I was wondering if anyone has an idea of what sort of facilities generally use EtG testing. I get drug tested at an IOP weekly, via urine samples which ARE sent out to a lab. However, I know they use the samples to test for all drugs (including alcohol, of course). In situations like this, are urine samples generally tested for drugs/alcohol and separately for EtG?

Note: Last week I drank (moderately, 4-6 beers each day) Sunday-Tues, drank nothing Weds + Thurs, then passed a urine test which I took on Friday at noon.

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Originally Posted by oedipus3

I was wondering if anyone has an idea of what sort of facilities generally use EtG testing. I get drug tested at an IOP weekly, via urine samples which ARE sent out to a lab. However, I know they use the samples to test for all drugs (including alcohol, of course). In situations like this, are urine samples generally tested for drugs/alcohol and separately for EtG?

Note: Last week I drank (moderately, 4-6 beers each day) Sunday-Tues, drank nothing Weds + Thurs, then passed a urine test which I took on Friday at noon.

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Sorry, just to clarify. IOP = Intensive Outpatient

Dr. Bill, interested in your take on this...

It would be my thinking that they would use EtG. It could be that they don't use it each time. But usually any program monitoring drug/alcohol use will not rely on urine EtOH only.

Thanks for your reply. If you wouldn't mind, I have a couple more questions for you:

1) Is EtG expensive for a lab or treatment facility? In other words, if what you said about sometimes using EtG, do you think it's possible they would reserve it for people who are newly sober/don't have much clean time?

2) I'm a bit unclear on whether EtG is always a pass/fail test or if the test comes back with levels of ethanol presence? From reading these forums it appears people have claimed both sides.

Thanks!

Also, what is your opinion on water intake (prior to the test) and exercise's effect on EtG testing?

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Originally Posted by oedipus3

Thanks for your reply. If you wouldn't mind, I have a couple more questions for you:

1) Is EtG expensive for a lab or treatment facility? In other words, if what you said about sometimes using EtG, do you think it's possible they would reserve it for people who are newly sober/don't have much clean time?

2) I'm a bit unclear on whether EtG is always a pass/fail test or if the test comes back with levels of ethanol presence? From reading these forums it appears people have claimed both sides.

Thanks!

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Would usually be both. Drug and Alcohol testing is a two step process. Step 1 is referred to as a screen is performed by immunoassay. That returns only a positive or negative. If that step is negative then the test is over. If it returns a positive then it should advance to Step 2 called the confirmation test. At Step to the amount of drug present is reported (quantified).

That is the proper protocol. Some agencies simply rely on the Step 1 return.

With alcohol, if the test is for EtOH only it will report in mg/dL, for instance somewhere between .02 and .20. If it is for EtG it will report in ng/mL. somewhere between 100 ng/mL up to 10000 ng for instance.

Well, now I'm pretty freaked out. With regard to your assessment of sometimes/sometimes not using an EtG, does that seem likely or reasonable to you? Just wondering if you hear of that kind of procedure (particularly in a setting such as an Outpatient facility).

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Originally Posted by oedipus3

Well, now I'm pretty freaked out. With regard to your assessment of sometimes/sometimes not using an EtG, does that seem likely or reasonable to you? Just wondering if you hear of that kind of procedure (particularly in a setting such as an Outpatient facility).

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Most facilities that monitor for total abstinence use EtG especially if testing only weekly. As to procedures any agency employs, that is anyone's guess. Whose term is IOP. Does that have medical connotations or is it court related.

IOP is simply an abbreviation (for Intensive Outpatient). They are generally facilities people voluntarily check into, although you can be court ordered. It's essentially a rehab that you do not stay at (the opposite being INpatient), and attend a few times a week (or once a week, in my case)

One more question! Then I'll give it a rest. I greatly appreciate your insight/answers.

To my knowledge, my urine sample usually sit for about 2.5/3 days (i.e. I take it Friday afternoon, at which point it has to be shipped to the lab, and sits there until the sample is analyzed Monday morning). Will this have any effect on the EtG test? Just trying to figure out why I passed my test last week if I was substantially under the 80 hour threshold. For what it's worth, I'm male, 20s, 150 lbs with a fast metabolism.

Thanks so much for your help.

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Originally Posted by oedipus3

IOP is simply an abbreviation (for Intensive Outpatient). They are generally facilities people voluntarily check into, although you can be court ordered. It's essentially a rehab that you do not stay at (the opposite being INpatient), and attend a few times a week (or once a week, in my case)

One more question! Then I'll give it a rest. I greatly appreciate your insight/answers.

To my knowledge, my urine sample usually sit for about 2.5/3 days (i.e. I take it Friday afternoon, at which point it has to be shipped to the lab, and sits there until the sample is analyzed Monday morning). Will this have any effect on the EtG test? Just trying to figure out why I passed my test last week if I was substantially under the 80 hour threshold. For what it's worth, I'm male, 20s, 150 lbs with a fast metabolism.

Thanks so much for your help.

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There is no 80 hour threshold. EtG is created and eliminated in relation to the amount of alcohol consumed.

Another little hidden secret, hidden from those paying for the test, is that EtG is unstable in the container post-collection. So in most cases, 24 hours later the sample you provided will either have more or less EtG. This process is rapid and substantial. See Rana & Ross

That's odd. Why would the results be considered reliable then (i.e. if they sit around for more than a day)? Especially considering EtG can show up in a test from hand sanitizer, shampoo,etc.

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Originally Posted by oedipus3

That's odd. Why would the results be considered reliable then (i.e. if they sit around for more than a day)? Especially considering EtG can show up in a test from hand sanitizer, shampoo,etc.

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EtG testing is unregulated*. The instability has been known for more than 5 years. The immunoassay used is known to return a high number of false positives and has been marketed illegally, in violation of FDA regulations, since 2007. Just this week I received notice that they now intend to investigate the company.

Don't be misled by the diversions of hand sanitizers and shampoos. The products containing alcohol that can influence this test number in the many thousands.

*There are regulations that should prevent it's use in a medical setting. Should not be used in diagnostics as you describe. But it is.

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Originally Posted by DrBill100

EtG testing is unregulated*. The instability has been known for more than 5 years. The immunoassay used is known to return a high number of false positives and has been marketed illegally, in violation of FDA regulations, since 2007. Just this week I received notice that they now intend to investigate the company.

Don't be misled by the diversions of hand sanitizers and shampoos. The products containing alcohol that can influence this test number in the many thousands.

*There are regulations that should prevent it's use in a medical setting. Should not be used in diagnostics as you describe. But it is.

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That's interesting. And pretty unsettling. Maybe this is giving the facility too much credit, but perhaps they recognize the inconsistencies of EtG and thus don't use it. The only other explanation I can think of regarding testing negative last week would be that they sometimes don't test EtG, or I just got lucky.

I will post the results of my test this coming Monday. I'm pretty sure I would not pass an EtG if they administer one though: drank about 6-8 bottles of beer every day for 4 days, last drink was around midnight yesterday (Weds), so that's rough 36 hour of no alcohol. Hoping that tons of water will help clear my system. Or that they don't do EtG. :)

Thanks for your help.