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Tested positive for random hair test , med review officer ruled of no addiction to substances with me. Required a contract of abstinence to keep career. Did fine for a couple of months and tested pos for etoh . I have abided by rules thoroughly up to this slip up. Does anyone know what they will do to me? Will they extend contract of abstinence or make me go to meetings? Does anyone know? Job in med field, Please help
The contract you refer to above should clearly outline the range of actions available. There are hundreds of these programs and the rules, regulations and penalties are widely variant.
For a serum Peth, what is the average time for a result? When the lab collects it is it overnighted? Is overnight the standard ? Are health care workers given priority ?
Thanks
How samples are handled is anyone's guess. Last I heard blood work for PEth was to be frozen from point of collection until test which would have course include shipment. Don't believe health care workers would even be specifically identified let alone given priority.Quote:
Originally Posted by Rusty22
Did you drink enough or across a week or two cumulatively to show positive on PEth?
It's close, about 6 oz in 3 days, drew Peth on a thurs then no word on following thurs or Friday . No word is negative. 3 months ago same lab I submitted a hair test and had a five day result including weekend days.
What were they testing in hair? What do you mean 5-day result?
PEth research is all over the board. Seriously doubt there is anyone that can properly interpret results. Nonetheless they will claim they can.
What lab is doing the PEth
It was 14 panel hair test, had results in 5 days. The lab is us labs or us test labs.
They state on there web site 4-7 days for results, I think I should have heard by now.
USDTL, Des Plaines, IL. They seem to be the prime mover in PEth testing. Just to confirm, this was by blood draw and not a finger prick. Right? This lab currently offers a dried blood spot test for PEth.Quote:
Originally Posted by Rusty22
When they ran the 14-HDT was it a quantified result (LC/MS/MS) or simply denoted negative. Just curious as it sounds like you are getting some pretty intense attention. Are you on someone's list?
Or was that the random HDT you first mentioned that got the ball rolling? Still a 14 is unusual.
It was the random I first mentioned on this thread. The one that got ball rolling. Peth ?It was blood. A serums draw. But do the weekends count as days in a lab this size? Should I have heard by now? They have had the sample 7 full days and negative results we are not notified ?
Also on another note, EtG,ets are run using liquid chromatography. This test must be ultra sensitive ? Case managers are using low levels and taking them very seriously . How much longer does ets hang around compared to EtG ?
Weekend seldom count for lab dayes, health care workers do not get any priority in testing.
Often at least in US, most employers will hold health care workers up to a higher standard, due to liabiltiy at the work place.
EtS has the same detection window as EtG. LC/MS/MS is extremely sensitive and reliable. Instrumental technology is far ahead of our knowledge of how to interpret the results.Quote:
Originally Posted by Rusty22
peth was negative, whew!
Is ets run always with EtG or following a pos EtG ?
also, if one oz of etoh is consumed on Friday, at 80 hours what
would you expect EtG to be, likely well below 100, but some people
don't follow cut off values. That's the whole reason peth is recommended
by us labs.
rusty22
1) EtS can only be tested for following a positive EtG if the EIA screen is being used, which in most cases it is. Why? Because there is currently no EIA available for EtS.Quote:
Originally Posted by Rusty22
So the lab advertisements that offer the 2 for 1 test are simply playing on the purchasers ignorance of the 2-step testing process. If the screen is EtG negative then there was no test for EtS.
In fairness, if the purchaser is willing to pay for LC/MS, in other words skip the lower cost screen and go directly to the test usually used only in confirmation then both EtG and EtS can be detected simultaneously. That is seldom the case.
2) Regardless of the instrumental setting EtG synthesized from one (1) oz of alcohol will not be present (let alone detectable) at 80 hours... not even at 24 hours. EtG and EtS are eliminated from the body just as the parent analyte EtOH. They have the same hydrophilic characteristic. These metabolites do not accumulate or secret in tissue like THC for instance.
3) EtG, EtS and PEth do not operate on a comparable scale. The former are supposedly direct metabolites created concurrently and immediately upon presentation of EtOH in the liver. PEth is a delayed pathological response to alcohol that occurs in blood and "requires 'sustained' drinking" over a period. The use of one to confirm the other would depend on the confluence of very unlikely events.
EtG testing has become a very lucrative field but the supporting science[?] has collapsed around it. So they introduced EtS as an "additive" without admitting the fallibility of EtG. The theory being that if both are present one confirms the other. Of course since they are created concurrently that is a ridiculous claim. But it keeps the money flowing. EtS has all of the major flaws as EtG so now the industry is introducing a third direct biomarker PEth.
Quest diagnostics is performing the EtG . They only advertise it as etoh but I know it via EtG. Which method is being used for EtG through quest ? I can tell you the cost is 30 dollars for etoh via EtG with quest.
Not following. EtOH is a different test. EtG test cannot identify EtOH. If Quest is offering the test(s) they should be separately listed as I'm certain they charge separately. Do you have a test number? It's not difficult to add EtG to EtOH test but it is two separate processes.Quote:
Originally Posted by Rusty22
Also, forgot to clarify the negative PEth. How much did you drink during the week leading up to that test? I'm trying to piece together the disparate findings that are emerging.
Found it, it's on there website, it is LC/ms/ms. They are running both EtG and ets. Wow ! This for 30 bucks ? Must be a volume price
LC/MS/MS is only run if there is a positive by EIA. They make some dandy deals if it is direct billing as opposed to insurance. If insurance is billed just the EIA w/o confirmation is 60.00 and as I recall 280.00 for both.Quote:
Originally Posted by Rusty22
Thanks , on Peth 7 oz of etoh were consumed in two separate days 3 days apart. 5 oz was one of those days.
Here is what I found with quest :
Ethyl Glucuronide with Confirmation, Urine
90418
CPT Code(s): 80101
Includes
If EtG /EtS Screen is positive or equivocal, confirmation testing will be performed at an additional charge (CPT code(s): 83789).
Preferred Specimen(s)
1 mL random urine
Minimum Volume
0.5 mL
Instructions
Avoid contact with ethanol, disinfectants, swabs
Transport Container
Plastic urine container
Transport Temperature
Room temperature
Specimen Stability
Room temperature: 7 days
Refrigerated: 7 days
Frozen: 30 days
Reject Criteria
Preserved specimens
Methodology
Liquid Chromatography, Tandem Mass Spectrometry (LC/MS/MS)
Performing Laboratory
Quest Diagnostics Nichols Institute
27027 Tourney Road
Valencia, CA 91355-5386
Reference Range(s)
Ethyl Glucuronide <500 ng/mL
Ethyl Glucuronide <500 ng/mL
Ethyl Sulfate <100 ng/mLPlease note: These results are for medical treatment only. Analysis was performed as non-forensic testing.
(The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.)
Bit misleading isn't it? See (1) above. Confirmation is not automatic but must be separately ordered. Urine may be stable for 7 days but the metabolite EtG is not and may degrade or synthesize in container within 24 hours at room temperature.
I knowThe screen is the initial test, but can this screen pick up levels less than 100 ?
The printout shows it at 500 doesn't it? There is always a +/- 20% on the screen regardless of cutoff. There is only one sceen in use for EtG. Every lab uses the same one. The test has never received FDA approval so the only data available is based on claimed testing by the manufacturer which claims 98% accuracy. That claim however is in direct conflict with SAMHSA which states that the EIA returns a high number of false positives.
Package insert company test
v.
Samhsa* Advisory p. 7
USDTL tested the reliability of the test in 2008 and found an error rate of 47% when using the 100 ng/mL cutoff. That is just about the same as flipping a coin; heads, he's drinking. Tails he's sober.
United States Drug Testing Laboratory, (2008) Field Testing the Microgenics DRI-EtG assay
*Substance Abuse and Mental Health Association (SAMHSA), Dept of Health and Human Services, Advisory, Spring 2012.
Yes it does show a ref range less than 500 being acceptable but, read the first line under the ranges. It states these values are for medical uses only and not forensic. Professional health or abstinence monitoring I think are different . What do u think ?
The reference ranges are just filling space because their printouts use that factor in different tests. So the notation <500 indicates that is an acceptable range just as they would show creatinine >20. That is all the ranges mean as shown.
The non-forensic means it doesn't pass muster for evidential purposes and mention of the fact that another test is required for medical use means it is not to be used for diagnostic purposes. Both shift the liability to the ordering party as the lab has stated how the tests are not to be used.
Ok good to know. When that case manager of the abstinence program gets the results do u think it gives them any specific numbers or levels of EtG,ets if below say 250 EtG ?
It can't give them any numbers whatsoever on EtS as a result of the screen. There is no screen. If LC/MS was run it will provide quantification above 500 only, providing that it the cutoff used. The only device that can quantify is the LC/MS.
I think they are using a cutoff of 100 for EtG , given this info, can a screen detect this level or concentration for EtG ?
If I'm understanding you, 100 detects at that level. But that is not what the form says. It's important to realize that these aren't individual tests. There may be as many as 200+ samples in each run. They all go through the analyzer at the same settings and conditions.
I'm glad that Dr. Bill is here to help interpret your results, however, as a health professional myself I'm going to take the moral high ground and ask why you felt that you could try to beat a test that you were required to take in order to save your job.
As a nurse who holds the lives of her patients in her hands I am appalled at the audacity of other health professionals who feel that they can beat the system.
It wasn't a "slip up." You KNEW that this was something you were required to avoid, but you didn't take it serously.
I have worked with several impaired nurses and you should consider yourself lucky to have been given a second chance, but you "slipped up." That's not an excuse for those of us in the medical profession.
So a positive might have to have a concentration or level of say 500 to even screen pos ?
I don't understand. Here is protocol that is supported by the printout from Quest you provided. The sample is subjected to an EIA immunoassay as screen at the cutoff of 500 ng. If the result is negative then that ends the test. Negative screens are not confirmed.Quote:
Originally Posted by Rusty22
If the above screen show positive >500 then, for more money, they could run confirmation by LC/MS/MS. Alternatively they would report the result as "positive" The positive could not include EtS because there is no screening EIA for EtS.
If this test was ordered by a licensing board I can't imagine reliance on anything less than the confirmed test. If confirmed then the results would be completely quantifified EtG = XXX EtS = XXX. It is only at this level of test that EtS can be detected or the result quantified.
That helps a lot , thanks a bunch dr bill
It confused me under methodology with no mention of eia then I saw LC/ms/ms which is only for confirmation right? The screen is an Eia card of some kind? And why tandem ms ?
EtG is unique in that there is no card such as you often see with other drug tests. There is no method for testing on-site. The EIA is laboratory based and is run only on a chemical analyzer.
LC/MS is confirmation only. Used only in event of a positive screen.
Thanks so much ! This analyzer does not screen ets ?
Correct. No analyzer does. No screen for EtS.Quote:
Originally Posted by Rusty22
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