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Aftercare monitoring programs for health care professionals with documented substance abuse problems are managed differently by various states and their respective licensing boards. Many programs have reported surreptitious alcohol use as a significant concern, yet there is no clear indication of the best methods for detecting alcohol use since the detection of ethanol is difficult due to its limited half-life in saliva, urine and serum. Ethyl glucuronide (EtG), a minor metabolite of alcohol metabolism, is only present in urine when alcohol has been consumed. EtG testing may therefore improve the detection of alcohol use by health care professionals in monitored aftercare programs. This study compared urine ethanol (Medpro B panel) and urine EtG in specimens from 126 clients enrolled in Arizona’s physician health aftercare monitoring program. Each client was tested twice per month for a two-month period in 2004. Of the 504 tests, there were no positive urine ethanol results using a standard, lab determined minimum cutoff level of 20mg/dL. There were four positive EtG results (one percent positive rate) using a minimum cutoff level of 100ng/mL. The four positive EtG results imply the presence of four false negative urine ethanol results. Therefore, the results suggest that the EtG test is more sensitive for alcohol detection and should be considered for future improvements in the testing and monitoring of health care providers enrolled in aftercare programs.

A Comparison of Ethyl Glucuronide and Ethanol Testing in Arizona’s State Physician Health Monitored Aftercare Program