ETOH Metabolites on UTS

[101N]

Hey:

How are you guys handling ETOH metabolites on UTS - Ethyl glucuronide & Ethyl sulfate.
I am not referring to AOB or the floridly drunk patient but rather a straight up schedule II patient with no h/o aberrancy but whose comes back with consistent results + ETOH metabolites. Do you pursue this and get quantitative, counsel about drinking/driving, drinking & opioid use, and then document in the chart? Ignore?

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[lobelsteve]

CAGE and done.
If problems with ETOH, problems with other drugs. But ETOH metabolites may be present if they had a glass of wine with dinner the night before.
Useless unless BAC >0.08

 

[drf]

CAGE and done.
If problems with ETOH, problems with other drugs. But ETOH metabolites may be present if they had a glass of wine with dinner the night before.
Useless unless BAC >0.08

The ETG stays positive for two weeks.

 

[101N]

Your patient is a straight shooter but has ETOH metabolites in the UTS repeatedly because they have 2 glasses of red wine with dinner. You blow it off because of the long half-life of the metabolite, lack of aberrancy, and b/c you like the patient. So you don't formally admonish the patient not to drink/drive, drive while using opoid etc in a CHART NOTE.

Straight shooter patient gets in an MVA and blows 0.08. UTS also shows opioids. Your chart gets subpoenaed by plaintiff's attorney. Now your former patient is certain that you never admonished them not to drink while using opoids or driving. You are on the hook.

 

[facets]

I have never understood why alcohol is looked at as anything less than a drug, a very toxic drug. It is legal so somehow it is OK to take it with opoids. Alcohol is more toxic than opoids and benzos combined and has no medical use. Oh I had a few glasses of wine with dinner is ok only because it is common. I have seen more misery, death and disability from alcohol than any other drug and it remains over the counter. Rant over. I have seen patients who drank for pain beacuse no opoids were available but once I have written that prescription, they better not show up with it on their breath or urine. If someone cannot abstain for a course of treatment with opoids, they are an alcoholic and cannot be trusted. No opiods, same with pot, they need to make their choice

 

[PMR 4 MSK]

1 drink of alcohol per day, particularly red wine, can have positive health benefits. That has to be balanced with the risks of using it with opioids, and the research on this is as poor as that of opioids + MJ.

Good alcoholics will lie on the CAGE, MAST, etc. But their behaviors and the nature of the lies will show up. I've had patients who tell me one time their last drink was 6 weeks ago, 4 weeks later it was 6 months ago, and then 4 weeks later again it was 6 weeks ago.

If your opioid agreement states they are barred from using alcohol while taking opioids, enforce it. Treat it like you would any other violation.

The worst thing is to set up the rules in writing, then ignore your own rules. Attorneys will eat you alive.