Suchttherapie 2009; 10 - PO55A
DOI: 10.1055/s-0029-1240484

Assessment of alcohol use among heroin maintenance patients by direct ethanol metabolites and self-reports

FM Wurst 1, N Thon 1, V Auwaerter 2, M Yegles 3, B Laskowska 4, C Halter 3, W Weinmann 2, G Wiesbeck 4, KM Dürsteler-MacFarland 4
  • 1Universitätsklinik für Psychiatrie und Psychotherapie II Christian-Doppler-Klinik, Salzburg, Österreich
  • 2Institute of Legal Medicine, Forensic Toxicology, University Hospital, Freiburg
  • 3Laboratoire National de Santé, Toxicology, Université du Luxembourg, Luxembourg, Luxembourg
  • 4Psychiatric University Clinic, Basel, Schweiz

Background: Heavy alcohol use may accelerate the progression of Hepatitis C (HCV)-related liver disease and/or may limit efforts at antiviral treatment. Since most of the patients in heroin maintenance treatment suffer from Hepatitis C infection, this study was conducted to identify alcohol intake among these patients at a Swiss Psychiatric University Clinic by self-reports and direct ethanol metabolites as biomarkers of ethanol consumption.

Patients and Methods: A convenience sample of 54 patients (16 female, 38 male, median age 39.5 years) consented to participate in this study. The Alcohol Use Disorders Identification Test (AUDIT) and self-reported ethanol intake during the previous 7 days were assessed. In addition, in urine and hair ethyl glucuronide (EtG) were determined using LC-MS/MS and GC/MS. The LOQs for UEtG and HEtG were 0.1mg/L and 2.3 pg/mg, respectively.

Results: 26 participants reported abstinence from alcohol for the previous 7 days. AUDIT scores were >8 in 16 male and >5 in 2 female participants. Direct ethanol metabolites were as follows (median, min, max, standard deviation): UEtG (26 positives; 10, 0.10, 39, 11.65mg/L); HEtG (12.1, 0, 142, 36.14 pg/mg), no HEtG- data available from 1 participant, 21 participants were abstinent (up to 7 pg/mg), 16 were social drinkers (up to 50g/day) and 16 were excessive users (>50/60g/d)). Of the 26 participants reporting no alcohol intake during the previous 7 days, 2 were UEtG-positive. Significant correlations were found for: HEtG and AUDIT (r=0.614, p<0.0001), HEtG and UEtG (r=0.569, p<0.0001) as well as HEtG and self-reported ethanol intake during the previous 7 days (r=0.582, p<0.0001)

Conclusion: Improved detection of alcohol consumption which is hazardous or harmful in the context of HCV and opiate dependence would allow for earlier intervention in this population which is at particular risk of liver disease and fatal respiratory-depressed overdose. The combined use of self-reports and direct ethanol metabolites seems promising.