title: Is contaminated unrecorded alcohol a health problem in the European Union? A review of existing and methodological outline for future studies.
abstract: OBJECTIVE
  Some European countries with high levels of unrecorded alcohol consumption have anomalously high rates of death attributable to liver cirrhosis. Hepatotoxic compounds in illegally produced spirits may be partly responsible. Based on a review of the evidence on the chemical composition and potential harm from unrecorded alcohol, the Alcohol Measures for Public Health Research Alliance (AMPHORA) project's methodology for identifying, analysing and toxicologically evaluating such alcohols is provided.
  
  
  METHODS
  A computer-assisted literature review concentrated on unrecorded alcohol. Additionally, we refer to our work in the capacity of governmental alcohol control authority and a number of pilot studies.
  
  
  RESULTS
  The risk-oriented identification of substances resulted in the following compounds probably posing a public health risk in unrecorded alcohol: ethanol, methanol, acetaldehyde, higher alcohols, heavy metals, ethyl carbamate, biologically active flavourings (e.g. coumarin) and diethyl phthalate. Suggestions on a sampling strategy for identifying unrecorded alcohol that may be most prone to contamination include using probable distribution points such as local farmers and flea markets for selling surrogate alcohol (including denatured alcohol) to focusing on lower socio-economic status or alcohol-dependent individuals, and selecting home-produced fruit spirits prone to ethyl carbamate contamination.
  
  
  CONCLUSIONS
  Standardized guidelines for the chemical and toxicological evaluation of unrecorded alcohol that will be used in a European-wide sampling and are applicable globally are provided. These toxicological guidelines may also be used by alcohol control laboratories for recorded alcohol products, and form a scientific foundation for establishing legislative limits.
authors.affiliation: Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany. lachenmeier@web.de
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Lachenmeier
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schoeberl
authors.forename: Fotis
authors.initials: F
authors.lastname: Kanteres
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuballa
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Sohnius
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000079:Acetaldehyde / Q000032:analysis; D000428:Alcohol Drinking / Q000401:mortality; D000434:Alcoholic Beverages / Q000009:adverse effects / Q000032:analysis*; D002273:Carcinogens / Q000032:analysis; D002492:Central Nervous System Depressants / Q000032:analysis; D000431:Ethanol / Q000032:analysis; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005062:European Union; D005506:Food Contamination / Q000032:analysis* / Q000331:legislation & jurisprudence; D019649:Food Industry / Q000331:legislation & jurisprudence; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D000432:Methanol / Q000032:analysis; D011634:Public Health; D018570:Risk Assessment; D012997:Solvents / Q000032:analysis; D014116:Toxicology / Q000379:methods*; D014520:Urethane / Q000032:analysis
chemical_list: D002273:Carcinogens; D002492:Central Nervous System Depressants; D012997:Solvents; D014520:Urethane; D000431:Ethanol; D000079:Acetaldehyde; D000432:Methanol