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Ethyl glucuronide (EtG) is a minor metabolite of alcohol ingestion and has the benefit of a longer detection period. Due to the instability of this metabolite in urine, CRL is also monitoring for the presence of ethyl sulfate (EtS) in every sample. EtS has been shown to be stable in urine and is not affected by the presence of bacteria or yeast. In order to provide the very best in safeguards for the donor and our clients, Clinical Reference Laboratory, Inc. ("CRL") is only offering EtG results in conjunction with EtS. That was important in a recent medical professional case brought by the Attorney General of Nebraska before the State's Chief Medical Officer (case number 67-040644).

In that case, the defendant's specimen was originally submitted for drug and alcohol testing at a non-CRL forensic toxicology lab. That lab reported the sample positive for EtG and did not report EtS levels. Those results were challenged on the grounds of incidental exposure. A sample was sent to CRL. We reconfirmed the original results, and also reported the sample positive for EtS.

As described in the court's finding of facts, CRL's "reconfirmation test included the gold standard EtS test."

Also from the Findings of Fact and Conclusions of Law and Order in that case:

"EtG and EtS are metabolites of alcohol, formed in different ways. Most alcohol ingested by humans is eliminated through processes involving acetaldehyde, carbon dioxide and water. Some alcohol is eliminated in urine, breath, and sweat. The elimination of alcohol from the body produces EtG and EtS through processes which occur in the liver. These are traces, or footprints, which are produced by ingested alcohol."

"Alcohol testing of blood, breath or urine determines the level of active alcohol in the sample collected. Alcohol testing of this kind is generally used to determine level of impairment. Testing for EtG and EtS metabolites are not used to determine physical impairment based on alcohol consumption. Instead, these tests are used to find out if there was alcohol in the test subject at some past time. The person being tested may not show any signs of alcohol use on the day of testing because the use of alcohol could have taken place the day (or days) before the sample was provided and the sample would still be positive for EtG/EtS."

Nebraska's Department of Health and Human Services "began EtG testing approximately four years ago. The decision to use this testing was based on national monitoring program information from the National Council of State Boards of Nursing, the State Physicians Health Program, and the Dental session of a national conference on drug and alcohol addiction."

While initially there was concern by "some toxicologists that EtG testing alone might lead to low level false positives due to incidental exposure&experts now agree that testing for EtG and EtS levels together will rule out the possibility of false positives."

"In this case, the Department took the cautionary step [by sending a sample to CRL for] an additional EtG test and combined it with the gold standard EtS test. The results showed there was no degradation or contamination in Defendant's positive sample."

Ready to expand your alcohol monitoring program to include EtG? Read the kind words from the State of Nebraska regarding CRL's service in this case, then contact us today to discover how CRL's "gold standard" testing can help you.