Over the last several years, more and
Abstinence monitoring programs that are testing for EtG should provide participants information regarding sources of incidental exposure to avoid.
more laboratories began offering EtG/ EtS testing to help bridge the gap that ex- isted with simple ethanol testing. While a urinalysis is likely the most common laboratory EtG test platform, hair and fingernail testing is also widely accepted for EtG testing as it provides a longer window of detection: up to 90 days. As a result, EtG and EtS tests are becoming more common with drug courts, proba- tion, parole, corrections, schools, and alcohol abstinence programs like those in treatment facilities. EtG is only produced by the liver fol-
lowing ingestion of ethanol/ethyl alcohol, thus it is possible to produce EtG following incidental exposure to ethanol found in commonly used products. Ethanol is used in cooking, over-the-counter medications, mouthwash, hygiene products, antibacte- rial gels, perfumes, etc. Abstinence moni- toring programs that are testing for EtG should provide participants information regarding sources of incidental exposure to avoid. Having a document that details this information can be helpful. Te follow- ing excerpt is from a sample drug court informed consent agreement:
When being monitored with EtG/EtS, it is important, as in any monitoring situation, to be aware of items to avoid so that inadvertent “incidental” exposure does not cause a positive test. In other words, it’s important to know what items contain alcohol and to avoid them. With reasonable caution it is rare for “inciden- tal” alcohol exposure to cause a positive test.
It is YOUR responsibility to limit and avoid exposure to the products and substances detailed below as well as any other substance that contains ethyl alcohol. It is YOUR responsibility to read product labels to know what is contained in the products you use and to inspect these products BEFORE you use them. Terms used to describe alcohol in products that must be avoided include: de- natured alcohol, SD alcohol, ethanol or ethyl
28 datia focus
alcohol. Use of the products detailed below or any other product containing alcohol is a violation of this contract and will NOT be allowed as an excuse for a positive test result.
When in doubt, don’t use, consume or apply anything that might contain alcohol.
While EtG is produced by the liver, the
quantity the body produces varies from per- son to person. Terefore, the quantitative lev- els of EtG should not be used to estimate how much alcohol someone may have consumed, but rather to determine whether they have in fact ingested alcohol. Tis was illustrated in the SAMHSA Spring 2012 Advisory: “Te Role of Biomarkers in the Treatment of Alcohol Use Disorders” Tis Advisory was a revision of the 2006 Substance Abuse Treatment Advisory (same title). Te 2012 revision was a result of increased scientific knowledge about alcohol biomarkers such as EtS, further studies examining the effect of incidental exposure to alcohol containing products, and requests from clinical and judicial professionals for greater clarification on the use and interpreta- tion of alcohol biomarkers.8 Te Advisory further illustrates that EtG
and EtS are the best biomarkers recognized as appropriate for abstinence monitoring, based primarily on the time to return normal levels following abstinence from alcohol. Due to the common use of EtG and EtS to document abstinence in various setings and the consequences for false positives, much atention has been given to the cutoff values of EtG. Although further research is needed before firm cutoffs for EtG and an absolute quantitative correlation can be established, sufficient research has been completed to reach the following conclusions:9
●
A “high” positive (e.g., >1,000 ng/mL) may indicate:
●
Heavy drinking on the same day or previously (e.g.,
● ● ● previous day or two) Light drinking the same day
A “low” positive (e.g., 500–1,000 ng/ mL) may indicate:
spring 2015
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76