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Background: The COVID-19 pandemic reportedly had a significant impact on drug and alcohol use. In this article, we determine positivity rates for urine drugs of abuse and blood alcohol in 5 emergency departments (ED) in the greater Boston metropolitan area over a 4-year period (pre-, during, and post-COVID-19 pandemic)., Methods: Positivity rates for the urine drug screening (UDS) panel and blood alcohol concentration (>80 mg/dL; over the legal limit in MA) were calculated in patients presenting to one of the 5 ED (2 academic hospitals in Boston, MA and 3 community hospitals outside Boston, MA) during each of the 4 different time periods: pre-COVID (January 1, 2019 to December 31, 2019), stay-at-home (March 24, 2020 to May 18, 2020), during COVID (May 19, 2020 to March 28, 2021), and post-COVID (May 12, 2023 to August 31, 2023). Trend analysis was performed. Additionally, positivity rates during and post-COVID were compared to pre-COVID to determine any significant changes in drug positivity., Results: Stimulant (amphetamines and cocaine), cannabinoid, and methadone positivity increased during the pandemic and cocaine, cannabinoid, and methadone positivity remains elevated. By contrast, benzodiazepine and opioid (opiates, fentanyl, oxycodone) positivity decreased and remains lower post-COVID compared to pre-COVID. Patients in the ED with blood alcohol over the legal limit decreased both during and post-COVID., Conclusion: Our study showed that the COVID-19 pandemic significantly affected drug and alcohol positivity rates in patients presenting to the ED in greater Boston area. We encourage other institutions to perform similar analyses to help determine local drug use patterns and appropriate composition of UDS panels., (© Association for Diagnostics & Laboratory Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: People regularly contact emergency medicine services concerned that they have been exposed to drink spiking, i.e., exposure to drugs without their knowledge or permission. We identified drugs in blood and urine samples from patients suspecting exposure to drink spiking, with special consideration for drugs not reported taken by the patient (unreported drugs)., Methods: From September 2018 to May 2019, we collected blood and urine samples from patients 16 years or older presenting at an emergency clinic in Oslo, Norway, within 48 hours of suspected exposure to drink spiking. We also collected information on ethanol ingestion and drugs taken. Blood samples were analyzed for 20 classical recreational drugs using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and an automated enzymatic method for ethanol. Urine samples were analyzed using immunoassay methods and a specific gas chromatography mass spectrometry (GCMS) method for gammahydroxybutyrate (GHB)., Results: From 100 included patients (median age 24 years, 62 females), we collected 100 blood samples and 72 urine samples. Median time since exposure was 5 hours. Unreported drugs were found in 15 patients. Unreported drugs in the blood samples were clonazepam in 3, methylenedioxymethamphetamine (MDMA) in 3, amphetamine in 2, tetrahydrocannabinol (THC) in 2, tramadol in 1, cocaine in 1, and methamphetamine in 1. Unreported drugs in the urine samples were cocaine in 5, amphetamine in 4, ecstasy in 3, and cannabis in 2. Ethanol was found in 69 patients, all reporting ethanol ingestion. Median blood ethanol concentration was higher in patients with no unreported drugs detected, 1.00‰ (interquartile range (IQR) 0-1.52) vs. 0‰ (IQR 0-0.46) (p<0.001). GHB was not detected., Conclusion: Unreported drugs, possibly used for drink spiking, were found in 15% of patients. Blood ethanol concentration was higher when no unreported drugs were found. GHB was not detected in any patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dalaker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This article traces the historical development of various biomarkers of acute and/or chronic alcohol consumption. Much of the research in this domain of clinical and laboratory medicine arose from clinics and laboratories in Sweden, as exemplified by carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth). Extensive studies of other alcohol biomarkers, such as ethyl glucuronide (EtG), ethyl sulfate (EtS), and 5-hydroxytryptophol (5-HTOL), also derive from Sweden. The most obvious test of recent drinking is identification of ethanol in a sample of the person's blood, breath, or urine. However, because of continuous metabolism in the liver, ethanol is eliminated from the blood at a rate of 0.15 g/L/h (range 0.1-0.3 g/L/h), so obtaining positive results is not always possible. The widow of detection is increased by analysis of ethanol's non-oxidative metabolites (EtG and EtS), which are more slowly eliminated from the bloodstream. Likewise, an elevated ratio of serotonin metabolites in urine (5-HTOL/5-HIAA) can help to disclose recent drinking after ethanol is no longer measurable in body fluids. A highly specific biomarker of hazardous drinking is CDT, a serum glycoprotein (transferrin), with a deficiency in its N-linked glycosylation. Another widely acclaimed biomarker is PEth, an abnormal phospholipid synthesized in cell membranes when people drink excessively, having a long elimination half-life (median ~6 days) during abstinence. Research on the subject of alcohol biomarkers has increased appreciably and is now an important area of drug testing and analysis., (© 2023 John Wiley & Sons Ltd.)

Background: The objective of the current study is to determine how alcohol and illicit substance use contributes to motorcycle crash fatalities by examining the relationship between toxicology levels found postmortem and the behavior of riders and passengers in fatal motorcycle crashes., Materials and Methods: All motorcycle fatalities in Miami-Dade County, FL, from 2009 to 2014 were reviewed using the Miami-Dade County Medical Examiner's toxicology reports and the corresponding crash reports., Results: Positive alcohol/illicit substance detection was found in 44% of our population of 227 fatalities. When compared with those with a negative alcohol/illicit substance detection, those with a positive alcohol/illicit substance detection were more likely to be found at fault of the crash (77% versus 50%, P < 0.001), more likely to be in a single-vehicle crash (47% versus 21%, P < 0.001) and less likely to wear a helmet (44% versus 64%, P = 0.002). However, there was no significant relationship between speeding and alcohol/illicit substance detection (29% versus 33%, P = 0.748). In addition, a regression analysis demonstrated that there was less helmet use and more single-vehicle crashes with higher blood alcohol concentration., Conclusions: In fatal motorcycle crashes, alcohol and illicit substance use had a significantly negative impact on the risk aversion of motorcycle fatalities in regard to fault, helmet use, and single-vehicle crashes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Alcohol Liver Disease (ALD) is one of the most prevalent conditions leading to liver transplantation for end-stage liver disease. There is lacking evidence of regular urine screening testing (RUST) impact on survival or liver transplantation of ALD patients. The aims of this study were to compare the sensitivity of RUST, to assess its impact on survival and liver transplantation, and to evaluate factors associated with adherence to RUST. We performed a single-centered retrospective study (N = 84) with ALD candidates for liver transplantation. Demographic, biochemical and clinical variables were recorded at baseline. Adherence to RUST was evaluated during follow-up. The sensitivity of both RUST and self-reports were calculated for all drugs. Multivariable logistic and survival regression analyses were performed to explore associated factors and the impact of adherence to RUST, and positive results on survival. RUST had high sensitivity for identifying active drinkers (76.9%), smokers (78.9%) and cannabis users (83.3%). High adherence to RUST was inversely associated with mortality during follow-up. Presence of personality disorders negatively impacted (OR 0.29, CI 95% 0.08-0.97) adherence to RUST. Both RUST and self-reports should be carried out in this setting. Professionals involved in liver transplantation programs must promote adherence to RUST, primarily in patients with personality disorders.

Aim: Claimed intake of alcohol after a traffic incident, called the hip-flask defence, can be objectively assessed by different methods. One of them is the use of two consecutive ethanol concentrations in urine and the ratio between ethanol concentrations in urine and blood. Another one is the concentrations of ethyl glucuronide (EtG) and ethyl sulphate (EtS) in blood and their ratio to ethanol. The experimental basis for both these models is from single dose studies only. The aim of this study was therefore to describe the kinetics of ethanol, EtG and EtS after ingestion of two repeated doses of ethanol and to investigate the usefulness of the different models for the assessment of the hip-flask defence., Methods: Thirty-five subjects ingested a first dose of 0.51 g of ethanol per kilo body weight, and two hours later a second dose (the hip-flask drink) of 0.25, 0.51 or 0.85 g of ethanol per kilo body weight. Ten urine and 17 blood samples were collected and analysed for ethanol, EtG and EtS using fully validated methods. It was investigated if all subjects fulfilled the criteria for recent drinking, according to the two different models, when using the samples collected 180-240 minutes after start of first dose drinking. According to the first model, increase in urinary ethanol concentrations and a ratio UAC/BAC below 1.3 indicated recent drinking. According to the second model, increase in blood EtG concentrations and a ratio ethanol (g/kg)/EtG (mg/L) above 1 indicated recent drinking., Results: All subjects in the high dose group fulfilled all criteria for recent drinking. One subject in the medium dose group and nine subjects in the low dose group failed to show increasing UAC and/or a UAC/BAC ratio below 1.3. One subject in the low dose group failed to show increasing concentrations of blood EtG, but all subjects showed a ratio ethanol/EtG above 1., Conclusions: The present study showed, by the use of experimental data, that both two models used to investigate the hip-flask defence can be used, but only when the hip-flask dose is sufficiently high., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Urine drug testing (UDT) is increasingly performed as a means of identifying aberrant behavior that may be grounds for discontinuation of long-term opioid therapy (LTOT). Little is known, however, about the ways in which positive UDT results may differentially inform decisions to discontinue LTOT based on the type of substance for which the UDT screened positive. The aim of this study was to examine the likelihood of clinician-initiated discontinuation of LTOT attributed to positive UDT results across three discrete categories of substances: (1) cannabis, (2) alcohol or illicit substances (excluding cannabis), and (3) controlled prescription medications that were not prescribed., Design: This retrospective study utilized the US Department of Veterans Affairs (VA) Health Care System. Corporate Data Warehouse to assemble a sample of 600 patients with substance use disorders and matched controls who were discontinued from LTOT in 2012. Comprehensive manual medical record review identified UDT results in the year prior to discontinuation and reason(s) for discontinuation., Patients, Participants: Patients with one or more UDTs positive for a single substance (N = 185) comprised the study sample., Main Outcome Measure(s): Likelihood of clinician-initiated discontinuation attributed to a positive UDT across the three categories., Results: Patients with one or more UDTs positive for cannabis were more likely to be discontinued from opioid therapy as a result of the positive UDT compared to those with one or more UDTs positive for nonprescribed prescription medication (adjusted odds ratio [OR] = 18.05, 95% CI = 7.29-44.66). Similarly, patients with UDTs positive for alcohol or illicit substances were more likely to be discontinued for the positive UDTs relative to patients who tested positive for nonprescribed prescription medications (adjusted OR = 13.10, 95% CI = 4.81-35.68). No difference in UDT-related discontinuation decisions was evident between patients with UDTs positive for alcohol/illicit substances versus cannabis (adjusted OR = 1.47, 95% CI = 0.57-3.77)., Conclusions: High odds of UDT-related discontinuation were found in patients who tested positive for cannabis, alcohol, or illicit substances, relative to nonprescribed prescription medications.

Background: Efforts aimed at reducing alcohol-related harm include early detection of risky drinkers as well as detection of early relapse in patients with alcohol dependence. Ethyl glucuronide (EtG) has been proven to be a reliable biomarker for the detection of recent drinking; however, no randomized, diagnostic trial to date has tested its impact on drinking outcomes. The aim of this study was to assess, in a randomized design, the implications of EtG screening on alcohol outcomes, compared to screening with a low sensitivity biomarker such as ethanol., Methods: Alcohol dependent outpatients were randomized to either 24 weeks of continuous screening with EtG or ethanol. Patients were aware of screening methods and results. After 24 weeks, all participants were screened with EtG. Self-reports were also gathered. A logistic regression compared the rate of EtG positive results at study end between groups. Generalized estimating equations evaluated the descending monthly rate of EtG positive patients in the EtG group., Results: A total of 162 patients were randomized. During the study period, the ethanol group showed less patients with positive screens (19/64 (29.7%) vs 58/98 (59%)). After 24 weeks, the EtG group showed a greater number of patients having a negative screening test compared to ethanol subjects when they were all screened with EtG (5/62 (8.1%) vs 13/39 (33.3%)). A significant decrease in the rate of EtG positive patients was found for the first three months of the study., Conclusions: Routine screening with EtG seems to reduce drinking and improve abstinence rates in alcohol dependent outpatients., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Urine drug screens are commonly performed to identify drug use or monitor adherence to drug therapy. The purpose of this retrospective study was to evaluate the true positive and false positive rates of one of our in-house urine drug screen panels. The urine drugs of abuse panel studied consists of screening by immunoassay then positive immunoassay results were confirmed by mass spectrometry. Reagents from Syva and Microgenics were used for the immunoassay screen. The screen was performed on a Beckman AU5810 random access automated clinical analyzer. The percent of true positives for each immunoassay was determined. Agreement with previously validated GC-MS or LC-MS-MS confirmatory methods was also evaluated. There were 8,825 de-identified screening results for each of the drugs in the panel, except for alcohol (N = 2,296). The percent of samples that screened positive were: 10.0% for amphetamine/methamphetamine/3,4-methylenedioxy-methamphetamine (MDMA), 12.8% for benzodiazepines, 43.7% for opiates (including oxycodone) and 20.3% for tetrahydrocannabinol (THC). The false positive rate for amphetamine/methamphetamine was ∼14%, ∼34% for opiates (excluding oxycodone), 25% for propoxyphene and 100% for phencyclidine and MDMA immunoassays. Based on the results from this retrospective study, the true positive rate for THC drug use among adults were similar to the rate of illicit drug use in young adults from the 2013 National Survey; however, our positivity rate for cocaine was higher than the National Survey., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Aims: To test the screening performance of urinary ethyl glucuronide (EtG) under routine clinical conditions in a sample of alcohol-dependent outpatients, comparing it against urinary ethanol, self reports and clinical judgment., Methods: A cross-sectional study under routine conditions was conducted in February 2015, where 613 consecutive urinary samples, provided by 188 outpatients with alcohol use disorders, were analyzed for ethanol and EtG (cut-off level = 500 ng/ml). Clinical variables such as the presence of aversive medication, comorbidities and clinician judgment were also collected. The discrepancy between the number of alcohol and EtG positives was recorded. A logistic regression analysis including clinical variables was conducted to assess for predictors of EtG positivity., Results: Urinary alcohol yielded 9 positives (1.5% of all urine samples) belonging to 8 patients. EtG yielded 136 positives (22% of all urine samples) belonging to 74 patients. Of these, 93.4% (127 of 136) were negative for alcohol. All urinary alcohol positives resulted in EtG positives. The clinician judged 48 samples from 26 patients as belonging to not abstinent patients and 550 samples from 178 patients as belonging to abstinent patients. She was unsure in 15 samples from 15 patients. When comparing it against EtG as the gold standard, the area under the curve was 0.592. Self reports were extremely unreliable in this study, with only 5 patients reporting drinking in a total of 6 urine samples. In the logistic regression model, only aversive medications (OR 2.1, 95% CI 1.3-3.3) and clinician judgment (OR 2, 95% CI 1.4-2.9) resulted in significant effects., Conclusions: EtG performed largely better than ethanol for urine screening in alcohol outpatients, detecting an extra 20.4% (125 out of 613) of positives. It means that for each alcohol-positive sample, there were 15 EtG-positive samples. Although better than ethanol, clinician judgment was also not performed efficiently. If routinely implemented in the screening of alcohol outpatients, EtG might bring relevant changes that merit further research., (© 2016 S. Karger AG, Basel.)

This study attempts to assess the utility of the urine matrix as an alternative to cosmetically treated hair for the detection of drugs and alcohol for driving licence re-granting in 1026 cosmetically treated hair samples and 33 262 urine routine samples. No significant difference was observed between the percentage positive samples in cosmetically treated hair to those in urine at both the 95% and 99% significance level for amphetamines, cocaine, opiates, benzodiazepines, and methadone. Significant difference was found between the positivity rates of cannabinoids in cosmetically treated hair and that in urine indicating urine to be a better alternative to the use of the hair matrix even when cosmetically treated. The opposite was observed for the alcohol consumption marker ethyl glucuronide (EtG) for which the positivity rate in cosmetically treated hair was twice that in urine samples. Particularly for alcohol abstinence monitoring, as for the rehabilitative driving licence re-granting medical and psychological assessment (MPA) programme in Germany, it seems that ethyl glucuronide (EtG) in hair presents a much better alternative than urine testing, even when cosmetically treated hair is analyzed. Moreover, segmentation is an additional advantage of hair testing which can provide additional useful information., (Copyright © 2014 John Wiley & Sons, Ltd.)

Background: Statistics from the National Trauma Data Bank imply that discretionary blood alcohol and urine drug testing is common. However, there is little evidence to determine which patients are appropriate for routine testing, based on information available at trauma center arrival. In 2002, Langdorf reported alcohol and illicit drug rates in Trauma Activation Patients., Methodology/principal Findings: This is a retrospective investigation of alcohol and illicit drug rates in consecutive St. Elizabeth Health Center (SEHC) trauma patients. SEHC Trauma Activation Patients are compared with the Langdorf Activation Patients and with the SEHC Trauma Nonactivation Patients. Minimum Rates are positive tests divided by total patients (tested and not tested). Activation patients: The minimum alcohol rates were: SEHC 23.1%, Langdorf 28.2%, combined 24.8%. The minimum illicit drug rates were: SEHC 15.7%, Langdorf 23.5, combined 18.3%. The minimum alcohol and/or illicit drug rates were: SEHC 33.4%, Langdorf 41.8%, combined 36.2%. Nonactivation patients: The SEHC minimum alcohol rate was 4.7% and the minimum illicit drug rate was 6.0%., Conclusions: Alcohol and illicit drug rates were significantly greater for Trauma Activation Patients, when compared to Nonactivation Patients. At minimum, Trauma Activation Patients are likely to have a 1-in-3 positive test for alcohol and/or an illicit drug. This substantial rate suggests that Trauma Activation Patients, a readily discernible group at trauma center arrival, are appropriate for routine alcohol and illicit drug testing. However, discretionary testing is more reasonable for Trauma Nonactivation Patients, because minimum rates are low.

Aims: This study determined the information about recent alcohol consumption obtained when urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS) were introduced as a routine test in outpatient treatment programs for alcohol and drug dependence., Patients and Methods: Outpatients (21 men and 3 women) undergoing treatment for alcohol (N = 8) or drug (N = 10) dependence, or in methadone maintenance therapy (N = 6) volunteered for the study. Twice weekly in connection with return visits to the unit, patients gave a urine sample and completed an anonymous single-question form about any drinking in the past 3 days. Urinary EtG and EtS were determined by liquid chromatography-mass spectrometry., Results: Totally, 214 urine samples (4-14 samples/patient; mean 9) and 211 self-reports were collected over a 2-8-week period. Altogether 26% of the urine samples from 12 of 24 patients tested positive for EtG (0.5-434 mg/l) and/or EtS (0.1-87 mg/l). In one patient, samples were only positive for EtS. In 21% of 211 self-reports from 11 patients, alcohol ingestion was admitted in the past 3 days. In 87% of the 211 complete cases, the self-report information agreed with the EtG/EtS results (i.e. true positives and true negatives). The highest frequency of drinking was seen in the drug-dependent group with only 20% of the patients being abstinent according to both measures. This compares with 62.5% abstinence in the alcohol-dependent group and 50% in the methadone maintenance therapy group., Conclusion: Although based on a limited number of subjects, these results indicated that urinary EtG and EtS testing is a useful tool for objective identification of recent drinking in outpatients treated for alcohol and drug dependence.

Background: Determination of ethanol use in the pain patient population being treated with chronic opioid therapy is critically important to the treating physician. Urinary ethanol, ethyl glucuronide (EtG), and ethyl sulfate (EtS) have been used to identify alcohol use. Because urine samples are shipped to reference laboratories, the possibility of glucose fermentation during transit producing ethanol complicates interpretation. The purpose of this study was to establish whether ethanol-positive urine samples were due to ingestion or fermentation during shipping., Methods: The authors obtained 94 ethanol-positive urine samples from pain patients, which were further tested for EtG, EtS, and glucose., Results: Only 62 of the 94 samples contained EtS or EtS. Of the 94 samples, 63 samples had glucose values above 10 mg/dL. Four of the 32 EtG-negative patients had ethanol levels that were nonphysiologic. Limitations of the study include the lack of demographic data beyond treatment with opioids for chronic pain., Conclusions: Roughly one-third of the time, ethanol-positive urine samples that have been shipped were positive because of fermentation and not because of patient alcohol consumption. This method is a combination of urinary ethanol measurement and liquid chromatography tandem mass spectrometry quantitation of both EtG and EtS. In the absence of these metabolites, the presence of urinary ethanol is attributed to fermentation. The improvement is a better definition of the source of the ethanol. Confirmatory testing showing the presence of the ethanol metabolites EtG and EtS is needed to validate that the ethanol is due to consumption. The presence of glucose, while common in the ethanol-positive samples, is not an absolute indicator that the ethanol was due to fermentation.

Laboratory of Analytical Toxicology and Drug Monitoring, Jagiellonian University Medical College in Kraków performs analysis for patients from Kraków and south-east Poland. The determinations are made for intoxicated patients treated in the Toxicology Ward, for addicted patients treated in Detoxification Unit and other hospitals. The most often determined compounds are psychoactive substances (ethanol, drugs of abuse, psychotropic medicines). The purpose of the paper was to study structure of positive results of some psychoactive substances within seven years. In the study archived data of determinations registered in Laboratory of Analytical Toxicology and Drug Monitoring UJ MC in Kraków in the years 2002-2008 were used. The material was blood and urine samples collected for diagnostic of poisoned and addicted patients. There were used methods: EMIT (amphetamines, benzodiazepines, ecstasy, opiates, THC), FPIA (barbiturates, cocaine, tricyclic antidepressants (TCA)), colorimetric test (phenotiazines), thin layer chromatography (tramal). Annual mean numbers of positive results of psychoactive substances in the years 2002-2008 were: 411.7 for benzodiazepines, 234.1--amphetamines, 195.7--phenotiazines 168.4--opiates, 158.3--THC, 149.9 TCA, 87.9--barbiturates, 23.4--tramal 5.0--cocaine, 3.0--ecstasy. The structure and number of abused psychoactive substances determinations in 2002-2008 was studied. The numbers of positive results of benzodiazepines, amphetamines, THC and opiates were stable. The greatest increase of numbers of positive results was observed for cocaine and ecstasy in the studied period of time.

Background: Within a maritime alcohol and drug testing programme, a case showing an unphysiological urine ethanol concentration (235 mmol/L, 10.8 g/L) was found. The sample contained low levels of the ethanol metabolites ethyl glucuronide (EtG) and ethyl sulphate (EtS) which confirmed prior drinking, but also tested positive for the fermenting yeast Candida albicans which suggested post-sampling ethanol formation. This and other questionable cases prompted investigation of the suitability of urine alcohol testing for the intended application., Methods: Besides the routine measurements of ethanol, illicit drugs and creatinine, randomly selected ethanol-positive and ethanol-negative urines collected within the maritime programme were checked for the presence of EtG and EtS and for fungal and bacterial growth. Data on sample handling and storage was also gathered., Results: Ten of 15 (67%) ethanol-positive and 4 of 9 (44%) ethanol-negative urines contained yeast and/or bacteria. Among the ethanol-positive cases, 4 (27%) were obviously false positives because EtG and EtS were not detected. Microbial action as the reason for false-high ethanol concentrations was indicated in other cases. When 17 bacteria-infected but fungi-negative urines were supplemented with glucose and stored for 1 week at 21 degrees C, ethanol was formed in 2 specimens containing Escherichia coli and E. coli plus P. aeruginosa. In these samples, EtG was also formed on storage while EtS was not., Conclusions: The routines employed for urine collection and handling within this substance abuse programme caused many false-positive identifications of alcohol use with unintended medico-legal consequences. Unpreserved urines stored without cooling should not be used for alcohol testing, given the high risk for microbial interference.

In recent years, there has been observed an increasing number of traffic users being under influence of psychoactive substances that affect the central nervous system. A total of 198 blood samples and 23 urine samples collected from traffic users (drivers, passengers and pedestrians) suspected of having ingested psychoactive substances were examined. The analysis included blood samples collected from living individuals and blood or urine from the deceased. Ethyl alcohol levels were determined by gas chromatography, while body fluids were examined by Elisa tests for determination of cannabinoids, amphetamines, opium narcotics, cocaine (benzoiloecgonine), benzodiazepines, barbiturates and tricyclic antidepressants. The confirmation of positive results was carried out by gas chromatography with mass detector. Twenty-nine blood samples were positive, what constituted 14.6% of the total number of investigated cases, including 12 (7.8%) of samples originating from living individuals and 17 (37.8)--from the fatalities. In both groups, the most commonly detected substances were cannabinoids (THC and its metabolite carboxy-THC) and amphetamines and its analogues.

Two methods for the determination of ethylglucuronide (EtG) in urine and in hair have been developed by liquid chromatography- tandem mass spectrometry. These two methods were fully validated, including linearity (0.25-100 microg/mL in urine; 0.05-5 ng/mg in hair; r(2) > 0.99, n = 5), limits of detection (0.1 microg/mL in urine, 0.025 ng/mg in hair) and quantitation (lowest level of the calibration curve), extraction efficiency (> 55%), within-day and between-day imprecision and bias (CV and mean relative error < 15%), matrix effect, and relative ion intensity. These methods have been applied to 541 urine samples and 17 hair specimens collected from 156 alcohol withdrawal patients. The determination of ethanol versus EtG in urine was compared, and also the convenience of EtG determination in hair. EtG in urine and in hair proved to be a powerful tool for monitoring abstinence in these patients.

Alleged sexual assault cases, identified from the forensic science Northern Ireland (FSNI) database, which had toxicology assays carried out on either blood or urine samples, were examined for the years 1999 up to and including 2005. In 1999 there were 30 toxicology requests while in 2005 there were 51, representing a 70% increase. The percentage of cases containing alcohol, drugs or both increased from 66% in 1999 to 78% in 2005. The estimated average blood alcohol concentration remained broadly similar throughout the spread of years. It was found to be 218mg% (milligrams per 100 millilitres) in 1999 and 217mg% in 2005. The actual number of cases studied within the 12h cut-off time rose from 9 in 1999 to 22 in 2005. The relationship between negative toxicology results and time delay between the alleged assault and forensic sampling was examined. This showed that between 44% and 74% of cases were found to have a time delay of >12h. Some of these cases may therefore represent false negative results. The presence of drugs, either alone or in combination with other drugs, doubled between 1999 and 2005. Increased identification was found with antidepressants, recreational drugs, benzodiazepines and analgesics, some of which were also associated with alcohol consumption. The findings are sufficient to cause alarm for the health and safety of certain individuals and their increased vulnerability to sexual assault in some social settings. Additionally, the legal implications of what constitutes valid consent needs to be considered further in the light of these findings, if attrition rates are to improve.

Accurate medical histories for all NHRVs screening to participate in clinical pharmacology trials are vital to ensure volunteers' safety, and integrity of study results. Evidence from previous studies illustrate the potential for NHRVs to misrepresent their histories, especially when monetary incentives are offered, and the need to objectively verify these self-reported histories whenever practical. This study demonstrates that among the sample participants, all of whom self-reported a negative history of drug and alcohol abuse and tobacco smoking, 16% failed urine testing for either alcohol and drugs of abuse (6%), or cotinine (11%). Male sex and increased number of screenings in the preceding 12 months were significantly associated with increased odds for urine screen failure whereas increased enrollments in the same time period and increased study stipend decreased the same odds. These results emphasize the importance of diligently screening NHRVs participating in phase I clinical trails.

Background: Ethyl glucuronide (EtG) is a minor ethanol metabolite used as a specific marker to document recent alcohol consumption; confirm abstinence in treatment programs, workplaces, and schools; and provide legal proof of drinking. This study examined if bacterial pathogens in urine may enable postsampling synthesis of EtG and ethyl sulfate (EtS) from ethanol, leading to clinical false-positive results., Methods: Urine specimens with confirmed growth of Escherichia coli, Klebsiella pneumoniae, or Enterobacter cloacae were stored at room temperature in the presence of ethanol. Ethanol was either added to the samples or generated by inoculation with the fermenting yeast species Candida albicans and glucose as substrate. EtG and EtS were measured by LC-MS., Results: High concentrations of EtG (24-h range 0.5-17.6 mg/L) were produced during storage in 35% of E. coli-infected urines containing ethanol. In some specimens that were initially EtG positive because of recent alcohol consumption, EtG was also sensitive to degradation by bacterial hydrolysis. In contrast, EtS was completely stable under these conditions., Conclusions: The presence of EtG in urine is not a unique indicator of recent drinking, but might originate from postcollection synthesis if specimens are infected with E. coli and contain ethanol. Given the associated risks for false identification of alcohol consumption and false-negative EtG results due to bacterial degradation, we recommend that measurement of EtG be combined with EtS, or in the future possibly replaced by EtS.

The present paper emphasizes the most common mistakes committed at the beginning of an analytical procedure. To shorten the time and decrease the cost of determinations of substances with similar to alcohol activity, it is postulated to introduce mass-scale screening analysis of saliva collected from a living subject at the site of the event, with all positive results confirmed in blood or urine samples. If no saliva sample is collected for toxicology, a urine sample, allowing for a stat fast screening analysis, and a blood sample, to confirm the result, should be ensured. Inappropriate storage of a blood sample in the tube without a preservative can cause sample spilling and its irretrievable loss. The authors propose updating the "Blood/urine sampling protocol", with the updated version to be introduced into practice following consultations and revisions.

Ethanol assays in the blood, saliva and urine were made according to two methods: alkylnitrite gas-liquid chromatography and direct vapor-phase method without thermostating. N-propanol was used as an internal standard. For saliva and urine the methods produced similar results. For blood, the direct vapor-phase method detected significantly lower level of ethanol compared to alkylnitrite one (p = 0.001). 24-h storage of the samples in refrigerator does not deviate the results. Recommendations are provided for most effective usage of each method.

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.

In a previous work, an automated alcohol dehydrogenase method for the quantification of ethanol in whole blood (blood) specimens was presented. In the present work the application of the method to urine specimens has been investigated. Also, method robustness to routine analysis of urine and blood specimens during a period of eight months is shown. The limits of detection and quantification for urine were 0.0012 g/dL and 0.0042 g/dL, respectively. Relative standard deviations for the repeatability and within-laboratory reproducibility were in the ranges 1.4-4.1% and 1.8-4.6%, respectively. The method was compared with two headspace gas chromatography-flame ionization detection methods using authentic forensic urine specimens (n = 305) and blood specimens (n = 3186). Passing-Bablok regression for the concentration range 0.01-0.48 g/dL (urine) and 0.002-0.40 g/dL (blood) showed a statistically significant difference, for urine y = 0.9313 (0.9250 - 0.9377)x + 0.0038 (0.0029-0.0044) and for blood y = 0.9493 (0.9491 - 0.9495)x + 0.0032 (0.00318-0.00323), at 95% confidence level. The results of the external quality control specimens were in accordance with the reported theoretical concentrations.

This study identified ethyl sulfate (EtS) in human urine and compared the excretion characteristics of EtS with that of ethanol and ethyl glucuronide (EtG). Urine samples were collected from healthy subjects after a single ethanol dose, and also selected from routine clinical samples. Simultaneous analysis of EtS and EtG was performed by direct electrospray liquid chromatography-mass spectrometry in the negative ion mode, with selected-ion monitoring of the pseudomolecular ions at m/z 125 for EtS (M(w) 126 g/mol) and m/z 221 for EtG (M(w) 222 g/mol). The identity of EtS in authentic urine specimens was established by co-chromatography with reference substance, the presence of product ions (m/z 97 and 80 from m/z 125) with correct relative intensity, and a correct sulfur isotope ratio for (34)S (m/z 127). After healthy subjects drank ethanol, EtS showed a much longer, dose-dependent elimination half-life than the parent compound. No EtS was detected in urines collected after abstention from ethanol for several days prior to sampling. Among 354 consecutive clinical samples, 86 were positive for both EtS and EtG with a mean EtG/EtS molar ratio of 2.3 (median 1.7). Another three urine samples were only positive for EtS and four only for EtG. The present results confirm that sulfate conjugation is a normal but minor metabolic pathway for ethanol in humans, and EtS a common constituent in the urine after alcohol intake. It is also indicated that the concurrent determination of EtS and EtG will improve sensitivity, when being used as biomarkers of recent drinking.

Acute poisonings by medical, narcotic substances and alcohol are actual in Russia in the recent years. Comparison of analytic facilities of modern analytical techniques: chromatographic (HPLC, GC, GC-MS) and immuno-chemical (FPIA) in clinical toxicology for urgent diagnostics, assessment of the severity of acute poisoning and the efficacy of the treatment in patients with acute poisonings by psychotropic drugs, narcotics and alcohol have been done. The object of the study were serum, blood, urine of 611 patients with acute poisonings by amitriptyline, clozapine, carbamazepine, opiates and also alcohol. Threshold concentrations (threshold, critical and lethal) of the toxicants and their active metabolites which corresponded to different degrees of poisoning severity have been determined. The most comfortable and informative screening method for express diagnostics and assessment of severity of acute poisonings by psychotropic drugs and narcotics showed the HPLC with using automatic analyzers. FPIA using the automatic analyzer could be applied for screening studies, if group identification is enough. GC-FID method is advisable in case of poisoning by medical substances and narcotics in view of repeated investigation for assessment of the efficacy of the therapy. GC-MS could be advisable for confirming the results of other methods. GC-TCD possess high sensitivity and specificity and is optimal for express differential diagnostics and quantitative assessment of acute poisoning by ethanol and other alcohols.

The subject of the research was the analysis of frequency and type of psychoactive substances used, basing on the determinations the blood and/or urine samples, performed in the toxicological laboratory of the Department of Clinical and Industrial Toxicology Jagiellonian University in Kraków in the period from December 2001 to November 2003. From 17,649 performed determinations--45.5% were positive. 50% of the positive determinations were psychoactive substances. The most often psychoactive substance determined was ethyl alcohol (52.86%), next benzodiazepines (17.41%), amphetamines (10.54%), opiates (8.05%), THC (6.87%), barbiturates (3.74%), and occasionally atropine and cocaine. There was observed a variety of mixed, simultaneously taking psychoactive substances, especially ethyl alcohol, opiates, amphetamine derivatives and cannabinoids. The analysis of the occurrence of psychoactive substances in biological samples from patients treated in different hospital departments, others hospitals and ordered by private persons also was performed. In the last two years 369 private patients ordered psychoactive substances determinations and 78 of them were positive.

This study was prompted by a recent judgment in the Royal Courts of Justice (Gregory v. Director of Public Prosecutions, 2002) in a case of driving a motor vehicle after consuming too much alcohol (Road Traffic Act 1988). An expert witness for the defence alleged that a deficient volume of blood in the tube sent for analysis meant an excess amount of sodium fluoride (NaF) preservative, which would increase the concentration of ethanol, determined by headspace gas chromatography (HS-GC), owing to a salting-out effect. The prosecution did not produce expert evidence to rebut this argument and the drunk driving suspect was acquitted. A small volume of blood and excess sodium fluoride might have increased the concentration of ethanol in the air-space in the tube sent for analysis but this does not mean that the result of the HS-GC analysis would be higher. This follows because prior to analysis an aliquot of blood is removed and diluted (approximately 10 times) with n-propanol as the internal standard. The dilution lowers the concentration of NaF in the blood and for quantitative analysis the ratio of the ethanol to n-propanol response is measured. The use of a ratio also helps to compensate for any salting-out effect of ethanol. Our experiments showed that a deficient volume of blood and excess NaF actually lowered the concentration of ethanol by 2-3% compared with heparinised blood. Seemingly, n-propanol (n-PrOH) a 3-carbon straight chain alcohol is salted out slightly more effectively than the 2-carbon ethanol (EtOH) causing a lower peak area ratio (EtOH/n-PrOH) and a lower apparent concentration of ethanol. In a separate study, we showed that the concentration of ethanol was lowered even more when a 4-carbon alcohol (t-butanol) was used as the internal standard.

The Arrestee Drug Abuse Monitoring (ADAM) Program collects self-report survey information and urine specimens from adult arrestees in 35 cities nationwide. In 2000, a new survey instrument was fielded that includes questions about alcohol and other drug (AOD) abuse and dependence. Despite high levels of drug use among national arrestee populations, no studies have examined need for AOD treatment among ADAM arrestees. To address this limitation, a secondary analysis was undertaken with New York City ADAM data collected in 2000. Thirty-seven percent of the arrestees were diagnosed in need of drug treatment, while 19% were diagnosed in need of alcohol treatment. Compared to those arrestees who were diagnosed as not needing AOD treatment, arrestees who met the criteria for ADAM abuse/dependence were more likely to be male, older, and to have tested positive by urinalysis for at least one illicit drug. Because "need for treatment" was operationalized as a diagnosis of abuse or dependence, the current results should be viewed as liberal estimates of treatment need. Implications for the delivery of drug treatment to criminal populations are discussed.

Use of drugs and alcohol by 43 predominantly male outpatients who had severe mental illness and a comorbid substance use disorder were assessed weekly through the ratings of experienced dual disorder case managers and through blinded research urine toxicology tests. The percentage of weeks in which drugs or alcohol were used was calculated on the basis of one or both assessments. The case managers often missed drug use over the weekends, which was detected by the urine toxicology tests. Agreement between the two methods varied widely, even when the ratings were made by highly experienced case managers. These findings have implications for monitoring patients with dual diagnoses and provide insight into the accuracy of case manager ratings.

This study compared the urinary excretion characteristics of ethyl glucuronide (EtG) with that of ethanol, with focus on the effect of water-induced diuresis. Six healthy volunteers ingested an ethanol dose of 0.5 g/kg (range 25.0-41.5 g) as 5% (v/v) beer in 30 min and the same volume of water after 3 h. Urine collections were made before starting the experiment and at timed intervals over 31.5 h. The concentration of EtG was determined by an LC-MS method (LOQ = 0.1 mg/L). The urine samples collected immediately before starting drinking were all negative for ethanol and EtG, thus confirming that the participants had not recently ingested alcohol. Intake of beer resulted in a marked increase in excreted urine volume and a concomitant drop in creatinine concentration. The concentration of ethanol peaked at a mean value of 17 mmol/L in the 1.5-h urine collection. Except for one subject, EtG was first detectable (range 0.9-5.5 mg/L) at 1 h. Intake of water at 3 h produced another increase in urine volume and a drop in creatinine. The ethanol concentration curve was not influenced by the water diuresis, whereas this caused a distinct drop in the EtG concentration. When EtG was expressed relative to the creatinine value, this ratio was seemingly not affected by the intake of water. The ethanol concentration returned to zero at 6.5 h, whereas EtG was still detectable for up to 22.5-31.5 h, albeit at low levels in the end (< 1 mg/l). Only about 0.02% of the administered dose of ethanol (on a molar basis) was recovered in the urine as EtG. The results demonstrated that EtG remains detectable in the urine for many hours after the ethanol itself has been eliminated. Moreover, it was possible to lower the concentration of EtG by drinking large amounts of water prior to voiding, whereas this strategy did not influence the EtG/creatinine ratio or the concentration of ethanol.

This article provides preliminary ideas regarding how the quantitative posturagraphy technique can be used as an alternative noninvasive tool to currently available blood/urine test for alcohol/drug/chemical exposure. It is argued that the urine or blood level of any chemical is highly dependent on the individual's metabolism without providing any insight into individual's task performance abilities under exposure to neurotoxic chemicals. On the other hand, the quantitative posturagraphy if carried out as proposed in this article will provide quantitative data regarding individual's ability to maintain "safe" upright balance while carrying out certain tasks. The proposed evaluation method is simple, portable, quick, and noninvasive and has been found to be sensitive to detecting low level solvent induced modifications in postural stability.

In Nova Scotia Canada, governmental authorities expressed concern in the late 1980s about the adverse effects of drug use by parents on the welfare of their children. Since 1991, parents with a history of drug abuse may be required to submit to urine drug and alcohol testing when ordered by the Family Courts of this province. The objective of this paper is to present this drug testing program and the results of drug testing on 125 clients from 1994-1996. Urine specimens were collected in the parents' residence by a nurse and transferred directly to the laboratory by the collector or a courier. Specimens were screened by immunoassay and TLC followed by GC-MS confirmation. Results were sent directly to the social worker. In the 3,613 urine specimens analyzed, 50.2% of specimens were negative, 45.6% were positive for one or more drug/metabolite and 4.2% of specimens were dilute (creatinine < 25 mg/dL). The distribution of positive results were: cannabinoids (11.5%), cocaine metabolite (5.0%), benzodiazepines (14.5%), codeine/morphine (7.1%), codeine (6.6%), diphenhydramine (2.2%) and ethyl alcohol (1.6%). Drug testing has been considered a success by these agencies since testing provides an objective indication of recent drug use and the overall prevalence of drug use in this drug abusing population has reduced from 100% to < 50%.

Eighty-nine of 178 consecutively admitted inpatients were administered the substance abuse sections of the Structured Clinical Interview for DSM-III-R--Patient Version (SCID-P). Patients also provided a urine sample for toxicologic analysis. In addition, primary clinicians assigned admission and discharge diagnoses. Test characteristics (e.g., sensitivity) for confirming a current diagnosis of psychoactive substance abuse were calculated for each measure and compared. Urine toxicology analyses and admission and discharge diagnoses were significantly less accurate in diagnosing psychoactive substance abuse than the SCID-P. This finding indicates that substance abuse is frequently not noted during routine admission and discharge assessments.

As the interest in urine drug testing grows, ethanol is frequently included in drug-abuse screening. Collection of urine for drug testing is less invasive than blood collection and is used to screen employees in a large cross-section of occupations. Because alcohol can be produced from carbohydrates via fermentation, our interest was to determine: (1) if ethanol could be produced in glucose-positive urine (2) under what microbiological conditions would this process occur, and (3) would the urine ethanol concentration be significant. Fourteen urine specimens were selected from the Urinalysis Laboratory of a large medical center. All specimens were tested for ethanol concentration on the day of voiding and were found to be negative (< 0.01 mg/100 mL). Urine glucose concentrations ranged from 0 to > or = 2000 mg/dL. Microbiological examinations were performed on all specimens. Storing the samples at room temperature, five of the specimens produced ethanol over the time course of the study (1 to 21 days) in concentrations ranging from 0.036 to 2.327 g/100 mL. Yeast was identified in the five glucose positive urine samples producing ethanol. Six glucose positive urine samples that did not produce ethanol were found to be yeast negative. Findings indicate that significant ethanol concentrations can develop from glucose and yeast positive urine, after the day of voiding.

The time courses of the effects of acute doses of amphetamine (5 and 10 mg/70 kg), alcohol (0.3 and 0.6 g/kg), diazepam (5 and 10 mg/70 kg), and marijuana (2.0% and 3.5% delta 9-THC) on performance engendered by each of four computerized behavioral tasks were evaluated in six human subjects. These performance-based tasks have potential commercial utility for drug-use detection in the workplace. Alcohol and marijuana effects were reliably detected for up to three hours following dose administration with most procedures. Amphetamine and diazepam effects were also detected, but the dose effects and time courses were variable. The profile of behavioral effects varied across drugs, suggesting that performance-based testing procedures might be useful in discriminating which drug was administered and the time course of the drug's effects. Results indicate that repeated measurement with performance-based drug detection procedures can provide immediate indications of performance impairment in a cost-effective and noninvasive manner and, as such, would be a useful supplement to biological sample testing for drug-use detection.

The performance of the Technicon Chem 1+ chemistry analyzer with the Syva Emit ethyl alcohol assay in plasma and urine was evaluated. Spiked specimens from 0 to 600 mg/dL were tested, and expected versus measured concentrations were monitored. Linear regression line equations of y = 0.9314x + 5.4 and y = 0.9005x + 4.6, and correlation coefficients (r) of 0.9997 and 0.9995, were obtained for plasma and urine, respectively. A limit of detection of 5 mg/dL for plasma and urine, and a limit of quantitation of 20 mg/dL for plasma and 15 mg/dL for urine were obtained. Recovery was within 10% of expected concentration from 20 to 600 mg/dL. Precision was evaluated, giving the following coefficients of variation: within-run precision: plasma, 1.31-2.20; urine, 1.16-1.21; total precision: plasma, 2.72-3.38; urine, 2.98-4.64. No carry-over was detected when alternating 600 mg/dL and negative specimens. No interference from acetone, isopropanol, or methanol was detected. No significant differences in evaporation of alcohol at two concentrations, or from the two matrices were observed. Evaporation from a small cup (200 microL) was more than twice as great as from a large cup (2 mL). The Chem 1+ was compared to a gas chromatographic method. Plasma specimens of 0-352 mg/dL produced a linear regression line of y = 1.0112x + 6.0, r = 0.9859; urine specimens of 0-313 mg/dL produced a line of y = 1.0493x - 0.3, r = 0.9910. The capability to separate positive and negative specimens at 20% around a cutoff concentration of 20 mg/dL was examined. Four hundred specimens were analyzed, with only one specimen incorrectly classified (a false positive). The Chem 1+ chemistry analyzer demonstrated reliable performance of the Emit ethyl alcohol assay of plasma and urine specimens.

The Syva ETS is an automated system designed for analysis of drugs of abuse in urine. Recently, the Syva Company has upgraded this system to the ETS Plus, which is capable of analyzing ethanol in urine, serum, or plasma. We evaluated the new ETS Plus for urine screening of barbiturates, benzodiazepines, cocaine metabolite, opiates, and phencyclidine. Results of 505 patient sample assays obtained by ETS Plus were compared with those of ETS. There were only four discrepant results which had absorbance rates close to the low calibrator cutoff values. The within-run precision of the ETS Plus Ethyl Alcohol Assay yielded a CV of 2.6% at a target value of 1.00 g/L (1.06 +/- 0.03 g/L, n = 32) and a CV of 3.2% at a target value of 0.40 g/L (0.42 +/- 0.01 g/L, n = 30). The linear regression analysis of 30 patient serum ethanol results by the ETS Plus and by gas chromatography yielded y = 0.939 x + 0.03 g/L. The software modifications in the new ETS Plus allow the accurate quantitation of ethanol in serum and reliable detection of drugs of abuse within the same batch.

Superabsorbent polymers are shown to be an excellent medium for the detection of enzymes used in enzyme assays. They offer increased sensitivity of 2-10 times over conventional blotter medium. Their usefulness is demonstrated with a quick, inexpensive, visual test for alcohol in urine with sensitivity approaching 0.001% (w/v). Alcohol levels in 500 random urine samples were determined and the levels ranged from 0.06 to less than 0.001%, with the majority of positives being near 0.005%.