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Alcohol Test May Be Condemning the Abstinent


 

SAN DIEGO — Nancy Clark, a registered nurse, had been drug free and sober for 3 years when she tested positive for alcohol on the new ethyl glucuronide test, the same one used for many chemically dependent physicians who are entered into monitoring programs and are on probation.

She kept her job the first time, but then she tested positive again—and lost it.

So Ms. Clark bought a plane ticket. She flew almost 3,000 miles from Pennsylvania to San Diego to meet with the one person she thought might be able to help her and others in her situation: Dr. Greg Skipper.

“When I tested positive, I looked on the Internet, and everything I saw said this test was perfect,” said Ms. Clark of Fleetwood, Penn., at the meeting where she met with Dr. Skipper—the annual conference of the American Society of Addiction Medicine.

“I thought: How am I ever going to be able to protest this?” she said.

Recent evidence, however, suggests that while the test may be highly accurate and sensitive, it may also be fallible, said Dr. Skipper, who helped develop ethyl glucuronide (EtG) as a drug test to monitor whether a person has consumed alcohol. In essence, the evidence suggests the test may be too good, picking up people who are exposed to alcohol in any number of ways without drinking it, said Dr. Skipper of Montgomery, Ala., director of that state's physician health program.

The EtG test is used widely by physician monitoring programs. In a survey of physician health programs conducted this year, 29 of 31 responding programs reported that they use the test, compared with 17 of 46 programs that reported using it in 2004, said Dr. Michael Sucher, medical director of the physician health program in Scottsdale, Ariz. Some of those states use it routinely, others just for cause.

Dr. Skipper says he knows of at least 60 people who claim that they have not touched a drink but have had positive results on the EtG test. Consequently, some people who have not been drinking may lose their jobs, licenses, or even custody of their children. Still others may be going back to jail.

For health care workers, washing hands with alcohol-containing sanitizers such as Purell might be the reason they are testing positive, Dr. Skipper said. “We're getting data, and we're worried about what [they show],” he said in an interview.

Dr. Skipper said that he does not want to see the test abandoned. He finds it often picks up monitored physicians whose alcohol use would not be detected otherwise, and even among those who deny drinking at first, 50%–80% later admit to it.

Random EtG testing surveys of physicians who are not supposed to be drinking in monitoring programs have found that around 7% will have a positive test result. It is important to catch those physicians to get them help, Dr. Skipper said.

Given the gathering evidence, however, the test needs to be used with some clinical judgment of the individual, he added. “I am urging no use in administrative hearings and courts,” he said. “It is a clinical test.”

Moreover, if hand sanitizer can cause measurable EtG levels, then probably any product containing alcohol could, he noted. And products that contain alcohol are everywhere, ranging from the cold medicine NyQuil to asthma inhalers, topical testosterone, and bug spray.

Ethyl glucuronide is a very specific metabolite of alcohol found in urine. It is considered a better test than a blood alcohol level, because it lasts much longer—about 5 days—depending on the amount ingested and individual variation. Although it has been theorized that certain rare individuals could automatically ferment alcohol in their system, such as yeast in the bowel, it has been assumed that a positive test meant someone had to have taken a drink.

At the meeting, Dr. Michael R. Liepman presented an experiment on the EtG test that he conducted using 24 abstinent subjects.

One group of subjects washed their hands with Purell (62% alcohol) 15 times at 4-minute intervals in a small enclosed room where, presumably, they would be inhaling the fumes from the washing. Each of those subjects was accompanied by another subject who did not wash their hands but stood close enough for inhalation.

A third group washed their hands in an air-flow chamber to prevent inhalation, and a fourth group served as controls.

Three of the subjects who washed their hands and could inhale the sanitizer had positive EtG tests 30 minutes after washing, as did one of the subjects observing in the same room, said Dr. Liepman, director of addiction psychiatry and research at Michigan State University's Kalamazoo Center for Medical Studies.

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