or the source of the urine alcohol. When alcohol is absorbed in the stomach, a portion of the alcohol is filtered and eliminated via the kidneys. Significant amounts of alcohol can also be produced during shipment as a result of yeast or bacterial fermentation of glu- cose. In an attempt to identify the source of the urine alcohol, the lab screens for the presence of glucose in a sample, often with a simple colorimetric dipstick test. Absence of glucose supports that alcohol was consumed rather than an artifact of fermentation. Te collection of urine for a “legal”
alcohol determination is unique. In the past decades, urine alcohol determinations were used in the legal community as a substitute for a blood alcohol collection. Wisconsin still has instructions for urine collections under SEC. 343.305(6) Wis. Stats. In their instructions, the first void by the individual is discarded and the donor is required to wait for approximately 30 minutes and the second void is collected and shipped to the laboratory, where the laboratory will test the sample for glucose and alcohol. If the alcohol test is positive, the lab will store the specimen for two days at room tempera- ture and repeat the urine alcohol test. If the concentration of the alcohol increases, it is possible that the alcohol in the urine sample may not be from the ingestion of
summer 2014
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