Improved detection of ethyl glucuronide and ethyl sulfate in a pain management population using high-throughput LC-MS/MS
DOI:
https://doi.org/10.5055/jom.2010.0039Keywords:
ethyl glucuronide, ethyl sulfate, pain patients, alcohol abuse, immunoassay, LC-MS/MSAbstract
Background: Ethyl glucuronide (EtG) and ethyl sulfate (EtS) have been proposed as markers for detecting alcohol use because they exhibit extended excretion lifetimes when compared with ethanol; however, their presence is not considered as absolute proof of alcohol use. Two methods are currently used for the detection and quantitation of EtG: immunoassay and mass spectrometry. The purpose of this study was to provide more patient data to better compare the two methods.Methods: A retrospective diagnostic accuracy study was performed to compare the methods. EtS was also measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) as an additional comparative analyte. The investigators examined 4,287 sequential urines from pain patients to determine the incidence of alcohol use and the corresponding presence of EtG by immunoassay at a cutoff of 500 ng/mL. EtG and EtS were subsequently quantitated in all the urines using LC-MS/MS.
Results: A total of 794 samples were found positive by immunoassay, and these results were compared at three distinct LC-MS/MS cutoffs of 100, 500, and 1,000 ng/mL. The incidence of ethanol use in this population was found to be at least 12 percent.
Conclusions: Approximately 30 percent of the samples screened by immunoassay as positive were confirmed to be negative by LC-MS/MS.
References
National Survey on Drug Use and Health: Substance use and dependence following initiation of alcohol or illicit drug use. The NSDUH Report; March 27, 2008. Available at http://www.oas.samhsa.gov/2k8/newUseDepend/newUseDepend.cfm. Accessed August 10, 2010.
Trescot AM, Boswell MV, Atluri SL, et al.: Opioid guidelines in the management of chronic non-cancer pain. Pain Physician. 2006; 9: 1-39.
Morgan RO, Kramer JR, Woodard LD, et al.: Impact of patient-physician communication on treatment of prescription pain reliever abuse. Available at http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103623519.html. Accessed July 2, 2010.
Bendtsen P, Jones AW: Impact of water-induced diuresis on excretion profiles of ethanol, urinary creatinine, and urinary osmolality. J Anal Toxicol. 1999; 23: 565-569.
Niemela O: Biomarkers in alcoholism. Clin Chem Acta. 2007; 377: 39-49.
Jones AW: Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship. Toxicol Rev. 2006; 25: 15-35.
Jones AW: Lack of association between urinary creatinine and ethanol concentrations and urine/blood ratio of ethanol in two successive voids from drinking drivers. J Anal Toxicol. 1998; 22: 184-190.
Schmitt G, Droenner, P, Skopp G, et al.: EtG concentration in serum of human volunteers, teetotalers, and suspected drinking drivers. J Forensic Sci. 1997; 42: 1099-1102.
Stephanson N, Dahl H, Helander A, et al.: Direct quantification of ethyl glucuronide in clinical urine samples by liquid chromatography-mass spectrometry. Ther Drug Monit. 2002; 24: 645-651.
Goll M, Schmitt G, Ganssmann B, et al.: Excretion profiles of ethyl glucuronide in human urine after internal dilution. J Anal Toxicol. 2002; 26: 262-266.
Dahl H, Stehpanson N, Beck O, et al.: Comparison of urinary excretion characteristics of ethanol and ethyl glucuronide. J Anal Toxicol. 2002; 26: 201-204.
Wurst FM, Wiesbeck GA, Metzger JW, et al.: On sensitivity, specificity, and the influence of various parameters on ethyl glucuronide levels in urine—Results from the WHO/ISBRA study. Alcohol Clin Exp Res. 2004; 28: 1220-1228.
Hoiseth G, Bernard JP, Karinen R, et al.: A pharmacokinetic study of ethyl glucuronide in blood in urine: Applications to forensic toxicology. Forensic Sci Int. 2007; 172: 119-124.
Hoiseth G, Bernard JP, Stephanson N, et al.: Comparison between the urinary alcohol markers EtG and GTOL/5-HIAA in a controlled drinking experiment. Alcohol Alcohol. 2008; 43: 187-191.
Zimmer H, Schmitt G, Aderjan R: Preliminary immunochemical test for the determination of ethyl glucuronide in serum and urine: Comparison of screening method results with gas chromatography-mass spectrometry. J Anal Toxicol. 2002; 26: 11-16.
Wojcik MH, Hawthorne JS: Sensitivity of commercial ethyl glucuronide (ETG) testing in screening for alcohol abuse. Alcohol Alcohol. 2007; 42: 317-320.
Helander A, Dahl H: Urinary tract infection: A risk factor for false-negative urinary ethyl glucuronide but not ethyl sulfate in the detection of recent alcohol consumption. Clin Chem. 2005; 51: 1728-1730.
Helander A, Olsson I, Dahl H: Post collection synthesis of ethyl glucuronide by bacteria in urine may cause false identification of alcohol consumption. Clin Chem. 2007; 53: 1855-1857.
Wurst FM, Dresen S, Allen JP, et al.: Ethyl sulphate: A direct ethanol metabolite reflecting recent alcohol consumption. Addiction. 2005; 101: 204-211.
Helander A, Beck O: Ethyl sulfate: A metabolite of ethanol in humans and a potential marker of acute alcohol intake. J Anal Toxicol. 2005; 29: 270-274.
Helander A, Böttcher M, Fehr C, et al.: Assessment and detection: Detection times for urinary ethyl glucuronide and ethyl sulfate in heavy drinkers during alcohol detoxification. Alcohol Alcohol. 2009; 44: 55-61.
Constantino A, Digregorio EJ, Korn W, et al.: The effect of the use of mouthwash on ethyl glucuronide concentrations in urine. J Anal Toxicol. 2006; 30: 659-662.
Glanz J, Grant B, Monteiro M, et al.: WHO/ISBRA study on state and trait markers of alcohol use and dependence: Analysis of demographic, behavioral, physiologic, and drinking variables that contribute to dependence and seeking treatment. International Society on Biomedical Research on Alcoholism. Alcohol Clin Exp Res. 2002; 26(7): 1047-1061.
Center for Substance Abuse Treatment: The role of biomarkers in the treatment of alcohol use disorders. Substance Abuse Treatment Advisory. Volume 5, Issue 4. HHS SAMHSA Center for Drug Abuse Treatment, 2006. Available at http://kap.samhsa.gov/products/manuals/advisory/pdfs/0609_biomarkers.pdf.
Thermo Fisher Scientific: DRI® Ethyl Glucuronide Assay. Fremont, CA: Microgenics Corp.
Horn PS: Reference intervals and clinical decision limits. In Kaplan LA, Pesce AJ (eds.): Clinical Chemistry: Theory, Analysis, and Correlation. New York: Elsevier, 2010: 439-455.
Høiseth G, Morini L, Polettini A, et al.: Serum/whole blood concentration ratio for ethyl glucuronide and ethyl sulfate. J Anal Toxicol. 2009; 33: 208-211.
Arndt T, Gierten B, Güssregen B, et al.: False-positive ethyl glucuronide immunoassay screening associated with chloral hydrate medication as confirmed by LC-MS/MS and self-medication. Forensic Sci Int. 2009; 184: e27-e29.
Böttcher M, Beck O, Helander A: Evaluation of a new immunoassay for urinary ethyl glucuronide testing. Alcohol Alcohol. 2007; 43: 46-48.
Wurst FM, Skipper GE, Weinmann W: Ethyl glucuronide—The direct ethanol metabolite on the threshold from science to routine use. Addiction. 2003; 98 (Suppl 2): 51-61.
Bergström J, Helander A, Jones AW: Ethyl glucuronide concentrations in two successive urinary voids from drinking drivers: Relationship to creatinine content and blood and urine ethanol concentrations. Forensic Sci Int. 2003; 133: 86-94.
Heit HA, Gourlay D: Urine drug testing in pain medicine. J Pain Symptom Manage. 2004; 27(3): 260-267.
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved
