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    Sunday, August 13, 2006

    Truth in a Bottle II: Yesterday's Wall Street Journal had an interesting article (subscription only) about a rapidly growing urine marker for alcohol that a just might be too sensitive to be useful. The marker, ethyl glucuronide is a metabolite of alcohol that stays in the system much longer and can be found in the urine up to five days after alcohol use. Although that link says that it is found in the urine after "heavy alcohol use," the WSJ article and the man who first advocated the test, Dr. Gregory Skipper, say that isn't necessarily true. Even incidental or accidental exposure to alcohol can cause positive readings, and the appropriate cut-off levels to distinguish drinking alcohol from washing your hands in Purell all day have not been established.

    And who would believe an alcoholic when they say they haven't been drinking, just washing their hands in Purell? Few would, but Dr. Skipper did a small experiment to see if it could happen, and it did:

    A small study of 24 people that Dr. Skipper helped perform found that use of Purell could result in EtG showing up in urine. It concluded alcohol in the sanitizer can enter the body through inhalation, rather than through the skin. That study, presented in May at the scientific conference of the American Society of Addiction Medicine, hasn't been published or peer-reviewed.

    At Dr. Skipper suggestion, Mrs. Garlick, 43, entered a treatment center in California and stayed two days under the supervision of counselors instructed to search her and her belongings for any products containing alcohol. Each morning, she provided a urine sample that tested negative for EtG. Then she washed her hands repeatedly during the day with Purell - and her urine that night had an EtG score of 770. That was more than seven times the cutoff that Dr. Skipper originally thought represented proof of drinking.

    Mrs. Garlick had her license to practice nursing suspended when her EtG test was positive. Do you know how many times a day a nurse rubs Purell into her hands? Kudos to Dr. Skipper for speaking out in defense of those suffering from the improper use of the test. Not many people would be willing to see the flaws in their pet project, especially when it gets them a lot of attention in their field. Hopefull, the drug testing industry and justice system will listen and begin to use it a little more wisely. But it doesn't look like that will happen soon:

    Despite innocent positives, some courts and licensing boards are digging in their heels. They are arguing that a participant "must produce a negative urine" sample, says Mr. Lewis, the drug-testing company president. "Trying to argue that you're an innocent victim- good luck."

    Indeed, the state of Pennsylvania isn't saying that Nancy Clark
    [another victim of overzealous interpretation of the test-ed.] drank, only that she failed to produce clean urine. "This case is not about relapse," said Mr. Smith, the lawyer for the state, in the June argument against her appeal."

    But what if doing your job requires incidental exposure to alcohol that is not consumption? I've heard that justice is blind, but this is ridiculous.

    posted by Sydney on 8/13/2006 08:23:00 AM 2 comments


    Although its a bit harder on my skin, I try to handwash over simply pumping the purell when Im in clinicals. Yet another reason to do so.

    By Blogger Intelinurse2B, at 12:01 PM  

    The point of my doing the experimentation with Purell was not to simply point out the obvious ("Stop using Purell"). Because of individual variations in metabolism, some of us are prone to producing higher-than-normal levels of EtG from very minor exposure to ethanol. And this seems to occur predominantly in women! For those of us with such quirky metabolism, it is impossible to avoid the thousands of products and food items that we are all exposed to every day. So even with meticulous attention to what I put in and on my body, I have absolutely no power or control over my EtG test results.
    Lorie Garlick

    By Blogger Lorie, at 4:38 AM  

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