[Rusty22]

I knowThe screen is the initial test, but can this screen pick up levels less than 100 ?

[DrBill100]

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.

[Rusty22]

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 ?

[DrBill100]

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.

[Rusty22]

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 ?

[DrBill100]

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.

[Rusty22]

I think they are using a cutoff of 100 for EtG , given this info, can a screen detect this level or concentration for EtG ?

[DrBill100]

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.

[J_9]

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.

[Rusty22]

So a positive might have to have a concentration or level of say 500 to even screen pos ?

[DrBill100]

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.

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.

[Rusty22]

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 ?

[DrBill100]

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.

[Rusty22]

Thanks so much ! This analyzer does not screen ets ?

[DrBill100]

Thanks so much ! this analyzer does not screen ets ?

Correct. No analyzer does. No screen for EtS.