Critical Issues in Alcohol and Drugs of Abuse Testing

Amitava Dasgupta

• Publisher: Academic Press
• Year: 2019
• Print ISBN: 9780128156070
• eBook ISBN: 9780128156087
• Edition: 2
• Topic: Biological Sciences
• Subtopic: Biology
• Index: Biological Sciences

Critical Issues in Alcohol and Drugs of Abuse Testing, Second Edition, addresses the general principles and technological advances for measuring drugs and alcohol, along with the pitfalls of drugs of abuse testing. Many designer drugs, for example, are not routinely tested in drugs of abuse panels and may go undetected in a drug test. This updated edition is a must-have for clinical pathologists, toxicologists, clinicians, and medical review officers and regulators, bridging the gap between technical and clinical information. Topics of note include the monitoring of pain management drugs, bath salts, spices (synthetic marijuana), designer drugs and date rape drugs, and more.- Serves as a ready resource of information for alcohol and drug testing- Ideal resource for making decisions related to the monitoring and interpretation of results- Includes concise content for clinical laboratory scientists, toxicologists and clinicians

Chapter 1

Alcohol

Pharmacokinetics, Health Benefits With Moderate Consumption and Toxicity

Amitava Dasgupta, Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, Houston, TX, United States

Abstract

Alcohol containing beverages are popular worldwide and are consumed on a regular basis. Current guidelines for drinking in moderation are up to 1 drink per day for woman and up to 2 drinks per day for man. If consumed in moderation, alcohol has many health benefits including protection from cardiovascular diseases, stroke, Type 2 diabetes, and many others, but if consumed in excess all these benefits disappear. Alcohol is a poison if consumed in excess. Major problem of drinking in excess is alcoholic liver diseases with most severe form being cirrhosis of liver. Moreover, drinking in excess increases risk of cardiovascular diseases, stroke and cancer as well as may significantly reduce longevity. Currently, legal limit of driving in all states is 0.08% whole blood alcohol (80 mg/dL).

Keywords

Alcohol; moderate drinking; heavy alcohol use; binge drinking; benefits of drinking in moderation

Introduction

Ethyl alcohol (also known as ethanol) is commonly referred as “alcohol.” Alcohol use by human can be traced back to prehistoric time. Professor Robert Dudley, University of California, Berkeley, proposed an interesting hypothesis known as “Drunken Monkey Hypothesis,” which speculates that the human attraction to alcohol may have a genetic basis because primate ancestors of Homo sapiens consumed large amounts of fruits. Alcohol produced by yeast from fructose diffused out of the fruit, and alcoholic smell could help a primate to identify fruits as ripe and ready to be consumed. As a result “natural selection” favored monkeys with a keen appreciation for the smell and taste of alcohol. By the time humans evolved from apes approximately 1–2 million years ago, fruits were mostly replaced by roots, tubers, and meat as diet. However, it is still possible that human taste for alcohol arose during our long-shared ancestry with primates. Anecdotally, humans often consume alcohol with food, suggesting that drinking alcohol along with food is a natural instinct [1].

The first historical evidence of alcoholic beverages came from the archeological discovery of Stone Age beer jugs, approximately 10,000 years ago. Egyptians probably consumed wine approximately 6000 years ago. Egyptians used alcoholic beverages (both beer and wine) for pleasure, rituals, medical, and nutritional purposes. Some myths suggest that Egyptian bakers noticed the formation of bubbles when wet grains sat for extended periods before being used to make bread. The earliest evidence of alcohol use in China dated back to 5000 BC, when alcohol was mainly produced from rice, honey, and fruits. In ancient India, alcohol beverages were known as “sura.” Use of such drinks was known in 3000–2000 BC and ancient ayurvedic texts concluded that alcohol is a medicine if consumed in moderation, but a poison if consumed in excess. Beer was known to Babylonians as early as 2700 BC. In ancient Greece, wine-making was common in 1700 BC. Hippocrates identified numerous medicinal properties of wine, but was critical of drunkenness. In ancient civilization, alcohol was used primarily to quench thirst because water was unsafe for drinking due to bacterial contamination. Hippocrates specifically cited that water only from springs, deep wells, and rainfall were safe for human consumption. Beer was a drink for common people, while wine was the preferred drink for elites. In ancient Eastern civilization, drinking alcoholic beverages for thirst-quenching was less common than Western civilization because drinking tea was very popular in Asian countries. Tea is a safe drink because during preparation, boiling kills pathogens [2].

Currently, few chemicals such as ethyl alcohol (alcohol) are widely found or generate the degree of debate and controversy. Not only is alcohol readily available in the form of alcoholic beverages, also its chemical properties make it an ideal solvent for flavoring and other compounds used in food industries. Furthermore, it is a product of decomposition by bacteria, giving rise to small, but measurable, amounts in some nonpreserved foods [3,4]. Additional sources of alcohol exposure include mouthwashes, cough and cold preparations, hand cleaners, aftershaves, window cleaners, and many other personal and household products.

Alcohol Content of Various Beverages

Alcohol content of various alcoholic beverages varies widely, for example, beer contains approximately 4%–7% alcohol while average alcohol content of vodka is 40%–50%. However, due to wide differences between serving size of various alcoholic beverages, one drink (often called one standard drink) contains approximately 0.6 ounces of alcohol, which is equivalent to 14 g of alcohol in each drink. In the United States, a standard drink is defined as a bottle of beer (12 ounces) containing 5% alcohol, 8.5 ounces of malt liquor containing 7% alcohol, a 5-ounce glass of wine containing 12% alcohol, 3.5 ounces of fortified wine containing about 17% alcohol, or one shot of a distilled spirits such as gin, rum, vodka, or whiskey (1.5 ounces) containing 40% alcohol. In general, the average bottle of beer contains an average of 0.56 ounce of alcohol, but a standard wine drink may contain 0.66 ounce of alcohol while distilled spirits may contain up to 0.89 ounce of alcohol [5]. Alcohol content of various popular beverages is given in Table 1.1.

Table 1.1

Alcohol Content of Various Alcoholic Beverages

Alcoholic Beverage	Alcohol Content (v/v)
Fruit juice	<0.1%
Ciders	4%–8%
American beer	4%–7%
Champagne	12%–13%
Table wine	8%–17%
Japanese Sake	14%–16%
Port wine	15%–22%
Whiskey, vodka, rum, and brandy	Usually 40% but much higher alcohol may be present in some brands
Tequila	45%–50%

Historically, the alcoholic content of various drinks was expressed as “proof,” a term originated in the 18th century when British sailors were paid with money as well as rum. In order to ensure that the rum was not diluted with water, it was “proofed” by dousing gunpowder with it and setting it on fire. If the gunpowder failed to ignite, it indicated that rum was diluted with excess water. In the United States, proof to alcohol by volume is defined as a ratio of 1:2. Therefore a beer which has 4% alcohol by volume is defined as 8 proof. In the United Kingdom, alcohol by volume to proof is a ratio of 4:7. Therefore multiplying alcohol by volume content with a factor of 1.75 would provide the “proof” of the drink.

Currently, in the United States, the alcohol content of a drink is measured as the percentage of alcohol by the volume. The Code of Federal Regulations requires that the label of alcoholic beverages must state the alcohol content by volume. The regulation does not require the “proof” of the drink to be printed. Alcoholic drinks primarily consist of water, alcohol, and variable amounts of sugars and carbohydrates (residual sugar and starch left after fermentation) but negligible amounts of other nutrients such as proteins, vitamins, or minerals. However, distilled liquors such as cognac, vodka, whiskey, and rum contain no sugars. Red wine and dry white wines contain 2–10 g of sugar per liter while sweet wines and port wines may contain up to 120 g of sugar per liter of wine. Beer and dry sherry contain 30 g of sugar per liter [6].

Pharmacokinetics of Alcohol

Alcohol is a weakly polar, aliphatic hydrocarbon soluble in both water and lipid, a characteristic that greatly influences the pharmacokinetics once in the body. Alcohol pharmacokinetics in humans are complex and depend on factors such as the amount and type of alcohol ingested, gender, age, body water, and metabolism. After ingestion, alcohol readily diffuses across cellular membranes and is rapidly absorbed within 30–60 min in the duodenum. Coingestion of food, some drugs, and medical conditions that inhibit gastric emptying delay absorption. In one study, 10 healthy men consumed a moderate dosage of alcohol (0.80 g of alcohol per kg of body weight) in the morning after an overnight fast or immediately after breakfast (two cheese sandwiches, one boiled egg, orange juice, and fruit yogurt). The blood alcohol analysis revealed that the average peak blood alcohol in subjects who consumed alcohol on an empty stomach was 104 mg/dL. In contrast, the average peak blood alcohol in subjects who consumed alcohol after eating breakfast was 67 mg/dL. The time required to metabolize total amount of alcohol was on average 2 h shorter in subjects who consumed alcohol after eating breakfast compared to subjects who consumed alcohol on an empty stomach. The autho...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of Contributors
• Preface
• Chapter 1. Alcohol: Pharmacokinetics, Health Benefits With Moderate Consumption and Toxicity
• Chapter 2. Alcohol Analysis in Various Matrixes: Clinical Versus Forensic Testing
• Chapter 3. Alcohol Biomarkers: Clinical Issues and Analytical Methods
• Chapter 4. Genetic Markers Related to Alcohol Use and Abuse
• Chapter 5. Ethylene Glycol and Other Glycols: Analytical and Interpretation Issues
• Chapter 6. Introduction to Drugs of Abuse
• Chapter 7. Legal Aspects of Drug Testing in US Military and Civil Courts
• Chapter 8. Pharmacogenomics of Drugs of Abuse
• Chapter 9. Immunoassay Design for Screening of Drugs of Abuse
• Chapter 10. Issues of Interferences With Immunoassays Used for Screening of Drugs of Abuse in Urine
• Chapter 11. Point of Care Devices for Drugs of Abuse Testing: Limitations and Pitfalls
• Chapter 12. Drugs of Abuse Screening and Confirmation With Lower Cutoff Values
• Chapter 13. Overview of Analytical Methods in Drugs of Abuse Analysis: Gas Chromatography/Mass Spectrometry, Liquid Chromatography Combined With Tandem Mass Spectrometry and Related Methods
• Chapter 14. High-Resolution Mass Spectrometry: An Emerging Analytical Method for Drug Testing
• Chapter 15. Confirmation Methods for SAMHSA Drugs and Other Commonly Abused Drugs
• Chapter 16. Critical Issues When Testing for Amphetamine-Type Stimulants: Pitfalls of Immunoassay Screening and Mass Spectrometric Confirmation for Amphetamines, Methamphetamines, and Designer Amphetamines
• Chapter 17. Cocaine, Crack Cocaine, and Ethanol: A Deadly Mix
• Chapter 18. Drug-Assisted Sexual Assaults: Toxicology, Fatality, and Analytical Challenge
• Chapter 19. Overview of Common Designer Drugs
• Chapter 20. New Psychoactive Substances: An Overview
• Chapter 21. Review of Bath Salts on Illicit Drug Market
• Chapter 22. Review of Synthetic Cannabinoids on the Illicit Drug Market
• Chapter 23. Application of Liquid Chromatography Combined With High Resolution Mass Spectrometry for Urine Drug Testing
• Chapter 24. Forensic Toxicology in Death Investigation
• Chapter 25. Drug Testing in Pain Management
• Chapter 26. How Do People Try to Beat Drugs Test? Effects of Synthetic Urine, Substituted Urine, Diluted Urine, and In Vitro Urinary Adulterants on Drugs of Abuse Testing
• Chapter 27. When Hospital Toxicology Report Is Negative in a Suspected Overdosed Patient: Strategy of Comprehensive Drug Screen Using Liquid Chromatography Combined With Mass Spectrometry
• Chapter 28. Testing of Drugs of Abuse in Oral Fluid, Sweat, Hair, and Nail: Analytical, Interpretative, and Specimen Adulteration Issues
• Chapter 29. Advances in Meconium Analysis for Assessment of Neonatal Drug Exposure
• Chapter 30. Analytical True Positive Drug Tests Due to Use of Prescription and Nonprescription Medications
• Chapter 31. Analytical True Positive: Poppy Seed Products and Opiate Analysis
• Chapter 32. Miscellaneous Issues: Paper Money Contaminated With Cocaine and Other Drugs, Cocaine Containing Herbal Teas, Passive Exposure to Marijuana, Ingestion of Hemp Oil, and Occupational Exposure to Controlled Substances
• Chapter 33. Abuse of Magic Mushroom, Peyote Cactus, LSD, Khat, and Volatiles
• Chapter 34. Performance Enhancing Drugs in Sports
• Index