title: High levels of agreement between clinic-based ethyl glucuronide (EtG) immunoassays and laboratory-based mass spectrometry.
abstract: BACKGROUND
  Immunoassay urine drug screening cups that detect use for two or more days are commonly used in addiction treatment settings. Until recently, there has been no comparable immunoassay test for alcohol use in these settings.
  
  
  OBJECTIVE
  The aim of this study was to assess the agreement of a commercially available ethyl glucuronide immunoassay (EtG-I) test conducted at an outpatient addiction clinic and lab-based EtG mass spectrometry (EtG-MS) conducted at a drug testing laboratory at three cut-off levels. High agreement between these two measures would support the usefulness of EtG-I as a clinical tool for monitoring alcohol use.
  
  
  METHODS
  Forty adults with co-occurring alcohol dependence and serious mental illnesses submitted 1068 urine samples over a 16-week alcohol treatment study. All samples were tested using EtG-I on a benchtop analyzer and 149 were randomly selected for EtG-MS analysis at a local laboratory. Agreement was defined as the number of samples where EtG-I and EtG-MS were both above or below a specific cut-off level. Agreement was calculated at low cut-off levels (100 and 250 ng/ml), as well as at a higher cut-off level (500 ng/ml) recommended by most by commercial drug testing laboratories.
  
  
  RESULTS
  Agreement between EtG-I and EtG-MS was high across all cut-off levels (90.6% at 100 ng/ml, and 96.6% at 250 and 500 ng/ml).
  
  
  CONCLUSIONS
  EtG immunoassays conducted at low cut-off levels in point-of-care testing settings have high agreement with lab-based EtG-MS. EtG-I can be considered a useful clinical monitoring tool for alcohol use in community-based addiction treatment settings.
authors.affiliation: Psychiatry & Behavioral Sciences, University of Washington , Seattle, WA , USA and.
authors.forename: Emily
authors.initials: E
authors.lastname: Leickly
authors.forename: Michael G
authors.initials: MG
authors.lastname: McDonell
authors.forename: Roger
authors.initials: R
authors.lastname: Vilardaga
authors.forename: Frank A
authors.initials: FA
authors.lastname: Angelo
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Lowe
authors.forename: Sterling
authors.initials: S
authors.lastname: McPherson
authors.forename: Debra
authors.initials: D
authors.lastname: Srebnik
authors.forename: John M
authors.initials: JM
authors.lastname: Roll
authors.forename: Richard K
authors.initials: RK
authors.lastname: Ries
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D015415:Biomarkers / Q000032:analysis; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005965:Glucuronates / Q000032:analysis*; D006801:Humans; D007118:Immunoassay; D008297:Male; D013058:Mass Spectrometry; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D015813:Substance Abuse Detection / Q000379:methods*
chemical_list: D015415:Biomarkers; D005965:Glucuronates; C093924:ethyl glucuronide
keywords: Alcohol biomarkers; alcohol use disorders; ethyl glucuronide; outpatient addiction treatment; urine drug testing