RE: Re: EtG Unreliable by itself to determine ethanol consumption per federal direction...

January 23, 2007

According to SAMSHA's research, positive EtG tests can result from the use of hand sanitizers, medications, hygiene products, cosmetics, foods and other products that contain even small levels of alcohol. People can test positive for alcohol consumption after being exposed to laundry detergent, antiperspirant, aftershave and even hair spray. There are hundreds of household products that contain ethanol, according to the National Library of Health's Household Products Database, which could possibly cause a false positive with the EtG urine test. The advisory also said that gender, age, or ethnicity may also affect EtG test results, but more research is needed to find out for sure. Where It Stands NowThe EtG test is simply not reliable by itself to

determine alcohol consumption. According to the SAMSHA advisory: "Currently, the use of an EtG test in determining abstinence lacks sufficient proven specificity for use as primary or sole evidence that an individual prohibited from drinking, in a criminal justice or a regulatory compliance context, has truly been drinking. "Legal or disciplinary action based solely on a positive EtG ... is inappropriate and scientifically unsupportable at this time. These tests should currently be considered as potential valuable clinical tools, but their use in forensic settings is premature." SAMSHA recommends that biomarker tests be used as a tool to launch a more extensive investigation into possible alcohol use, but not as a stand-alone confirmation. Source:The Role of Biomarkers in the Treatment of Alcohol Use

Disorders (PDF), September 2006, Substance Abuse and Mental Health Services AdministrationTom Damon <tomnplano@...> wrote: The earlier post I sent was meant to say un-intentional imbiding in the consumption of alcohol"Moering, " <rmoeringhealth (DOT) usf.edu> wrote: “The test's purpose was to catch intentional consumption of alcohol users, not catch the incidental users of alcohol products.” No! The test only indicates when ethanol has been in the system. It is the interpretation by others that indicate intentional use versus incidental use. The test is doing what it was designed to do – identify the presence of EtG.

From: Ethylglucuronide [mailto:Ethylglucuronide ] On Behalf Of HighSent: Tuesday, January 23, 2007 1:16 PMEthylglucuronide Subject: RE: Re: EtG DENIAL(Didn't Even Notice I Am Lying) Absolutely, Lorie. I signed a contract stating I would abstain from all mind altering substances, including alcohol. The contract had no mention of abstinence of using Purell hand cleanser or any other product containing alcohol. i did not drink any alcoholic bevarage and not once do I remember gulping down Purell hand sanitizer or drinking my Calgon body spray which contains tons of alcohol denat. The test's purpose was to catch intentional consumption of alcohol users, not catch the incidental users of alcohol products. Let's get real here. Marsha Dienelt <marshadienelt > wrote: THANK YOU, Lorie!!!Lorie Garlick <saclorie > wrote: WHY must you continue to split hairs? EtG was developed to monitor for DRINKING BOOZE, plain and simple. "Moering, " <rmoeringhealth (DOT) usf.edu> wrote: Was the test developed to distinguish consumption from other causes or was the test developed to identify the presence of EtG? Clinical correlation should be part of the process, but at some point a cut-off level is needed to say beyond all reasonable doubt that a person did, in fact, consume alcohol regardless of their denial. Don’t fault the test for it’s ability to detect what it is being asked to detect. From: Ethylglucuronide [mailto:Ethylglucuronide ] On Behalf Of robin murraySent: Tuesday, January 23, 2007 8:10 AMEthylglucuronide Subject: RE: Re: EtG DENIAL(Didn't Even Notice I Am Lying) Lie #2...continued... specificity in the ha nds of the best investigator in the world far less than 99%...and that is just the experimental test EtG,notinstrument error,collection error,creatinine etc...and of course the bottom line...no abilityto distinguish "consumption" from all other causes of endogenous blood alcohol...regards, Alcohol Clin Exp Res. 2004; 28(8):1220 -8 (ISSN: 0145-6008) Wurst FM;

Wiesbeck GA; Metzger JW; Weinmann WPsychiatric University Hospital, University of Basel, Switzerland. friedrich.wurstpukbasel (DOT) ch BACKGROUND: Ethyl glucuronide (EtG), a direct ethanol metabolite, seems to meet the need for a sensitive and specific marker for monitoring recent alcohol consumption in different settings. Our aim was to study sensitivity, specificity, and the influence of various parameters on EtG levels in urine. PATIENTS AND METHODS: Urine samples for a total of 453 patients (373 male, 80 female) were statistically analyzed. The mean age was 37.1 years (median 36, S D 12.59), body mass index was 24.7, total ethanol consumed last month was 1817.66 g (each median), and 80 patients reported

cannabis use within the last 30 days. Determination of EtG was performed with a liquid chromatography-tandem mass spectrometry method with deuterium-labeled EtG as internal standard. RESULTS: For EtG in urine, a good correlation was found with other state markers and days of sobriety. In a regression analysis, age, gender, marijuana use, kidney disease, and total grams of ethanol consumed last month were the variables that significantly influenced EtG levels in contrast to race, smoking, body mass index, cirrhosis of liver, age began drinking regularly, packs of cigarettes smoked last month, and total body water. Furthermore, in a receiver operating characteristic curve analysis to distinguish between nondrinkers and individuals sober > 4 days versus individuals drinking in the recent 4 days, area under the curve was 0.834. At a cutoff of 0.145 mg/liter, sensitivity was 83.5% and specificity 68.3%. A receiver operating characteristic curve was calculated for

lifetime alcohol abuse or dependence against those who had never been abusers or depende nt. In this case, subjects were either never dependent or lifetime dependent, but those currently dependent were excluded. The resulting area under the curve was 0.694. At a cutoff of 0.145 mg/liter, Alcohol Clin Exp Res. 2004; 28(8):1220-8 (ISSN: 0145-6008) Wurst FM; Wiesbeck GA; Metzger JW; Weinmann WPsychiatric University Hospital,

University of Basel, Switzerland. friedrich.wurstpukbasel (DOT) ch BACKGROUND: Ethyl glucuronide (EtG), a direct ethanol metabolite, seems to meet the need for a sensitive and specific marker for monitoring recent alcohol consumption in different settings. Our aim was to study sensitivity, specificity, and the influence of various parameters on EtG levels in urine. PATIENTS AND METHODS: Urine samples for a total of 453 patients (373 male, 80 female) were statistically analyzed. The mean age was 37.1 years (median 36, SD 12.59), body mass index was 24.7, total ethanol consumed last month was 1817.66 g (each median), and 80 patients reported cannabis use within the last 30 days. Determination of EtG was performed with a liquid

chromatography-tandem mass spectrometry method with deuterium-labeled EtG as internal standard. RESULTS: For EtG in urine, a good correlation was found with other state markers and days of sobriety. In a regression analysis, age, gender, marijuana use, kidney disease, and total grams of ethanol consumed last month were the variables that significantly influenced EtG levels in contrast to race, smoking, body mass index, cirrhosis of liver, age began drinking regularly, packs of cigarettes smoked last month, and total body water. Furthermore, in a receiver operating characteris tic curve analysis to distinguish between nondrinkers and individuals sober > 4 days versus individuals drinking in the recent 4 days, area under the curve was 0.834. At a cutoff of 0.145 mg/liter, sensitivity was 83.5% and specificity 68.3%. A receiver operating characteristic curve was calculated for lifetime alcohol abuse or dependence against those who had never been abusers or dependent.

In this case, subjects were either never dependent or lifetime dependent, but those currently dependent were excluded. The resulting area under the curve was 0.694. At a cutoff of 0.145 mg/liter, sensitivity was 73.8% and specificity 60.3%. For those with a self-reported sobriety of less than 24 hr, the area under the curve was 0.899, sensitivity was 90.8%, and specificity was 76.5% at a cutoff of 0.435 mg/liter when we calculated nondrinkers and light drinkers against heavy drinkers and drinkers needing treatment. Cannabis-using patients showed significant differences with regard to almost all state markers when compared with nonconsuming subjects. CONCLUSIONS: Age, gender, marijuana use, kidney disease, and total grams of ethanol consumed last month should be taken into consideration when interpreting results of EtG in urine. Sensitivity and specificity seem promising. Cannabis use can be regarded as an

indicator for other serious mental problems in alcohol-using subjects. at a cutoff of 0.435 mg/liter when we calculated nondrinkers and light drinkers against heavy drinkers and drinkers needing treatment. Cannabis-using patients showed significant differences with regard to almost all state markers when compared with nonconsuming subjects. CONCLUSIONS: Age, gender, marijuana use, kidney disease, and total grams of ethanol consumed last month should be taken into consideration when interpreting results of EtG in urine. Sensitivity and specificity seem promising. Cannabis use can be regarded as an indicator for other serious mental problems in alcohol-using subjects. robin murray <remurraymd > wrote: Lie #2..."any test that is 99% effective is effective by any standard" Methods to detect EtG include immunoassay (EIA or ELISA), gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), and liquid chromatography/mass spectrometry/mass spectrometry (LC/MS/MS). Immunoassay methods are of limited specificity and sensitivity with a

limit of detection of approximately 1000 ng/mL. GC/MS and LC/MS methods are much more specific than immunoassay, and offer detection limits of approximately 500 ng/mL. iref redwood labs toxicology data...most lab instruments like immunoassay cannot accurate detect and measure samples below 1000ng/dl...that is just the instrument, you have to add in the creatinine error,collection error,EtG exponential variability and low specificity..."99% effective??????"..so false as to be hilarious if the test were not harming so many people...regards, robin murray <remurraymd > wrote: Lie #1... "EtG is on ly formed as a result of ethanol consumption" The origin for the presence of EtG in urine is ethanol in vivo, and the only ways for significant ethanol to be present in the body are: 1. Drink an alcoholic beverage, 2. Consume "incidental" alcohol (alcohol in food, normal use of hygiene products, OTC meds, etc), 3). Produce ethanol endogenously ("auto brewery syndrome"). ref. ethylglucuronide.homsead.com..as an alleged scientist please post precisely and source your

allegations to have any credibility on this site...step 10...when we were wrong we promptly admitted it... regards, "Moering, " <rmoeringhealth (DOT) usf.edu> wrote: “human rights” The reality of this whole issue is “the safety of the public” will trump your “human rights” every time. If the State (does not matter a whole lot what Uncle Sam thinks) believes that you have a problem with drugs or alcohol, for public safety they can/will suspend your license or prohibit you from ever practicing in the health field (e.g., re voke license). You have a right to drink as much alcohol as you want, just not as an “impaired professional.” Should the test used to monitor individuals be fair? Define fair (an d I know half a dozen will rant about this and

probably call me all kinds of names, but come at this from an objective perspective and you can see “fair” has multiple meanings or interpretations). Life’s not fair. If the “false positive” rate of EtG (and to date there are no published reports supporting false positive results – in other words a person MUST have ethanol to make ethylglucuronide; EtG is only formed as a consequence of ethanol consumption. A small percentage of ethanol (.02-.04 percent) is conjugated in the liver with UDP-glucronic acid, which forms ethyl glucuronide, and is excreted in the urine) is 1% than the test is catching the 99% who have relapsed on alcohol or are drinking alcohol when they should not. Any test that is 99% effective, is effective by any standard. The percentage of individuals claiming the “false positive” is probably 1% of the total number of cases tested (yes this is a best, educated guess - if the percentage were larger we would hear from a lot

more individuals about this test’s ‘injustice’) Do you think the class action suit, if won, will make any difference in this? Nope! At least not in the short to medium range. State’s rights to control their own rules and laws win. The Supreme Court (as I understand it) has repeatedly upheld the rights of each state to govern themselves. Again, I’m no lawyer, but I do believe that States can ignore any data they chose to ignore or believe any data they

chose to believe. Any lawyers on this site know differently? Anyone know of any case law that says differently? If I’m wrong, I’ll be the first to acknowledge. size=2 width="100%" align=center tabIndex=-1> From: Ethylglucuronide [mailto:Ethylglucuronide ] On Behalf Of HighSent: Monday, January 22, 2007 5:55 PMEthylglucuronide Subject: RE: Re: How to avoid positive Etg hello Robin...thanks for your response. So what

you're saying is that we must abide by the rules of the state that we live in no matter what, even if "it" involves our human rights? Do y ou think the class action suit, if won, will make any difference in this? Do you know if any of those individuals that are and have been in the past affected by this have hired an individual attorney, and if so, gotten any results? Unbelievable that we are proven gulity before we even have a chance to prove our in nocence. That's f--d up. Keep in touch and thanks for the info....Jessrobin murray <remurraymd > wrote: so your point

is that each state can screw each of us over with a federally proven forensically invalid test and we must accept and take it up the rump?i think no t... each state is liable for not having the federal tox data of EtG forensic invalidity / DIV> clearly posted here SAMHSA ethylgluronide.homestead.com for

months...ignorance of the data is no excuse...if they do not know they are negligent amd liable..regards, "Moering, " <rmoeringhealth (DOT) usf.edu> wrote: You ask the question “How in the world could a monitoring agency that deals exclusively with recovering nurses and drug screens not know what the hell is going on?” & nb sp; Many others on this site have had similar questions.

I am not a lawyer nor am I a political science major and I recognize my knowledge of how laws work when it comes to federal versus state rights; however, I offer this opinion. The answer may be that the federal government does not have the right to interfere with the manner in wh ich states run their professional monitoring programs. The federal government may provide guidance, but they do not run the state programs and have no right to interfere with how each state conducts business. Until the federal government (i.e., congress or the federal courts) mandate the use of the SAMHSA guidelines, states are free to use or not use them. size=2 width="100%" align=center tabIndex=-1> < DIV> From: Ethylglucuronide [mailto:Ethylglucuronide ] On Behalf Of jess4111Sent: Sunday, January 21, 2007 12:56 PMEthylglucuronide Subject: Re: How to avoid positive Etg There are many different types of alcohols. Does

anyone know which of > these alcohols found in foods, household products, cosmetics, etc., > will cause a positive urine > Hello All....I have been a participant in a program called IPN for recovering nurses here in Fla for 14, going on 15 months. I have been clean and sober since the beginning , following all the programs rules and requests. I have abstained from a ll mind altering substances during the entire 14 months. I was recently informed that my ETG test was pos itive. I have not had a drop of alcohol. Alcohol was never in my history of "drug of Choice". I voluntarily entered this program due to my addiction to opiates and ambien. I was told that I may not return to nursing, obtain an evaluation that costs $350.00, from an "addictionologist"/ psychiatrist, in order for him to determine my fate. I cannot begin to express the amont of anger and frustration I feel. I would know exactly what to do

and feel if this were a true relapse. I would feel remorse, guilt, and deal with the consequences but I have done nothing wrong but am being treated as if I am guilty.>My case manager at IPN states she knew "nothing about the advisory issued by SAMHSA". How in the world could a monitoring agency that deals exclusively with recovering nurses and drug screens not know what the hell is going on? Please tell me if you are in a similar situation or have been in the past. There is a class action suit in process regarding etg testing but in the meantime, what do I do about paying my bills and buying food. This has affected every aspect of my life. I am a newly diagnosed, brittle diabetic and the stress has made my blood sugars off the chain. Desperate and pissed off in Fla. > > > ---------------------------------> Access over 1 million songs - Music

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January 23, 2007