BIOMARKER: Assessment of alcohol consumption among hepatitis C‐positive people receiving opioid maintenance treatment using direct ethanol metabolites and self‐report: a pilot study

Abstract

This study was conducted to identify the alcohol consumption among hepatitis C-positive people receiving opioid maintenance therapy using self-report and biomarkers. A total of 49 people (28 male, 21 female) were hepatitis C virus (HCV) positive and were included. The alcohol use disorder identification test (AUDIT) and self-reported ethanol intake in the last 28 days were assessed. In addition to gamma-glutamyl-transferase (GGT) and mean corpuscular volume (MCV), ethyl glucuronide (EtG) and ethyl sulphate (EtS) were determined in serum and urine (UEtG, UEtS, SEtG) using liquid chromatography/tandem mass-spectroscopy (LC/MS-MS) with deuterated internal standards. Abstinence from alcohol was reported for the last 28 days by 13 participants and for the last 7 days by 22. AUDIT was > 8 in 27 cases. The maximum values were 34.8 mg/l for UEtG, 5.3 mg/l for UEtS and 0.15 for SEtG. Among the 19 UEtG positives, 8 had not reported any ethanol intake in the 7 days prior to the study. Six participants reported intake of up to 320 g of ethanol in the last 7 days, but were negative for SEtG, UEtG and UEtS. Self-reported ethanol intake in the last 28 days correlated with AUDIT score (r = 0.733, P < 0.001), with the direct ethanol metabolites and MCV. In this population, abstinence and episodic heavy drinking are more common than in the general population. Episodic heavy drinking is a significant cause of acute risk in this population. Results from biomarker testing could indicate cases of under- as well as over-reporting of alcohol consumption. Further research on the diagnostic accuracy of direct ethanol metabolites, including the use of phosphatidylethanol (PEth), in this setting is needed.

Ethyl glucuronide and ethyl sulfate in meconium and hair-potential biomarkers of intrauterine exposure to ethanol

“…These compounds were already determined in other biological matrices in an attempt to diagnose acute (blood and urine) or chronic (hair) ethanol misuse in adults [11][12][13][14][15][16][17]. Our preliminary results demonstrated that both EtG and EtS could discriminate between samples which tested negative and those which tested positive for prenatal ethanol exposure, as evidenced by cumulative meconium FAEEs < and !2 nmol/g [18,19].…”

Alcohol Use Disorders in Opioid Maintenance Therapy: Prevalence, Clinical Correlates and Treatment

“…Increased mean corpuscular volume (MCV) or carbohydrate-deficient transferrin values are other relevant biomarkers for alcoholism [30,31,32]. More recently, direct alcohol metabolites, especially ethyl glucuronide, was reported to be useful for measuring alcohol consumption in patients on opioid maintenance therapy [33,34,35]. Also, the 5HTOL/HIAA ratio in urine was used to detect alcoholism in methadone maintenance patients [36].…”

Urine Ethyl Glucuronide Unraveling the Reality of Abstinence Monitoring in a Routine Outpatient Setting: A Cross-Sectional Comparison with Ethanol, Self Report and Clinical Judgment

“…The comparison of the DRI-EtG EIA with a reference LC-MS method for 126 urine samples (100-50,000 ng/ml) was made with Passing-Bablok regression (EIA = -0.104 + 0.960 LC-MS). Both methods showed an overall good and statistically significant agreement r 2 = 0.961 (p < 0.0001) [25] .…”

“…This fact might yield relevant consequences, such as the fact that patients from experimental settings might differ significantly from patients in routine settings [19,20] , ultimately jeopardizing the feasibility, applicability and even the relevance of experimental findings [21] . Other concerns regarding previous EtG studies are small sample sizes or the use of inpatient populations [22][23][24][25] . Therefore, we believe that it is important to assess the performance of EtG in 'the real world'.…”