Public release date: 14-Feb-2007
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Contact: Claire Bowles
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New Scientist 

US teenage drinkers face alcohol test
BIG Brother has arrived at a high school in New Jersey. Determined to stop 
their students consuming alcohol at weekends, staff at Pequannock Township High 
School in Morris county are to start using a controversial test that can detect 
if students have been drinking up to a week earlier.

The test measures urine concentrations of an ethanol breakdown product called 
ethyl glucuronide (EtG). "We plan to use this new test as part of our 
comprehensive testing programme to keep our kids safe from the dangers of drugs 
and alcohol," says Larrie Reynolds, superintendent of Pequannock High School. 
"About four to eight kids will be tested every day." In New Jersey drinking 
alcohol is illegal under the age of 21.

Drinking is a growing problem in US schools. "As many as half of our kids are 
doing this," says Reynolds. An estimated 1700 US high-school students died from 
alcohol poisoning or related accidents in 2005 alone.

However, the EtG test poses a problem. It is so sensitive that even total 
abstainers can sometimes test positive. Alcohol absorbed from soaps, 
mouthwashes or contaminated vinegars or by drinking a sip of communion wine can 
be enough.

Despite this, the test's popularity is growing, and around a dozen commercial 
versions are now available. Estimates by the US Department of Health and Human 
Services (DHHS) suggest that as many as 20,000 tests are being performed each 
month, mainly among medical staff - including 9000 physicians - pledged to 
abstinence following the discovery that they have a drink problem. Law firms 
and the military have started using it on their staff too. Greg Skipper, 
medical director of the Alabama Physician Health Program, says the test has 
been invaluable for monitoring doctors in recovery from alcoholism. "It enables 
them to comply, stay sober and keep their jobs," he says.

Skipper is, however, critical of health boards and agencies in some states that 
he says have been automatically sacking people who fail the EtG test without 
using other tests to confirm its findings. In the three to four years that the 
test has been commercially available in the US, more than 100 nurses in 
recovery from alcoholism have complained of losing their jobs after testing 
positive despite, they say, not drinking. Blood tests for a second metabolite 
such as phosphatidyl ethanol would be far less likely to give a false positive, 
as this substance appears only after large amounts of alcohol have been 
consumed, but these tests are more expensive.

In 2006, Skipper helped compile an advisory document for the DHHS which stated 
that "legal or disciplinary action based solely on a positive EtG test is 
inappropriate". Since the advisory was published, Skipper says there has been a 
fall in the number of complaints of unfair dismissal posted on a website he set 
up (www.ethylglucuronide.com). 

Using the EtG test alone, the risk of false positives remains, particularly in 
hospital wards, where nurses and doctors routinely use soaps containing 
ethanol. "In intensive care units, nurses and doctors apply it every 5 
minutes," Skipper says. He has shown that the test could give a positive result 
in ward staff who have simply breathed vapour in. Even bystanders can test 
positive. Both Skipper and the test's creator, Friedrich Wurst of the 
psychiatric clinic at the University of Basel, Switzerland, say that there is 
not yet an agreed threshold concentration that can be used to separate people 
who have been drinking from those exposed to alcohol from other sources. Below 
1000 nanograms of EtG per millilitre of urine is probably "innocent", and above 
5000 booze is almost certainly to blame. In between there is a "question zone", 
Skipper says.

Skipper backs use of the tests by schools if they accept its limitations. 
"Schools must have a system for dealing with positives, managed by a medical 
review officer, and not automatically expel the child," he says.


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