Urine alcohol test of 0.02

Urine alcohol test of 0.02

Postby Helent » Sun Jan 15, 2012 7:07 pm

This is a follow-up test on an employee who has undergone rehab. following a positive test for marijuana.

The employer requires tests for urine alcohol ( inclusion is part of union agreement) and also for breath alcohol.

In this employee's case, his breath alcohol result was negative and his urine alcohol result was 0.02.

I interviewed the employee, He is not a diabetic. He said he did have a drink the night before. I told the employee I would verify the test negative, since the breath test should be the more valid test.

I subsequently learned that the client has a policy of no substance use, including alcohol, for individuals returning after rehab. The employee has not returned to work yet, because he has been on vacation. I have told the employer to "hold" his return pending discussion, which is this coming week.

What is the significance of a urine alcohol of 0.02? It is my understanding that urine alcohol can be positive due to bacterial action on urine and that it would be hard to defend "firing" an employee based on the results above, especially if employee recants and states he never had a drink, which is likely to happen. He has always maintained to the SAP who is following him that he does not drink alcohol post-rehab.

Are these the appropriate next steps?

1) I would offer a re-analysis of the same specimen at second lab, since that is a standard procedure for this client. What, however, is the likelihood of alcohol still being positive 4 weeks after collection?

2a) I am thinking of suggesting that we might use EtG and EtS monitoring for this employee henceforth, ( presuming the reanalysis is negative) - but what are reasonable cut-off concentrations since they are sensitive tests?

2b) What is the likelihood of positive alcohol on re-analysis? And should that be reported as positive?

Thank you very much for your assistance in sorting this out with me. HT
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Re: Urine alcohol test of 0.02

Postby Robert Swotinsky MD » Sun Jan 15, 2012 9:35 pm

The breath and urine specimens measure for use over different time frames. Thus, both results may be correct. That is, the urine result identifies alcohol use because it measures for a longer time frame, e.g., 12-24 hours, than does breath.

In general, there is MRO no interpretation of an alcohol test result because there's no issue about alternative medical explanations. Now, if the employer asks your opinion about the policy, by all means point out that urine alcohol is not as valid for workplace testing as is breath alcohol. You might also want to ask the lab if it detected glucose in the urine. (Or, this may already be indicated on the lab report.) If there's no glucose in the urine, than microbial contamination and production of ethanol from glucose is not an issue.
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Re: Urine alcohol test of 0.02

Postby Helent » Tue Jan 17, 2012 7:44 pm

This is a follow-up question to my earlier one of Jan 15.

The donor is now stating that he used Nyquil prior to and on the day of testing. The test was performed 12/13/2011 at 11 a.m. He did admit to drinking a few beers the evening before. He also stated he took a capful (recommended dose) of the Nyquil the night before and the morning of the test at 4 a.m., and for a few days prior to testing. He is claiming Nyquil is what caused his urine alcohol to be 0.02.

Would an EtG or EtS ordered on the same specimen with a cut-off of 500 ng/mL at this time help differentiate between the cough syrup in the morning and a couple of beers the night before?

Since he did provide a history of having had a couple of beers the night before, should I verify this a positive test ? If the 0.02 could be due to the cough medicine, would I verify this differently?
[ Note: Although his return to work agreement did specify "alcohol" on follow-up testing would be a violation, there was nothing in the agreement that addresses abstinence from all other alcohol containing substances such as cough syrup, mouth wash etc.]

Thanks again, HT
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Re: Urine alcohol test of 0.02

Postby Robert Swotinsky MD » Tue Jan 17, 2012 8:22 pm

Would an EtG or EtS ordered on the same specimen with a cut-off of 500 ng/mL at this time help differentiate between the cough syrup in the morning and a couple of beers the night before?


No. There are too many variables, and too little science, to draw such conclusions.

Since he did provide a history of having had a couple of beers the night before, should I verify this a positive test ? If the 0.02 could be due to the cough medicine, would I verify this differently?


There is no MRO role for interpretation. There is in particular no exploring for alternative medical explanations for the result. With alcohol, the result is generally reported "as is." Also, if alcohol is being tested as a measure of impairment, urine alcohol is a bad tool because it doesn't correlate well w/the worker's alcohol at the time he or she is tested. If your employer/client is pushing you to interpret whether the result could have been caused by Nyquil use the night before, I think you could respond that it is unlikely but not impossible.
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Re: Urine alcohol test of 0.02

Postby jagdishpatelmd » Sat Jan 21, 2012 12:32 am

I have been under similar situation several times and have to make decision to help the employer to decide what to do about it. I start with several questions which include medications, drugs and alcohol use. This is followed by last drink he had prior to urine drug test. I carefully note the time he came to work and urine drug collection. Last question is what time he got up and went to bath room in that morning. If he had emptied his bladder prior to coming to work, I report the result: “It is more likely than not that he had alcohol intake while at work”.

I disclosed results of the test at the end of the interview. I make sure there is no Diabetes or Diabetes medication.

At times I feel like I am taking lot of risk but so far it has worked out in favor of the donor in long term. I have noticed that union representative usually intervenes and bargains for his job back and they provide alcohol rehabilitation and promise follow up drug testing. Donor has choice to go through rehabilitation to keep his job and most accept this because it is only way out to keep job.
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