[MCOH-EH] [EXTERNAL] Re: Re: blood, oral secretion and hair collection for screening

[Vaughn, Andrew I., M.D., M.P.H.]

When doing for-cause alcohol testing, the reliability and legal standing of the test result is of paramount importance.  As the reference below indicates, the relationship between blood and urine alcohol concentrations is complex and may be difficult to explain.  And that assumes properly timed, double voided urine samples have been properly collected.

Andrew I S Vaughn, MD, MPH
Medical Director, Rochester Employee Health & Safety
Mayo Clinic | Rochester, MN 55905 | www.mayoclinic.org

-------------------

Jones AW1.  Toxicol Rev. 2006;25(1):15-35. Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship.

Abstract
This article concerns the use of urine as a biological specimen for determination of alcohol in clinical and forensic toxicology and discusses factors that might influence variability in the urine/blood concentration ratio of alcohol. A large number of human drinking experiments were conducted to determine the time course of urine-alcohol concentrations (UAC) in relation to blood-alcohol concentrations (BAC). The UAC and BAC curves were shifted in time and the BAC curve always began to decrease before the UAC started to decline. During the early absorption phase the UAC/BAC ratio was less than unity, whereas in the late absorption/distribution period the ratio was between 1.0-1.2. On reaching the post-absorptive phase, the UAC always exceeded BAC and UAC/BAC ratios averaged 1.3-1.4, increasing appreciably as BAC decreased towards zero. Alcohol-induced diuresis was most pronounced during the rising portion of the BAC curve and near to the peak value. After about 2 hours post-drinking, the production rate of urine diminished to the pre-drinking rate of about 0.5-1 mL/min. Drinking water during the post-absorptive phase of the alcohol curve produced dilute urine, as reflected in lower creatinine content and osmolality, although the concentration of ethanol remained unchanged. After subjects drank a moderate dose of ethanol (0.54-0.85 g/kg) about 2% of the dose was recoverable in the urine after 7 hours. Ethyl glucuronide, a minor metabolite of ethanol, was measured in urine samples from drunk drivers. The UAC/BAC ratio of ethanol in drunk drivers did not depend on the creatinine content of the urine and therefore the relative dilution of the specimens. When alcohol-free urine was spiked with glucose and infected with the yeast species Candida albicans, ethanol was produced by fermentation after approximately 24 hours storage at room temperature. This post-sampling synthesis of ethanol was prevented by sodium fluoride (1% weight by volume) in the urine tubes or by keeping the specimens in the cold (4 degrees C). The UAC and BAC were highly correlated (r > 0.95) in drunk drivers and in autopsy cases, although the residual standard deviations were appreciable. This speaks against attempting to estimate BAC indirectly from UAC in any individual case. The UAC/BAC ratio and the change in UAC between two successive voids can help to resolve whether a large amount of alcohol had recently been consumed. This information is useful to support or challenge allegations of drinking alcohol after driving, which has become known as the hip-flask defence.

PMID: 16856767

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Nancy Rodway
Sent: Thursday, April 05, 2018 10:04 AM
To: MCOH/EH
Subject: [EXTERNAL] Re: [MCOH-EH] Re: blood, oral secretion and hair collection for screening

Urine alcohol has a reasonable equivalent to breath alcohol...and can be considered as an alternative since you are doing urine anyway.
Nancy
________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Swift, Melanie D., M.D. via MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Sent: Thursday, April 5, 2018 10:55 AM
To: MCOH/EH
Cc: Swift, Melanie D., M.D.
Subject: Re: [MCOH-EH] [EXTERNAL] Re: blood, oral secretion and hair collection for screening


Karen - I assume from the question this is for unregulated testing?



For saliva testing, here would be no reason you could not use standard STT procedures as outlined in the CFR. Having BATs/STTs trained under federal protocol is good practice for unregulated testing programs because the protocols ensure integrity of the results (and give you a leg to stand on if an adverse employment action were challenged).



The advisability of blood collection will depend upon your employer policies and state regulations, and it cannot be used for routine DOT screens of course. I disagree with Dr. Rodway on the "assault" characterization - if legal in your state and supported by thoughtful policy, one could certainly use blood alcohol in non-regulated testing - for example reasonable suspicion with shy lung, or if you don't have ability to do BATs. And actually there are states (Minnesota being one) that prohibit employers collecting breath alcohol on the premises, but will allow blood testing in a lab. Assuming you have collectors already trained in phlebotomy, you could overlay the chain of custody procedures as you would use for a urine collection. Work with your lab to see if they support chain of custody and request they provide a CCF.



The lab you are using for the hair testing likely has their own collection protocol. There is training available for that if you decide to collect your own - the lab may be able to point you to training.



Melanie



Melanie Swift, MD
Senior Associate Consultant

Division of Preventive, Occupational, and Aerospace Medicine

Phone 507.284.2560

_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Natalie Hartenbaum
Sent: Thursday, April 05, 2018 9:43 AM
To: MCOH/EH
Subject: [EXTERNAL] Re: [MCOH-EH] blood, oral secretion and hair collection for screening



Actually only Matrix permitted in Maryland - also required by FRA as post accident



Natalie P.  Hartenbaum, MD, MPH, FACOEM
President and Chief Medical Officer
OccuMedix
PO Box 197
Dresher, PA 19025
215-646-2205
occumedix at comcast.net<mailto:occumedix at comcast.net>



On Apr 5, 2018, at 10:41 AM, Nancy Rodway <nrodway at hotmail.com<mailto:nrodway at hotmail.com>> wrote:



BLOOD alcohol????  That is regarded as assault

________________________________

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Morelli, Karen J <kmorelli at emhs.org<mailto:kmorelli at emhs.org>>
Sent: Thursday, April 5, 2018 9:15 AM
To: 'mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>'
Subject: [MCOH-EH] blood, oral secretion and hair collection for screening



Good Morning,

I am trying to write protocols for blood alcohol/marijuana collection, oral secretion and hair collection for drug screening.  Does anyone have protocols already created that I could use as a guide?

Thank you in advance!

Karen



Karen Morelli RN, BSN, Clinical Manager

WorkHealth LLC

973-7382

kmorelli at emhs.org<mailto:kmorelli at emhs.org>



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BANGOR | PITTSFIELD | PORTLAND | PRESQUE ISLE





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