Big Brother has arrived at a high school in New Jersey. Determined
to stop their students consuming alcohol at weekends, staff at
Pequannock Township High School in Morris county are to start
using a controversial test that can detect if students have been
drinking up to a week earlier.
The test measures urine concentrations of an ethanol breakdown
product called ethyl glucuronide (EtG). "We plan to use this
new test as part of our comprehensive testing programme to keep
our kids safe from the dangers of drugs and alcohol," says
Larrie Reynolds, superintendent of Pequannock High School. "About
four to eight kids will be tested every day." In New Jersey
drinking alcohol is illegal under the age of 21.
Drinking is a growing problem in US schools. "As many as
half of our kids are doing this," says Reynolds. An estimated
1700 US high-school students died from alcohol poisoning or related
accidents in 2005 alone.
However, the EtG test poses a problem. It is so sensitive that
even total abstainers can sometimes test positive. Alcohol absorbed
from soaps, mouthwashes or contaminated vinegars or by drinking
a sip of communion wine can be enough.
Despite this, the test's popularity is growing, and around a dozen
commercial versions are now available. Estimates by the US Department
of Health and Human Services (DHHS) suggest that as many as 20,000
tests are being performed each month, mainly among medical staff
- including 9000 physicians - pledged to abstinence following the
discovery that they have a drink problem. Law firms and the military
have started using it on their staff too. Greg Skipper, medical
director of the Alabama Physician Health Program, says the test
has been invaluable for monitoring doctors in recovery from alcoholism.
"It enables them to comply, stay sober and keep their jobs,"
he says.
Skipper is, however, critical of health boards and agencies in
some states that he says have been automatically sacking people
who fail the EtG test without using other tests to confirm its
findings. In the three to four years that the test has been commercially
available in the US, more than 100 nurses in recovery from alcoholism
have complained of losing their jobs after testing positive despite,
they say, not drinking. Blood tests for a second metabolite such
as phosphatidyl ethanol would be far less likely to give a false
positive, as this substance appears only after large amounts of
alcohol have been consumed, but these tests are more expensive.
In 2006, Skipper helped compile an advisory document for the
DHHS which stated that "legal or disciplinary action based
solely on a positive EtG test is inappropriate". Since the
advisory was published, Skipper says there has been a fall in
the number of complaints of unfair dismissal posted on a website
he set up (www.ethylglucuronide.com).
Using the EtG test alone, the risk of false positives remains,
particularly in hospital wards, where nurses and doctors routinely
use soaps containing ethanol. "In intensive care units, nurses
and doctors apply it every 5 minutes," Skipper says. He has
shown that the test could give a positive result in ward staff
who have simply breathed vapour in. Even bystanders can test positive.
Both Skipper and the test's creator, Friedrich Wurst of the psychiatric
clinic at the University of Basel, Switzerland, say that there
is not yet an agreed threshold concentration that can be used
to separate people who have been drinking from those exposed to
alcohol from other sources. Below 1000 nanograms of EtG per millilitre
of urine is probably "innocent", and above 5000 booze
is almost certainly to blame. In between there is a "question
zone", Skipper says.
Skipper backs use of the tests by schools if they accept its
limitations. "Schools must have a system for dealing with
positives, managed by a medical review officer, and not automatically
expel the child," he says.
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