Peth test

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I’m looking to get in touch with nurses who have had false positive Peth tests.

I’m the victim of one in a similar situation for pilots. I’ve amassed a lot of info that may help.

Mike

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Specializes in ED RN and Case Manager.

@MikeD No, I specifically haven’t. I recently finished a 5 year Monitoring program for narcotic addiction. I only had one PEth (which was neg). The other 104 tests were all urines that either included ethanol or etg.

I’m following your feed out of curiosity. I’ve read many stories of nurses having UDS w/unexplained positive ethanol or etgs (possibilities ranging from incidental exposure to alcohol, diabetics, post-collection fermentation if both bacteria & yeast are present, etc.). I didn’t realize that this was occurring with PEth.

Many states are now ordering routine PEth. I’ve seen posts from nurses on this site that are routinely getting them while enrolled in IPN in Florida- even without ANY history of alcohol use. Frustrating since the cost is double or triple that of a UDS. I’m sure that you’ll have some nurses interested in your information.

Here’s a link to a current Washington Post story- about a guy arrested for DUI & hospitalized. He was swearing that he didn’t drink, despite elevated blood alcohol level of 0.2 (twice the legal limit). It turns out that fungi in his digestive system were turning his carbohydrates into alcohol — a condition known as “auto-brewery syndrome

https://www.google.com/amp/s/www.washingtonpost.com/health/2019/10/24/he-was-acting-drunk-swore-he-was-sober-turns-out-his-stomach-was-brewing-its-own-beer/%3foutputType=amp

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I saw that article... Geesh!

Turns out LOTS of false positive peths for nurses. I just found a research paper claiming to have caused false positives with hand sanitizers, similar to the ETG test demise.

I have two expert forensic opinions on the inefficacy of peth with two more on the way. It’s simply not reliable. Period.

Ok for clinical use, with proper safeguards and interpretation, but not for forensic use.

Mike

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Specializes in ED RN and Case Manager.

Mike-

I read about your experience in another post. (+ urine etg & + PEth followed by Neg etg hair test). Did the hair test “clear” you? Or did you face repercussions in your Pilot Monitoring program??

KyBeagle

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Oh, had four exonerating tests... meant nothing, got fired.

No investigation, no interviewing the three doctors, one chief pilot or peer monitor none of whom thought I had relapsed, nothing.

Mike

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https://www.centerforprofessionalrecovery.com/specificity-of-phosphatidylethanol-as-a-marker-for-alcoholic-beverage-consumption

See attached 2013 paper which is the primar "research" relied on by the commercial labs that are marketing the PEth test as 100% specific for drinking. Greg Skipper is the primary author and this is the 3rd biomarker he introduced and promoted as a reliable indicator for drinking and it is also the 3rd time that the test has proven to be unreliable. On January 14, 2020 he posted an analysis of the specificity of PEth that is diametrically opposite what he has been saying for the past 7-years noting this is a "relatively new test" of unknown specificity, there is no known cutoff that differentiates incidental exposure to alcohol from drinking and that until the proper studies have been done the PEth test should not be relied on as the sole basis for disciplinary action.

As Skipper introduced PEth as a CONFIRMATORY blood test for positive EtG/EtS in the urine in 2013 and claimed 100% specificity for drinking at a cutoff level of 20 ng/ml because only HEAVY drinking would result in a level above the cutoff this is despicable. He is also acting as an expert witness supporting his new perspective and this is the 3rd alcohol biomarker test he introduced and and promoted as confirming drinking at a precise cutoff that was subsequently found to be unreliable and of unknown validity. EtG from 2001 > 2006 then EtS from 2006 > 2013 and now PEth from 2013 > 2020. How many have been harmed in the past 7-years? A positive PEth test near the end of a contract is common and this is when those in monitoring programs are most vulnerable to suicide given the choice between "voluntary agreement" for a re-evaluation (knowing it will result in unneeded treatment followed by a new monitoring contract) or a refusal which with absolute certainty results in disciplinary action. I am looking for as many cases as possible in which the PEth test led to unneeded referrals for assessment, false diagnosis of AUD (the diagnostic criteria for "unspecified" "mild" and "moderate" AUD is typically arrived at by using the +biomarker test and whatever complaint led to the referral or the referral itself making these tests the proximate cause of the diagnosis or that led to disciplinary action (suspension, revocation, limitations) placed on licenses. The specific questions I have are:

1. What was the reason for your referral to the agency that ordered the test?

2. What other tests were done by the agency (EtG, EtS, BAC, breathalyzer, CDT, MCV, GGT AST/ALT, etc.) and did you get independent testing to support your position? If so did the agency acknowledge and address these tests in your evaluation? Did the board address these tests at your hearing? Did the statement of reasons for the decision contain any of these test results?

3. What was the Peth level used in the decision making process and who made the determinations and decisions?

4. What weight did the PEth test play in each decision and what was the outcome?
You can e-mail me at [email protected]. If you feel comfortable using your real name please do but if you do not please send some sort of unique identifier in order to be able to communicate at some point in the future. Additionally if there is a board order or other document showing the weight of this test in the decision making process that would be helpful.

PEth-Article-in-ACER.pdf

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https://www.centerforprofessionalrecovery.com/specificity-of-phosphatidylethanol-as-a-marker-for-alcoholic-beverage-consumption

Prior perspective of 100% specificity for drinking reversed. He now claims no known cutoff for drinking and the previously marketed "confirmatory" test for drinking heavy amounts of alcohol is of unknown validity or reliability. What this means is that all of the biomarker testing they have used in the past 19 years in monitoring programs has absolutely no value and should be removed from the equation. A blood test of unknown specificity does not confirm urine urine tests of unknown specificity. Without a known cutoff the values reported are meaningless

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Specializes in ob.

right now where I work I am using copus amounts of hand sanitizer. we can just wash out hand during care. about two hours of using it again and again. without washing. all due to covid 19. I just had a peth test 7 days ago. no results yet. should I worry?

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I don’t think so. Honestly it would take a ton of that stuff to impact a PeTh as I understand it

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Specializes in ob.

it is like I am taking a bath in it at this point

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Quite frankly no one knows for sure. I personally know pilots that were FIRED because of a positive peth test associated with incidental exposure.

I know a woman to owns a monitoring company who created a false positive using hand sanitizer.

there is a research paper about false positives being created with hand sanitizer.

They say it can’t happen, but when it does they don’t admit the test is flawed... it’s weird.

I personally think it’s a collection of pre analytical and analytical errors.

Pre analytical in that the blood spots aren’t dried properly allowing fermentation, and enzymatic activity while in transport.

Pre analytical in that collection is done in a non sterile environment allowing contaminants onto the filter paper.

analytical in that the donors hematocrit levels aren’t recorded and used to either normalize the results, like creatinine normalization for ETG urine tests, or to properly prepare the internal reference standard for LC/MSMS

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Specializes in ob.

well just found out it does come out positive. I havent had alcohol in a couple years. and I'm lately constantly rubbing santitizer all over me. face, arms. my patients literally spit meds at me so I am always in it. grr

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