WSJ article 10/05/2006

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I request everyone buy a copy of the WSJ to make sure I have not violated any copywrigt laws. Lorie and -if I have, please remove this post.Federal Agency Warns

That Alcohol Test

Isn't 100% Reliable

By KEVIN HELLIKEROctober 5, 2006; Page B1

A widely used method of detecting alcohol consumption

in people prohibited from drinking is under assault from a federal

agency that has declared the test too scientifically uncertain to be

the sole basis for legal or disciplinary action.

The federal Substance Abuse and Mental Health Services

Administration last week issued a so-called black-box warning asserting

that the urine-alcohol screen called EtG doesn't offer surefire proof

of drinking. Officials at the agency say the screen is so sensitive

that a positive reading may reflect exposure to alcohol-based hand

sanitizers or alcohol-containing foods or medicines. A carton of apple

juice left a long time in the refrigerator could conceivably produce a

positive EtG test, says Hoffman, the agency physician who wrote

the warning.

The warning represents a victory for the growing

number of people who insist they flunked the EtG test despite having

abstained from liquor. Their cases, replete with polygraph exams and

other evidence of sobriety, convinced even the scientist who pioneered

EtG screening in America that the test is prone to so-called innocent

positives.

Whether the agency's warning will help these people

reclaim the jobs that some lost after flunking EtG tests is unclear. In

any case, the warning is a blow to the credibility of the $4

billion-a-year urine-testing industry, which introduced the EtG test

two years ago as offering fail-safe proof of alcoholic-beverage

consumption.

EtG, short for ethyl glucuronide, is a unique

metabolite of alcohol that stays in urine for up to 80 hours -- four

times as long as does alcohol itself. Earlier, detection of alcohol had

been difficult because it dissipates so quickly. The wider window of

detection made EtG an instant hit with drug courts, professional

licensing boards and other agencies that monitor sobriety -- and an

instant star of the urine-testing industry, which is performing tens of

thousands of EtG tests per month in the U.S.

However, SAMHSA officials say the industry never

conducted the large-scale clinical trials needed to prove EtG isn't

prone to snare the innocent. No federal regulatory approval or rigorous

trials are required for a urine-testing firm to introduce a new product

or process.

Even after evidence emerged that the EtG test could

detect incidental exposure to alcohol in food and the environment, many

urine-testing firms continued marketing the screen as definitive proof

of alcohol consumption. Some continue to do so. "EtG is not detectable

in urine unless an alcoholic beverage has been consumed," says the Web

site of a urine-testing firm called AccuDiagnostics LLC. An

AccuDiagnostics spokesman attributes that claim to toxicologists at

laboratories to which it outsources its samples.

At industry giant Quest Diagnostics

Inc., the director of the Salt Lake City laboratory conceded during a

July interview that exposure to alcohol in foods or medicines could

produce a positive EtG score. After The Wall Street Journal published a

page-one article

on Aug. 12 about EtG tests, Quest removed from its Web site a claim

that "EtG is not detectable in urine unless an alcoholic beverage has

been consumed."

A Quest spokeswoman says the company regrets not

removing that information sooner. However, Quest says that the claim

was based on an internal study of 1,500 abstinent people, none of whom

tested positive for EtG. That study wasn't published. The spokeswoman

says Quest is carefully studying the SAMHSA warning.

The warning makes clear that the EtG test remains

useful. Increasingly, drug and drunken-driving defendants, along with

recovering addicts in high-risk professions such as health care, are

required to abstain entirely from alcohol and illicit drugs. But

monitoring these people has been difficult because while illicit drugs

can be detected for days after usage, alcohol consumption has been easy

to disguise -- until the advent of EtG. About 10% of EtG tests have

turned up positive, the vast majority of them reflecting genuine

violations of sobriety requirements.

But a small percentage of those positive findings

appears to involve no wrongdoing. In one case, a California pharmacist

named Lorie Garlick -- whose pharmacy license has been suspended since

she failed an EtG test in the spring of 2005 -- quarantined herself in

an addiction-treatment center with no access to booze and flunked the

test again.

Because of such cases, "legal or disciplinary action

based solely on a positive EtG ... is inappropriate and scientifically

unsupportable at this time," said the SAMHSA warning, recommending that

a positive EtG be regarded as a possible sign of relapse that triggers

a broader investigation.

A negative EtG score appears to represent persuasive

evidence of sobriety. This was what Skipper, a physician who

runs the Alabama monitoring and assistance program for recovering

doctors, was seeking when he helped to pioneer the EtG test along with

some European doctors several years ago. As a recovering addict

himself, Dr. Skipper understood that malpractice insurers and state

licensing boards desire documentation of abstinence. Dr. Skipper, who

supports the SAMHSA warning, says he hopes it doesn't overshadow the

EtG's value as a marker of sobriety.

Many urine-testing firms say that they merely provide

the EtG results and that their clients -- drug courts or professional

licensing boards -- bear responsibility for deciding whether a positive

finding represents proof of drinking. But some urine-testing companies

themselves have guided clients to interpret positive results as proof

of drinking. On a laboratory report stating that , a

Pennsylvania nurse, had an EtG score of more than 300 nanograms per

milliliter, National Medical Services included the statement that "any

value above 250 ng/ml indicates ethanol consumption."

Ms. has passed a polygraph test stating that she

hasn't drunk, and her 12-step group awarded her a medallion in May

honoring five years of abstinence from alcohol and drugs. But two

positive EtG scores prompted Pennsylvania to suspend her nursing

license early this year. Now, the 20-year veteran of nursing waits

tables at Charlie Brown's Steak House in Reading, Pa.

The state has argued that it wasn't accusing Ms. of drinking, only of failing to produce clean urine.

Write to Helliker at kevin.helliker@...