Determination of ethylglucuronide in oral fluid by ultra-performance liquid chromatography- tandem mass spectrometry

[Comparison of two types of sorbents for solid-phase extraction of cannabimimetic MDMB(N)-073F metabolites from urine]

The purpose of this work is to study the possibility of using cartridges with a mixed sorbent C8/SAX for the extraction of synthetic cannabimimetic metabolites MDMB (N)-073F from urine. It was used enzymatic hydrolysis of urine, solid phase extraction using cartridges C8/SAX and C8/SCX with mixed phase, derivatization and gas chromatography with a mass spectrometric detector. The results of the study allow us to recommend cartridges for solid-phase extraction with an anion-exchange phase (C8/SAX or SAX) when conducting a targeted study for the presence of cannabimimetics metabolites that have compounds with a carboxyl group as the main metabolites.

Nonoxidative ethanol metabolism in humans-from biomarkers to bioactive lipids

Ethanol is a widely used psychoactive drug whose chronic abuse is associated with organ dysfunction and disease. Although the prevalent metabolic fate of ethanol in the human body is oxidation a smaller fraction undergoes nonoxidative metabolism yielding ethyl glucuronide, ethyl sulfate, phosphatidylethanol and fatty acid ethyl esters. Nonoxidative ethanol metabolites persist in tissues and body fluids for much longer than ethanol itself and represent biomarkers for the assessment of ethanol intake in clinical and forensic settings. Of note, the nonoxidative reaction of ethanol with phospholipids and fatty acids yields bioactive compounds that affect cellular signaling pathways and organelle function and may contribute to ethanol toxicity. Thus, despite low quantitative contributions of nonoxidative pathways to overall ethanol metabolism the resultant ethanol metabolites have important biological implications. In this review we summarize the current knowledge about the enzymatic formation of nonoxidative ethanol metabolites in humans and discuss the implications of nonoxidative ethanol metabolites as biomarkers of ethanol intake and mediators of ethanol toxicity. © 2016 IUBMB Life, 68(12):916-923, 2016.

Alternative sampling strategies for the assessment of alcohol intake of living persons

Monitoring of alcohol consumption by living persons takes place in various contexts, amongst which workplace drug testing, driving under the influence of alcohol, driving licence regranting programs, alcohol withdrawal treatment, diagnosis of acute intoxication or fetal alcohol ingestion. The matrices that are mostly used today include blood, breath and urine. The aim of this review is to present alternative sampling strategies that allow monitoring of the alcohol consumption in living subjects. Ethanol itself, indirect (carbohydrate deficient transferrin, CDT%) as well as direct biomarkers (ethyl glucuronide, EtG; ethyl sulphate, EtS; fatty acid ethyl esters, FAEEs and phosphatidylethanol species, PEths) of ethanol consumption will be considered. This review covers dried blood spots (CDT%, EtG/EtS, PEths), dried urine spots (EtG/EtS), sweat and skin surface lipids (ethanol, EtG, FAEEs), oral fluid (ethanol, EtG), exhaled breath (PEths), hair (EtG, FAEEs), nail (EtG), meconium (EtG/EtS, FAEEs), umbilical cord and placenta (EtG/EtS and PEth 16:0/18:1). Main results, issues and considerations specific to each matrix are reported. Details about sample preparation and analytical methods are not within the scope of this review.

Bioanalytical procedures and developments in the determination of alcohol biomarkers in biological specimens

Excessive alcohol consumption is a global problem, and consequently its evaluation is of great clinical and forensic interest. Alcohol biomarkers have been the focus of several research works in the past decades, with new compounds being studied in more recent years. The main objective of this review is to discuss topics for an analyst to consider when evaluating alcohol consumption through the analysis of alcohol biomarkers in biological specimens. For this, existing alcohol biomarkers will be reviewed, including carbohydrate-deficient transferrin, 5-hydroxytryptophol, ethanol, hemoglobin-associated acetaldehyde, fatty acid ethyl esters, ethyl glucuronide, ethyl sulfate and phosphatidylethanol. Additionally, their potential will be discussed, as well as analytical considerations, main challenges, limitations, data interpretation and existing methodologies for their determination in biological specimens.

Quantitation of Ethyl Glucuronide and Ethyl Sulfate in Urine Using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Ethyl glucuronide and ethyl sulfate are minor conjugated metabolites of ethanol that can be detected in urine for several days after last ingestion of ethanol. The monitoring of ethanol use has both clinical and forensic applications and a longer detection window afforded by monitoring these metabolites is obvious. LC-MS/MS is used to analyze diluted urine with deuterated analogs of each analyte as internal standards to ensure accurate quantitation and control for any potential matrix effects. High aqueous HPLC is used to chromatograph the metabolites. Negative ion electrospray is used to introduce the metabolites into the mass spectrometer. Selected reaction monitoring of two product ions for each analyte allows for the calculation of ion ratios which ensures correct identification of each metabolite, while a matrix-matched calibration curve is used for quantitation.

Use of alcohol and drugs among health professionals in Norway: a study using data from questionnaires and samples of oral fluid

Working under the influence of drugs and/or alcohol may affect safety and job performance. However, the size of this possible problem among health professionals (HPs) is unknown. The aim of this study was threefold: (i) to analyze samples of oral fluid and self-reported data from questionnaires to investigate the prevalence of alcohol and drugs among a sample of HPs in Norway, (ii) to study self-reported absence from or impairment at work due to alcohol and/or drug use, and (iii) to examine whether such use and absence/impairment due to such use depend on socio-demographic variables.

A total of 916 of the 933 invited HPs from hospitals and pharmacies participated in the study (participation rate = 98.2%), and 81.1% were women. Associations were analyzed in bi-variate cross tables with Chi-square statistics to assess statistical significance.

Alcohol was not detected in any of the samples. Ethyl glucuronide, a specific alcohol metabolite, was found in 0.3% of the collected samples. Illicit drugs and medicinal drugs were identified in 0.6% and 7.3% of the samples, respectively. Both analytical results and self-reported use of alcohol and drugs during the past 12 months indicate that recent and past year alcohol and drug use was lower among HPs than among workers in other business areas in Norway, Europe and US. Nevertheless, several HPs reported absence from work due to alcohol (0.9%) and medicinal drug use (0.8%) during the past 12 months. A substantial part (16.7%) of the self-reported medicinal drug users reported absence from work because of use of medicinal drugs during the past 12 months, and more than 1/4 of those reported in-efficiency at work because of the use of medicinal drugs during the past 12 months. Reduced efficiency at work due to alcohol use during the past 12 months was reported by 12.2%.

This sample of HPs seldom used illicit drugs, few had a high level of alcohol consumption, and few tested positive for medicinal drugs. Absence or hangover related to the use of medicinal drugs or alcohol appeared to be a bigger issue than the acute intoxication or the use of illicit drugs.

Ethyl glucuronide and ethyl sulfate

Alcohol misuse is associated with significant morbidity and mortality. Although clinical history, examination, and the use of self-report questionnaires may identify subjects with harmful patterns of alcohol use, denial or under-reporting of alcohol intake is common. Existing biomarkers for detecting alcohol misuse include measurement of blood or urine ethanol for acute alcohol consumption, and carbohydrate-deficient transferrin and gamma-glutamyl transferase for chronic alcohol misuse. There is a need for a biomarker that can detect excessive alcohol consumption in the timeframe between 1 day and several weeks. Ethyl glucuronide (EtG) is a direct metabolite of ethanol detectable in urine for up to 90 h and longer in hair. Because EtG has high specificity for excess alcohol intake, it has great potential for use in detecting "binge" drinking. Using urine or hair, this noninvasive marker has a role in a variety of clinical and forensic settings.

EtG/EtS in Urine from sexual assault victims determined by UPLC-MS-MS

In cases of sexual assault, victims often present too late for the detection of ethanol in biological samples. An ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) method was developed and validated for the determination of ethyl glucuronide (EtG) and ethyl sulfate (EtS) in urine. Sample preparation prior to UPLC-MS-MS analysis was a simple sample dilution. The calibration ranges were 0.2-20 mg/L, and between-assay relative standard deviations were in the range of 0.7-7.0% at concentrations of 0.3, 3.0 and 7.0 mg/L. Urine samples were analyzed from 59 female patients presenting to the Sexual Assault Centre at St. Olav University Hospital in Trondheim, Norway between November 2010 and October 2011. EtG and EtS results were fully concordant, and positive in 45 of the 48 cases with self-reported alcohol intake. In contrast, ethanol was detectable in only 20 of these cases, corresponding to sensitivities of 94 and 42%, respectively. Of the patients reporting no alcohol intake, none had positive EtG/EtS findings. These data show that analysis of EtG and EtS greatly increases the detection window of alcohol ingestion in cases of sexual assault, and may shed additional light on the involvement of ethanol in such cases. The victims' self-reported intake of alcohol seems to be reliable in this study, according to the EtG/EtS findings.

Liquid Chromatography-Tandem Mass Spectrometry Assay to Detect Ethyl Glucuronide in Human Fingernail: Comparison to Hair and Gender Differences

Over the past decade, the use of hair specimens for the long-term detection of the alcohol biomarker ethyl glucuronide has been increasing in popularity and usage. We evaluated the usefulness of fingernail clippings as a suitable alternative to hair for ethyl glucuronide detection. A liquid chromatography-tandem mass spectrometry method for the detection of ethyl glucuronide in fingernail clippings was fully validated and used to analyze the hair and/or fingernail specimens of 606 college-aged study participants. The limit of detection was 2 pg/mg, the limit of quantitation was 8 pg/mg and the method was linear from 8 to 2000 pg/mg. Intra- and inter-assay imprecision studies at three different concentrations (20, 40, 200 pg/mg) were all within 7.8% and all intra- and inter-assay bias studies at these levels were within 115.1% of target concentration. Ethyl glucuronide levels in fingernail (mean = 29.1 ± 55.6 pg/mg) were higher than ethyl glucuronide levels in hair (mean = 9.48 ± 22.3 pg/mg) and a correlation of the matched pairs was observed (r = 0.552, P < 0.01, n = 529). Evaluating each gender separately revealed that the correlation of male fingernail to male hair was large and significant (r = 0.782, P < 0.01, n = 195) while female hair to female fingernail was small yet significant (r = 0.249, P < 0.01, n = 334). The study results demonstrated that fingernail may be a suitable alternative to hair for ethyl glucuronide detection and may be the preferred sample type due to the lack of a gender bias.

Ethyl glucuronide

Alcohol is associated with significant morbidity and mortality. Subjects abusing alcohol can be identified through clinical history, examination or self-report questionnaires. A range of biomarkers is available for detecting alcohol misuse, but there is still a need for a marker that can detect alcohol consumption in the time window between one day (ethanol) and one week (gamma-glutamyl transpeptidase and carbohydrate-deficient transferrin). Ethyl glucuronide is a direct metabolite that can be detected in urine for up to 90 h and has the potential to become a useful marker of 'binge' drinking. As a non-invasive marker, it could have a role in a variety of clinical and forensic settings.

Screening for drugs of abuse: which matrix, oral fluid or urine?

Urine is recognized as the prime matrix for drug test screening with well-established methods and testing protocols. Its major limitation is with regard to the inconvenience of sample collection and lack of integrity due to adulteration, dilution, drug spiking or sample exchange. The question is whether oral fluid, with its apparent better sample integrity, can replace urine for drug screening. This review examines the sample integrity problems and the advantages and limitations of oral fluid and urine in drug screening programmes. The variety of sample collection devices for oral fluid is shown to be a problem with recovery and detection for some drugs. This is examined in relation to the pharmacokinetics of drug metabolism and excretion in this matrix. Buccal contamination with drugs in oral fluid may also cause problems with interpretation. The clinical advantages of oral fluid analysis compared with urine testing are highlighted. Parent drugs are often found in oral fluid where only their metabolites may be found in urine, for example the benzodiazepines. 6-Monoacetylmorphine, an indicative marker of heroin, has a high prevalence in oral fluid from users of this drug but its detection in urine is limited due to its short half-life. Advances in analytical techniques, particularly chromatography linked to tandem mass spectrometry, are helping to promote oral fluid analysis. However, the lack of concordance studies examining both urine and oral fluid drug levels and kinetics in the clinical setting is of some concern.

Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid

Background

The use of alcohol and drugs may affect workplace safety and productivity. Little is known about the magnitude of this problem in Norway.

Methods

Employee recruitment methods with or without individual follow-up were compared. The employees filled in a questionnaire and provided a sample of oral fluid. Samples were analysed for alcohol, ethyl glucuronide (EtG; a biological marker of recent large alcohol intake), psychoactive medicinal drugs and illegal drugs.

Results

Participation rates with and without individual follow-up were 96% and 68%, respectively. Alcohol was negative (≤0.1 mg/ml) in all samples, but 21.0% reported the intake of alcohol during the last 24 h. EtG was positive (>2.2 ng/ml) in 2.1% of the samples. In-efficiency or hangover at work during the past year was reported by 24.3%, while 6.2% had been absent from work due to the use of alcohol. The combination of self-report and analytical testing indicated that medicinal or illegal drugs had been used during the last 48 h by 5.1% and 1.7% of the participants, respectively; while only 4.2% and 0.4% admitted the use in the questionnaire.

Conclusions

Self-reported data suggest that hangover after drinking alcohol appears to be the largest substance abuse problem at Norwegian workplaces, resulting in absence and inefficiency at work. Analysis of oral fluid revealed that the use of illegal drugs was more common than drinking alcohol before working or at the workplace. The analysis of oral fluid may be a valuable tool in obtaining additional information on alcohol and drug use compared to using questionnaires alone.